Every finding on record at Egb Holdings

Observed in Record Review. In 1 of 14 patient records reviewed, the Surveyor noted an RN did not visit the hospice patient every 15 days to conduct an assessment. For example, in RRNHV #3, there had been 17 days between RN visits. This was validated with the DPCS.

Observed in Record Review. In 2 of 14 patient records reviewed, the Surveyor noted care provided to the patient without an order. For example, in RRNHV #3, the clinician documented that they made an as needed visit to irrigated the patients ears; however, there had been no order for the clinician to complete this procedure. In RRNHV #4 the patient had Bisacodyl 10 mg rectal suppository and MOM 15 ml both ordered 'daily, as needed for constipation' without clear clinical indications for when to utilize each medication. This was validated with the DPCS. Observed in Patient Home. In 1 of 3 home visits conducted, The Surveyor noted medication orders that had not been updated with the correct administration information. For example, in RRHV #2, the patient had Oxygen 3 lpm continuous on the medication profile. The patient had not been observed wearing Oxygen. When asked, the family replied that for the past 5-6 months, they utilize the oxygen as needed only. This was validated with the RN present during the visit.

Observed in Record Review. In 10 of 10 patient records reviewed, where the patient had a Hospice Aide providing care, the Surveyor noted that the name of the Hospice Aide (HA) being supervised had not been documented on the supervisory form. The Clinician completing the supervision had checked a box that stated: Employed by this company, so the Surveyor had been unable to validate which HA had been supervised. In RRNHV #3, there had not been an HA supervisory visit completed every 14 days to assess services. There had been 17 days between supervisory visits. This was validated with the DPCS.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization did not assess its patient by conducting and documenting a patient-specific comprehensive assessment that identified the patient's need for hospice care and services, including factors that alleviate or exacerbate physical symptoms. Upon reveiwed of the record for HV#1, it was noted the Braden Scale in the initial nursing comprehensive assessment was not completed by the RN. It was documented the patient was chair/bed-bound requiring assistance with transfers. In RR#6, the Braden scale was not documented on the patient with a documented dramatic decline, sleeping 20 hours a day, thin, frail, and with bowel/bladder incontinence The organization's Comprehensive Assessment Policy and Procedure (Policy No. 2-030-1) indicated baseline and relevant information was to be documented during the comprehensive assessment, including complications and risk factors that affect care planning. This was reveiwed and verified with the Director of Patient Care Services and Administrator.

Observed in Record Review. In 1 of 11 patient records reviewed, the organization did not plan the patient's care by including all services needed for the palliation and management of the terminal illness and related conditions, including interventions to manage symptoms. In RR#1, the Oxygen order documented on the patient's plan of care was 2-5 liters per nasal cannula prn for shortness of breath. Oxygen 2-3 liters per nasal cannula prn for shortness of breath was also documented on the patient's medication profile with a later start date than the Oxygen on the patient's plan of care. This was reveiwed and verified with the Director of Patient Care Services and Administrator.

Observed in Record Review. In 1 of 11 patient records reviewed, the interdisciplinary group, in collaboration with the patient's attending physician, did not review and revise the plan of care at least every 15 days. In RR#8, it was noted the members of the interdisciplinary team (IDT) did document individual plan of care update notes, but there was no documentation in the hospice record that the IDT had reveiwed/revised the plan of care in collaboration with the physician at least every 15 days. This was reviewed and verified with the Director of Patient Care Services and Administrator..

Observed in Record Review. In 1 of 11 home visits conducted, the organization did not supervise staff effectively by assessing the quality of care and services provided by the hospice aide to ensure the services ordered met the patient's needs. In RR#4, the registered nurse did not supervise the hospice aide at least every 14 days during an on-site visit to the patient's home. It was noted there was one month between aide supervisory visits completed/documented by the RN. This was reveiwed and verified with the Administrator.