Every finding on record at Djri Health Inc.

Observed in Emergency Management Session. Upon review of the organization's emergency preparedness documents and drills, there was no documentation to validate the organization had tested their emergency plan and/or had activated their plan as a result of an actual event during 2021 and 2022. This was validated with leadership during the Emergency Management discussion.

Observed in Record Review. In 1 of 1 discharged records reviewed with Medicare as the payer, the patient was not notified in advance of any changes in the care to be furnished. According to CMS form 10123, a Medicare provider must deliver a completed copy of the Notice of Medicare Non-Coverage (NOMNC) to beneficiaries/enrollees receiving covered home health services at least two calendar days before Medicare covered services end or the second to last day of service if care is not being provided daily. Upon review of RR#10, it was noted the patient was discharged for extended prognosis; however, the Notice of Medicare Non-Coverage form was completed and signed the day before discharge. This was reviewed and validated with the Director of Patient Care Services Designee.

Observed in Record Review. In 2 of 11 patient records reviewed, the plan of care did not include all visit frequencies based on the patient's needs. Upon review of HV#3, it was noted the aide was seeing the patient twice a week for personal care; however, on review of the plan of care, there was no visit frequency established for aide services. Upon review of RR#4, it was noted the spiritual counselor was routinely seeing the patient monthly; however, the visit frequency established on the plan of care indicated visits only as needed. This was reviewed and validated with the Director of Patient Care Services.

Observed in Record Review. In 1 of 11 patient records reviewed, orders included on the plan of care were incomplete. Upon review of RR#4, it was noted there was an order for oxygen; however, the order did not include a dosage, route, or frequency. This was reviewed and validated with the Director of Patient Care Services.

Observed in Record Review. In 3 of 5 patient records reviewed with aide services, complete written patient care instructions were not prepared by the RN. Upon review of HV#1, it was noted the patient had a scalp wound with staples in place; however, on review of the aide plan of care, there were no instructions provided to the aide regarding the patient’s wound and keeping the dressing dry during bathing. The patient was started on oxygen later in the certification period; however, the aide plan of care was not revised to include instructions regarding oxygen precautions. The aide was assigned to obtain vital signs; however, there were no parameters included on the aide plan of care regarding when to notify the RN. Upon review of HV#2, it was noted the patient developed a new Stage Two pressure ulcer to their coccyx; however, the aide plan of care was not revised to include instructions regarding the patient's new wound and bathing. The patient was started on oxygen later in the certification period; however, the aide plan of care was not revised to include instructions regarding oxygen precautions. Upon review of RR#4, it was noted the patient was started on oxygen later in the certification period; however, the aide plan of care was not revised to include instructions regarding oxygen precautions. This was reviewed and validated with the Director of Patient Care Services.

Observed in Record Review. In 2 of 5 patient records reviewed with aide services, the hospice aide did not provide care as ordered. Upon review of HV#1 and multiple aide visit notes, it was noted the aide documented to completing the following tasks that were not assigned: applying lotion, changing linens, and emptying trash. The aide did not document to completing vital signs as ordered on the plan of care. Upon review of RR#5, it was noted the aide documented to completing a bed bath; however, a shower with chair was ordered. This was reviewed and validated with the Director of Patient Care Services.

Observed in Record Review. In 2 of 5 patient records reviewed with aide services, hospice aide supervision did not confirm the aide was following the patient's plan of care as assigned. Upon review of the record for HV#1 and RR#5, it was noted the aide visit documentation reflected the aide was not following the plan of care; however, the supervisory visit documentation completed during the time frame in which those visits were made, reflected the aide was providing services according to the plan of care. This was reviewed and validated with the Director of Patient Care Services.