Every finding on record at Floyd Healthcare Management, Inc

Observed in Tracer Activities. In 1 of 3 volunteer records reviewed, the organization had not documented emergency management education and training during the last two calendar years. This finding was discussed with hospice leadership.

Observed in Record Review. In 1 of 19 patient records reviewed, the organization failed to assess and reassess its patient's. During record review for RRGIP#1, the Hospice Nurse Surveyor observed the patient had an IV for IV pain medications at admission but the IV site was not assessed at admission or in further nursing visits. This was discussed and reviewed with the Hospice Leadership Team. Observed in Record Review. In 1 of 1 patient records reviewed, where a wound was present, the organization failed to assess and reassess. During record review for RRNHV#1, the Hospice Nurse Surveyor observed the patient developed a wound 1 month prior to survey but it was not measured weekly as required by policy and documentation of the wound appearance and drainage was not assessed during each nursing visit. There was 14 days between the first two measurements and the wound had not been measured in 13 days as of the day of review. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Tracer Activities. In 1 of 3 bereavement records reviewed, the organization had not documented a post death bereavement assessment. The organization's bereavement policy, Bereavement Services - HO 804 states that the bereavement coordinator will complete an assessment after a patient's death. This assessment is used to create a bereavement plan of care. This finding was discussed with hospice leadership.

Observed in Record Review. In 9 of 19 patient records reviewed, the organization failed to plan the patient's care. During record review for RRHV#1, RRHV#2, RRHV#3, RRHV#4, RRNHV#1, RRNHV#2, RRNHV#3, RRMHV#4, and RRNHV#5, the Hospice Nurse Surveyor observed the plan of care did not contain all needed elements. For example in RRHV#1, all goal timeframes were set for the last day of the certification period, which was not individualized. The patient had a goal of Pt/CG can identify potential complications actions to take and when to call hospice which was started at SOC and had a goal date of the end of the first certification, 90 days after SOC. In RRHV#2, all goals were expected to be achieved by the same date, the last day of the certification. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Record Review. In 1 of 19 resident records reviewed, the organization failed to provide care, treatment, or services. During record review for RRNHV#1, the Hospice Nurse Surveyor observed the patient developed a wound 4 weeks prior to survey with wound care orders to be done every 5-7 days and PRN by either the Hospice RN or the facility. The wound care was only documented twice since its development with one being at onset. There was also no documentation that the facility had provided the wound care. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Patient Home. In 6 of 9 patient records reviewed, where aide services were ordered, the organization failed to provide interdisciplinary, collaborative care, treatment, or services. During record review for RRHV#1, RRHV#2, RRHV#3, RRNHV#3, RRNHV#5, and RRNHV#9, the Hospice Nurse Surveyor observed the aide did not collaborate with the RN when the patient refused tasks on the plan of care. For example in RRHV#1 and RRHV#2 the patients had multiple visits with refusal of oral care ( ordered at every visit) but there was no documentation of collaboration with the RN. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Tracer Activities. The organization's Quality Assurance and Performance Improvement (QAPI) program did not include all services provided. The QAPI program did not include the contracted DME service. This finding was discussed with hospice leadership.

Observed in HR File Review. In 1 of 3 volunteer records reviewed, the organization had not documented any training and education regarding infection control and prevention. This finding was discussed with hospice leadership.

Observed in Individual Tracer. In 1 of 3 bereavement records reviewed, the organization had not completed an initial post death bereavement assessment. Therefore, the organization had not created a bereavement plan of care based on the assessed needs of the bereaved. This finding was discussed with hospice leadership.

Observed in Document Review. The organization's written agreement with the durable medical equipment providing contracted services did not include the following: 1. a stipulation that services will be provided only with the authorization of the hospice2. a stipulation that services will be delivered in accordance with the patient’s plan of care 3. the manner in which contracted services will be coordinated, supervised, and evaluated by the hospice4. the delineation of the role of the hospice and contractor in the admission process, patient/family assessment, and the interdisciplinary group conferences5. requirements for documenting that services are furnished in accordance with the agreement6. the qualifications of the individuals providing the servicesThis finding was discussed with hospice leadership.

Observed in Tracer Activities. In 1 of 2 volunteer records reviewed, there was no evidence that a volunteer had received orientation and training relating to the hospice philosophy consistent with the organization s orientation and training policy. This finding was discussed with hospice leadership.

Observed in Patient Home. In 1 of 4 home visits conducted, the organization failed to maintain a patient record that reflected the patient's care, treatment, or services. During the home visit for RRHV#2, the Hospice Nurse Surveyor observed the medication list in the EMR and in the home did not match the medications in the home. For example in RRHV2, the patient was taking Macrobid for a UTI. The medication was completed a month prior to survey but was not removed from the medication list. The patient also had Zofran and Ativan on her home and EMR list but was not currently taking either. There had been a change in caregivers and the nurse was unsure when the meds were stopped. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Tracer Activities. In 1 of 19 patient records reviewed, the organization failed to maintain a complete and accurate patient record. During record review for RRHV#2, the Hospice Nurse Surveyor observed a DNR form signed and entered in the patient record was for another patient. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Record Review. In 1 of 19 patient records reviewed, the organization failed to plan the patient's care. During record review for RRNHV#1, the Hospice Nurse Surveyor observed the patient had wound care ordered for a SNF patient but it did not indicate who would provide the wound care when. The plan of care stated the facility or the RN would provide wound care every 5-7 days. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Record Review. In 5 of 13 patient records reviewed, the initial chaplain assessment was not completed within five days after the election of hospice. The Hospice Nurse Surveyor observed delays and/ or missed visit opportunities for records RR#1, RR#2, RR#3, RR#4 and RR#6. For example: in RR#1 the Chaplain had a missed visit for the first assessment with no further communication. In RR#2, the chaplain had an initial call on 12/03 with discussion of a visit the following week for spiritual care assessment and there was no further follow up. In RR#3, the SOC was 9/01 and the Chaplain reached out 9/28 to offer services. For RR#4, the chaplain called on 2/09 for initial contact and there was no documentation of a refusal of services or setting up a visit. There was no further contact. In RR#6, the chaplain called on 2/14 and was asked by family to call back. There was no documentation of further phone calls. This was reviewed and discussed with the Director.

Observed in Record Review. In 13 of 13 patient records reviewed, the organization failed to plan the patient's care. During record review, the Hospice Nurse Surveyor observed: for HV#2, the plan of care did not contain bleeding precautions due to taking an anticoagulant. The nurse gave verbal orders for the aide to provide a shave for the patient using a manual razor. for all records reviewed, the Hospice Nurse Surveyor observed there were no goals and interventions listed by the SW or Chaplain for current needs. All care plan goals were entered and documented on by the registered nurse. Although patients had orders for PRN visits with Chaplains and SW. for all records reviewed, the Hospice Nurse Surveyor observed the goal time frames were not individualized. All timeframes, for all goals and all disciplines were listed as the last day of the certification period. This was discussed with the Hospice Leadership team.

Observed in Record Review. In 1 of 13 patient records reviewed, all entries in the patient record were not appropriately authenticated according to the organization's policy. During record review, the Hospice Nurse Surveyor observed HV#1 had a verbal order for evaluation and treatment for hospice but it had never been signed by the provider. The verbal order was received on 9/15/21 and as of 4/13/22 had not been signed. The organizational policy was within 30 days. This was discussed with the Director.