Every finding on record at Embracing Hospicecare of New Jersey, LLC

Observed in Record Review. In 19 of 19 patient records reviewed, The organization failed to inform the patient of rights related to payment prior to the beginning of care. During record review for all records, the Hospice Nurse Surveyor observed no cost section on the consent form. And upon discussion with the Accreditation Specialist the organization was not aware of this requirement. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 19 of 19 patient records reviewed, the organization failed to plan the patient's care. During record review for all records, the Hospice Nurse Surveyor observed the documentation failed to include timeframes for meeting patient goals. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Record Review. In 12 of 16 patient records reviewed, the organization failed to plan the patient's care. During record review for RRHV#1, RRHV#4, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5, RRNHV#6, RRNHV#7, the plan of care did not contain all needed items for the palliation and management of the terminal illness and related condition. For example in RRHV#1 and RRHV#4, the patient's had PRN meds- Morphine and Acetaminophen- for pain with no indication for when to use which one. For RRNHV#1, the plan of care stated a goal of remaining free from injury with an intervention of preventing further skin breakdown by use of ____________ which was not filled in. The narrative nursing notes also stated wound to sacrum on 9/13 with use of zinc oxide and fungal cream but this was not included in the orders on the POC. In RRNHV#2, the patient had a goal of relief of urinary retention with an intervention of maintaining foley patency but the patient had no foley and was voiding on their own. For RRNHV#4, the patient had an unclear goal of access degree of hearing loss with same wording for intervention. This was not measurable. The patient was placed on Citalopram for depression on 8/14 but this was not addressed on the POC. And the patient had a goal of patient comfort in relation to fluid level excess. This was not measurable. The patient also had a goal for sleep disturbance with a goal of minimizing disruptions in sleep as patient verbalized difficulty falling asleep. This goal was added 3.21.23 but on 9.12.23 the patient was observed with a change of condition, increased sleep as much as 15 hours a day per documentation. The POC was not updated. In RRNHV#5, the patient has a goal for relief of urinary retention using a foley and the patient does not have a foley. Pt also has a goal for understanding how to give Morphine for SOB, but the patient did not have an order for Morphine. In RRNHV#6, the RN was providing wound care but there were no orders. And the RN discontinued wound care without documentation from the physician. For RRNHV#7, the patient had a goal of will meet dyspnea related goal by third visit. Patient also had a goal for nutritional needs addressed/ maintained. These goals were not measurable or updated with recent change and decline in status. This was discussed and reviewed with the Hospice Team.

Observed in Patient Home. In 2 of 4 home visits conducted, the organization failed to implement infection prevention and control activities when cleaning and performing disinfection of medical equipment. During RRHV#1 and RRHV#2, the Hospice Nurse Surveyor observed staff did not follow the organizational policy for equipment cleaning. During RRHV#1, , the RN returned her pulse oximeter to her bag without cleaning, which was outside of the organizational policy. She also cleaned her Stethoscope and blood pressure cuff with paper towel and hand sanitizer. In RRHV#2, the RN used the patients aloe wipes to clean her blood pressure machine and cuff, pulse oximeter and stethoscope ( not following the guidelines for disinfection). This was discussed and reviewed with the Hospice Leadership Team. Observed in Patient Home. In 2 of 4 home visits conducted, the organization failed to implement the infection prevention and control activities it had planned. During HV#1 and HV#2, the Hospice Nurse Surveyor observed the RN did not follow the organization policy for hand hygiene. During HV#1, the RN did not perform hand hygiene upon entering the patient room, and she did not perform hand hygiene each time she entered her nursing bag, . In HV#2, the nurse did not perform hand hygiene when reentering her nursing bag. This was discussed and reviewed with the Hospice Team.

Observed in Tracer Activities. The organization failed to implement the infection prevention and control activities it had planned. During tracer activities for Data Management, the Hospice Nurse Surveyor observed RRNHV#10 was placed on Keflex for cellulitis in July and it was not reported per organizational policy for data collection and aggregation. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Tracer Activities. The organization failed to document improvement in hand hygiene. During tracer activities for Data Management, the Hospice Nurse Surveyor observed the organization was not currently aggregating and analyzing the hand hygiene data. This was discussed and reviewed with the Compliance Officer.

Observed in Record Review. In 10 of 17 patient records reviewed, the organization failed to provide care, treatment, or services in accordance with the aide plan of care. During record review for RRHV#1, RRHV#2, RRHV#3, RRHV#4, RRNHV#1, RRNHV#3, RRNHV#4, the aide care plan stated monthly weights but no weights were documented. Also in RRHV#1, shampoo was ordered 2x week and was not documented the week of 6/4. For RRHV#2, the patient was to get shampoo 2x week but the week of 4/30 no shampoo was completed and for the week of 5/7 only one shampoo was completed. For RRHV#3, the week of 7/31 one shampoo was completed and several weeks had 5x completed although shampoo was ordered 2x week. For RRNHV#3, the shampoo was ordered 2x week- done 6x week of 8/21 and not done at all week of 7/3. In RRNHV#2, the aide care plan did not say what kind of bath to provide. In RRNHV#4, the aide care plan stated shower but the aides had been documenting both bed bath and shower. And there was no frequency ordered on the care plan for showers. In RRNHV#6, the aide care plan stated bed bath but shampoo hair with shower was checked. The aides were documenting shampoo with shower and bed bath. In RRNHV#7, the aide care plan stated shower 2x weekly and bed bath 5x weekly, along with mouth care and assist with meals every visit. On 7/3 no bath/ shower was given and no mouth care or assist with meals was provided and it was not documented that IDG was made aware. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Tracer Activities. In 1 of 1 HR files reviewed, the organization failed to supervise effectively. During HR file review, the Hospice Nurse Surveyor observed HR#4 (HHA) last had an on-site supervisory visit to observe patient care 19 months prior to survey. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Record Review. In 16 of 16 patient records reviewed, The organization failed to maintain a patient record containing all information reflecting the patient's care, treatment, or services. During record review for all records, the Hospice Nurse Surveyor observed the CTIs were not completely documented due to a recent change from paper charting to EMR. For all records reviewed, the check box for terminal illness less than 6 months to live was not checked and the physician had not written in all the key components including primary diagnosis, secondary diagnosis, medications and treatments. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 19 of 19 patient records reviewed, the organization failed to maintain an authenticated medical record. During record review for all records, the Hospice Nurse Surveyor observed the Chaplain assessments, Aide notes and SW notes were all being done on paper but were not timed. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Patient Home. In 1 of 4 home visits conducted, the organization failed to implement the infection prevention and control activities it had planned. During HV#1, the Hospice Nurse Surveyor observed the RN placed her nursing bag directly on the floor and left the bag open during care. This was outside the organizations policy on bag technique. This was discussed and reviewed with the Hospice Team.