Every finding on record at Elk City Comforting Hands Hospice LLC

Observed in Record Review. In 1 of 10 patient records reviewed, the plan of care did not include all interventions to manage pain and symptoms. In RRNHV#5, the patient was admitted to hospice with Parkinson's Disease and Dysphagia. On a recent skilled nursing visit note the patient was also assessed with bilateral bruising to upper extremities and reddened area to coccyx. Interventions related to the patient's dysphagia and alterations in skin/integumentary were not included in the hospice plan of care. This was reviewed and verified with the Clinical Manager.

Observed in Surveyor review but corrected onsite pending acceptable Evidence of Standards Compliance. In 1 of 10 patient records reviewed, the organization did not plan the patient's care by ensuring the plan of care included all services needed for the palliation and management of the terminal illness and related conditions, including medications and treatment necessary to meet the patient's needs. In RRHV#1, the hospice plan of care included an order for the skilled nurse to change the patient's indwelling foley catheter prn. The documented order did not include the type, size, and balloon size of the catheter. This was reveiwed and verified with the Clinical Director.

Observed in Patient Home. In 2 of 3 home visits conducted, the organization did not implement its infection prevention and control activities to minimize, reduce, or eliminate the risk of infection. In RRHV#1 and RRHV#2, after cleaning care equipment (blood pressure cuff, temporal thermometer, pulse oximeter, and stethoscope), the skilled nurse placed the items in the same compartment of the field bag where other general supplies (a package of plastic trash bags used for barriers) were also stored. This was not in compliance with the organization's bag technique policy/procedure and was reviewed and verified with the Clinical Director.

Observed in Infection Control System Tracer. The organization did not identify risks for acquiring and spreading infection based on its geographic location, community, and population served, as well as the care, treatment, and services it provided. During the Infection Control Session Tracer, it was noted the organization's infection control policies and procedures outlined the process for an annual risk analysis to be completed/documented. Although clinical leaders verbalized identified risks and coordinated the program based on these risks, there was no Infection Control Risk Analysis/Assessment completed and documented. This was reviewed and verified with the Clinical Director.

Observed in Record Review. In 1 of 10 patient records reviewed, the organization did not provide care, treatment, or services in accordance with the plan of care as required by law/regulation. In RRHV#3, the Hospice Aide indicated to the surveyor that a coloring hair rinse was applied to the patient's hair weekly with shampooing. Upon record review, it was noted the haircare and shampoo was not included/documented on the aide plan of care. This was reviewed and verified with the Clinical Manager.

Observed in Record Review. In 1 of 14 patient records reviewed, the record did not contain information related to the patient's care, treatment, or services, including an updated and accurate list of medications. In RRHV#3, the patient's hospice plan of care/medication profile included Tramadol Hydrochloride 50 mg one (1) oral tablet 3 times a day and another order for Tramadol 50mg oral 1 tablet 3 times a day prn. The actual order for the Tramadol was verified with the primary hospice physician and reconciled with the skilled nursing facility medication record by the Clinical Director. It was determined the current order was for Tramadol 50 mg oral tablet 2 times a day. There was no evidence/documentation that the patient's medications had been reconciled and updated in the record by the hospice RN. This was reviewed and confirmed with the Clinical Director.

Observed in Record Review. In 2 of 2 patient records reviewed, the organization did not provide patient care, treatment, or service information to other providers when the patient was discharged or revoked the election of hospice care. In RRDC#1 and RRDC#2, there was no evidence that the organization provided the attending physician a copy of the Hospice Discharge Summary. This was reveiwed and verified with the QAPI Coordinator.

Observed in Patient Home. In 3 of 3 home visits conducted, the organization did not safely manage returned medications. In RRHV#1, RRHV#2, and RRHV#3, a copy of the organization's policies and procedures on management and disposal of controlled medications was not provided to the patient/caregiver. It was noted the hospice provided education to the patient and family on the use and disposal of controlled medications. This was reveiwed and verified with the Administrator.

Observed in Record Review. In 1 of 2 patient records reviewed with Home Health Aides services, During BR# 1's patient record review it was noted the organization had not ensured the register nurse prepared written patient care instructions for the home health aide (HHA). For example: review of the patients record revealed the HHA provided the task of showers, or complete bed baths, or partial bed baths on 23 documented HHA visit notes. Further review of the patient record revealed no documented HHA written instructions. This was reviewed and discussed with Leadership and validated.