Every finding on record at Family Home Health LP

Based on a review of agency policy and protocol, clinical records (CRs), and staff interview, the agency failed to include measurable outcomes anticipated from implementing and coordinating the plan of care for two (2) of ten (10) active patient clinical records reviewed, (CR4, CR7). Findings included: Review of facility policy/procedure/protocol on 2/3/2022 revealed the following; "...Development of Plan of Care...Procedure...13. The nurse will contact the physician for clarification, acceptance, and development of the initial plan of care...Initial Plan of Care will be completed as well as the Physician Plan of Care to include all treatment orders...15. After admission...the initial nursing...assessments will be completed...This is completed by the...RN (registered nurse) upon admission and throughout the service period...16. A clinical record is initiated..." "...Wound Skills Competency (protocol)...14. If measuring the wound(s)...Measure length of wound...measure the width of the wound...measure the depth of the wound...Measure wounds weekly...22...documentation of comprehensive wound assessment and interventions in clinical note..."" CR4 review 2/2/2022 at approximately 11:15 AM. Start of Care 1/11/2022. Reviewed Plan of Care (POC) Certification period 1/11/2022 to 4/10/2022. Skilled nursing admission assessment on 1/11/2022 revealed "...Integumentary...Pressure ulcer to sacral region was present prior to hospitalization. Currently being treated with Santyl, covered with border dressing..." POC did not contain documentation of interventions for wound care that included measurable outcomes and/or anticipated goals. CR7 review 2/2/2022 at approximately 1:10 PM. Start of Care 12/28/2021. Reviewed Plan of Care (POC) Certification period 12/28/2021 to 3/27/2022. Skilled nursing admission assessment on 12/282/2021 revealed "...Integumentary...L (left) and R (right) buttocks...stage 1...pressure ulcer/injury present..." POC did not contain documentation of interventions for wound care that included measurable outcomes and/or anticipated goals. An exit conference was conducted on 2/3/2022 at approximately 1:00 PM with the facility administrator (EMP1) and vice president (EMP3). The above findings were reviewed.

Based on a review of agency policy and procedure, clinical records (CRs), and staff interview, the facility failed to ensure that the individualized written plan of care included all drugs and treatment necessary to meet the needs of the patient for six (6) of ten (10) active patient clinical records reviewed, (CR2, CR3, CR5, CR6, CR7, CR10). Findings Included: Review of facility policy/procedure on 2/3/2022 revealed the following; "...Development of Plan of Care...Procedure...13. The nurse will contact the physician for clarification, acceptance, and development of the initial plan of care...Initial Plan of Care will be completed as well as the Physician Plan of Care to include all treatment orders...15. After admission...the initial nursing...assessments will be completed...This is completed by the...RN (registered nurse) upon admission and throughout the service period...16. A clinical record is initiated..." CR2 review 2/2/2022 at approximately 10:00 AM. Start of Care 1/26/2022. Reviewed Plan of Care (POC) Certification period 1/26/2022 to 3/26/2022. Physician order: "...1/26/2022...Oxygen: 1-5 Liters via nasal cannula PRN (as needed) for shortness of breath/end of life care..." There was no documentation of the physician Oxygen order listed on the POC medications nor on the patient medication profile in CR2. CR3 review 2/2/2022 at approximately 10:30 AM. Start of Care 2/22/2021. Reviewed Plan of Care (POC) Certification period 12/19/2021 to 2/16/2022. Physician order: "...2/22/2021...Oxygen: 1-5 Liters via nasal cannula PRN (as needed) for shortness of breath/end of life care..." There was no documentation of the physician Oxygen order listed on the POC medications nor on the patient medication profile in CR3. CR5 review 2/2/2022 at approximately 12:00 PM. Start of Care 8/20/2021. Reviewed Plan of Care (POC) Certification period 11/18/2021 to 2/15/2022. Physician order: "...11/18/2021...Oxygen therapy: 1-5 Liters via nasal cannula PRN (as needed) for shortness of breath/end of life care..." There was no documentation of the physician Oxygen order listed on the POC medications nor on the patient medication profile in CR5. CR6 review 2/2/2022 at approximately 12:25 PM. Start of Care 6/10/2020. Reviewed Plan of Care (POC) Certification period 12/2/2021 to 1/30/2022. Physician order: "...12/2/2021...Oxygen therapy: 1-5 Liters via nasal cannula PRN (as needed) for shortness of breath/end of life care..." There was no documentation of the physician Oxygen order listed on the POC medications nor on the patient medication profile in CR6. CR7 review 2/2/2022 at approximately 1:10 PM. Start of Care 12/28/2021. Reviewed Plan of Care (POC) Certification period 12/28/2021 to 3/27/2022. Physician order: "...12/28/2021...Oxygen therapy: 1-5 Liters via nasal cannula PRN (as needed) for shortness of breath/end of life care..." There was no documentation of the physician Oxygen order listed on the POC medications nor on the patient medication profile in CR7. CR10 review 2/2/2022 at approximately 2:40 PM. Start of Care 12/15/2021. Reviewed Plan of Care (POC) Certification period 12/15/2021 to 3/14/2022. Physician order: "...12/15/2021...Oxygen therapy: 1-5 Liters via nasal cannula PRN (as needed) for shortness of breath/end of life care..." There was no documentation of the physician Oxygen order listed on the POC medications nor on the patient medication profile in CR5. An exit conference was conducted on 2/3/2022 at approximately 1:00 PM with the facility administrator (EMP1) and vice president (EMP3). The above findings were reviewed.

Based on a review of agency policies and procedures, clinical records (CRs), and staff interview, the facility failed to ensure documentation on the plan of care included the medical supplies and appliances necessary to meet the needs of the patient for seven (7) of ten (10) active patient clinical records reviewed, (CR2, CR3, CR4 CR5, CR6, CR7, CR10). Findings included: Review of facility policy/procedure on 2/3/2022 revealed the following; "...Development of Plan of Care...Procedure...13. The nurse will contact the physician for clarification, acceptance, and development of the initial plan of care...Initial Plan of Care will be completed as well as the Physician Plan of Care to include all treatment orders...15. After admission...the initial nursing...assessments will be completed...This is completed by the...RN (registered nurse) upon admission and throughout the service period...16. A clinical record is initiated..." "...Interdisciplinary team Coordination of care...Procedure...11. Nursing services will be available twenty-four hours per day, as are...medical supplies..." CR2 review 2/2/2022 at approximately 10:00 AM. Start of Care 1/26/2022. Reviewed Plan of Care (POC) Certification period 1/26/2022 to 3/26/2022. Physician orders: "...1/26/2022...Skilled nurse to perform wound care to pressure area...L (left posterior lower leg wound...cleanse with NSS (normal Saline Solution), pat dry with gauze...cover with kling (wrap)... POC revealed "...DME (Durable Medical Equipment) and Supplies: No DME needed at this time...Functional Status:..Bowel/Bladder (incontinence)...Wheelchair..." There was no documentation in the POC under "DME and Supplies" that included, but not limited to, patient wound care/incontinence supplies and/or wheelchair. CR3 review 2/2/2022 at approximately 10:30 AM. Start of Care 2/22/2021. Reviewed Plan of Care (POC) Certification period 12/19/2021 to 2/16/2022. Physician order: "...2/22/2021...Foley cath (catheter): may insert/connect...PRN (as needed) for retention/slow flow/no flow/end of life care...May irrigate with normal saline PRN...2/2/2021...Oxygen therapy: 1-5 Liters via nasal cannula PRN (as needed) for shortness of breath/end of life care..." POC revealed "...DME (Durable Medical Equipment) and Supplies: Wheelchair, O2 (oxygen) concentrator, humidifier...Functional Status:..Bowel/Bladder (incontinence)..." There was no documentation in the POC under "DME and Supplies" that included, but not limited to, foley catheter supplies and/or bowel/bladder incontinence supplies. CR4 review 2/2/2022 at approximately 11:15 AM. Start of Care 1/11/2022. Reviewed Plan of Care (POC) Certification period 1/11/2022 to 4/10/2022. Physician order: "...1/11/2022...Foley cath (catheter): may insert/connect...PRN (as needed) for retention/slow flow/no flow/end of life care...May irrigate with normal saline PRN...1/11/2022...Oxygen therapy: 1-5 Liters via nasal cannula PRN (as needed) for shortness of breath/end of life care..." POC revealed "...DME (Durable Medical Equipment) and Supplies: LAL (low air level) mattress and broda chair...Functional Status:..Bowel/Bladder (incontinence)..." There was no documentation in the POC under "DME and Supplies" that included, but not limited to, patient oxygen equipment/supplies, foley catheter supplies and/or bowel/bladder incontinence supplies. CR5 review 2/2/2022 at approximately 12:00 PM. Start of Care 8/20/2021. Reviewed Plan of Care (POC) Certification period 11/18/2021 to 2/15/2022. Physician order: "...11/18/2021...Oxygen therapy: 1-5 Liters via nasal cannula PRN (as needed) for shortness of breath/end of life care...11/18/2021...Foley cath (catheter): may insert/connect...PRN (as needed) for retention/slow flow/no flow/end of life care...May irrigate with normal saline PRN..." POC revealed "...DME (Durable Medical Equipment) and Supplies: No Hospice DME at this time..." There was no documentation in the POC under "DME and Supplies" that included, but not limited to, patient oxygen equipment/supplies and/or foley catheter supplies. CR6 review 2/2/2022 at approximately 2:25 PM. Start of Care 6/10/2020. Reviewed Plan of Care (POC) Certification period 12/2/2021 to 1/30/2022. Physician order: "...12/2/2021...Foley cath (catheter): may insert/connect...PRN (as needed) for retention/slow flow/no flow/end of life care...May irrigate with normal saline PRN...12/2/2021...Oxygen therapy: 1-5 Liters via nasal cannula PRN (as needed) for shortness of breath/end of life care..." POC revealed "...DME (Durable Medical Equipment) and Supplies: LAL (mattress), O2 concentrator, broda chair...Functional Status:..Bowel/Bladder (incontinence)...Other: mechanical lift required..." There was no documentation in the POC under "DME and Supplies" that included, but not limited to, foley catheter supplies, bowel/bladder incontinence supplies, and/or mechanical lift device. CR7 review 2/2/2022 at approximately 1:10 PM. Start of Care 12/28/2021. Reviewed Plan of Care (POC) Certification period 12/28/2021 to 3/27/2022. Physician order: "...12/28/2021...Foley cath (catheter): may insert/connect...PRN (as needed) for retention/slow flow/no flow/end of life care...May irrigate with normal saline PRN...12/28/2021...Oxygen therapy: 1-5 Liters via nasal cannula PRN (as needed) for shortness of breath/end of life care..." POC revealed "...DME (Durable Medical Equipment) and Supplies: shower chair, walker, BSC (bed side commode), and raised toilet seat...urinal...Functional Status:..Bowel/Bladder (incontinence)..." There was no documentation in the POC under "DME and Supplies" that included, but not limited to, patient oxygen equipment/supplies and/or foley catheter supplies. CR10 review 2/2/2022 at approximately 2:40 PM. Start of Care 12/15/2021. Reviewed Plan of Care (POC) Certification period 12/15/2021 to 3/14/2022. Physician order: "...12/15/2021...Foley cath (catheter): may insert/connect...PRN (as needed) for retention/slow flow/no flow/end of life care...May irrigate with normal saline PRN...12/15/2021...Oxygen therapy: 1-5 Liters via nasal cannula PRN (as needed) for shortness of breath/end of life care..." POC revealed "...DME (Durable Medical Equipment) and Supplies: No DME needed at this time..." There was no documentation in the POC under "DME and Supplies" that included, but not limited to, patient oxygen equipment/supplies and/or foley catheter supplies. An exit conference was conducted on 2/3/2022 at approximately 1:00 PM with the facility administrator (EMP1) and vice president (EMP3). The above findings were reviewed.

Based on a review of agency policy and procedure, clinical records (CRs), home visit observation, and staff interview, the facility failed to ensure a system of integration with all disciplines providing care and services in all settings related to patient medication profiles for one (1) of three (3) clinical records reviewed during patient home visits. (CR1). Findings include: Review of facility policy/procedure on 2/3/2022 revealed the following; "...Development of Plan of Care...Procedure...13. The nurse will contact the physician for clarification, acceptance, and development of the initial plan of care...Initial Plan of Care will be completed as well as the Physician Plan of Care to include all treatment orders...15. After admission...the initial nursing...assessments will be completed...This is completed by the...RN (registered nurse) upon admission and throughout the service period...16. A clinical record is initiated..." CR1 review 1/31/2022 at approximately 1:30 PM. Start of Care 7/20/2021. Reviewed Plan of Care (POC) Certification period 1/16/2022 to 3/66/2022. Patient CR1 home visit conducted on 2/1/2022 at approximately 11:55 AM. During home visit (patient resided in personal care home-PCH), surveyor requested copy of patient medication profile from PCH medication technician. Review of PCH medication profile revealed the following medications that were not documented on the hospice facility medication profile for patient CR1: Antifungal Powder 2%...active...order date 1/21/2022. Escitalopram Oxalate Tablet 5 mg (milligram)...active...order date 1/12/2021. Immodium A-D Capsule 2 mg...active...order date 12/9/2021. Further review of CR1 current hospice facility medication profile on 2/1/2022 revealed the following medications that were not documented on the PCH medication profile for patient CR1: warfarin 2.5 mg tablet...active...start date 11/15/2020. warfarin 5 mg tablet...active...start date 11/15/2020. Hospice facility registered nurse staff member (EMP11) present at observation confirmed medication reconciliation was to be completed by skilled nurse on the first visit of each week for all hospice patients. An exit conference was conducted on 2/3/2022 at approximately 1:00 PM with the facility administrator (EMP1) and vice president (EMP3). The above findings were reviewed.