Every finding on record at Geana Hospice Care, Inc.

Observed in Record Review. In 1 of 9 patient records reviewed, for active patients, it was noted by the nurse, the patient was not seen by a RN every 15 days as required to complete an assessment. For RRNHV#5, the assessment was completed by the RN on day 16. Finding was verified by the Director of Patient Care Services. Observed in Record Review. In 9 of 9 patient records reviewed, for active patients, it was noted by the nurse surveyor that the IDG meeting notes were signed only by the Registered Nurse and the Medical Director and did not document who else attended the meeting. No other documentation was included in the EMR to indicate who attended each IDG meeting. The organization kept a separate notebook with sign in sheets. Finding was verified by the Director of Patient Care Services.

Observed in Patient Home. In 3 of 3 home visits conducted, it was noted by the nurse surveyor upon review of the patient admission folder and observation in the homes that patients were not given any written information or education regarding infection control beyond “cover the cough”, medication safety, pain control, or basic health practices and safety. Interview with the Director of Patient care services revealed that this information is taught to patients from a comprehensive admission notebook the admitting nurses take into the home but no printed education is left in the home for the patient/family to reference or for future education use by the skilled nurse.

Observed in Patient Home. In 3 of 3 home visits conducted, it was observed by the Nurse Surveyor that the organization did not implement the infection prevention and control activities it had planned per “Hand Washing Policy No. 7-009.01”. For example, during RRHV#1 the registered nurse washed his hands, then donned gloves and did not change them between assessing the patient and documenting. He did not perform hand hygiene after completing the medication reconciliation and beginning to document. For RRHV#2, the CHHA washed her hands with soap and water and applied gloves, she did not perform hand hygiene again between removing and changing gloves. For RRHV#3, the LVN did not hand sanitize after removing her gloves after performing the patient’s vital signs. Findings were discussed with the Director of Patient Care Services upon return to the office. Observed in Patient Home. In 2 of 3 home visits conducted, it was observed by the nurse surveyor that the nurses did not clean their equipment per agency “Bag Technique Policy No. 7-014.1”. For RRHV#1 the registered nurse cleaned his equipment (BP cuff, stethoscope, thermometer, pulse oximeter) with disinfectant wipes and put them back on the dirty portion of the barrier that he had taken them off. He then put them into their case without allowing them to dry per the recommended product dry time of three minutes. For RRHV#3, the LVN cleaned her equipment (BP cuff, stethoscope, thermometer, pulse oximeter) with disinfectant wipes and dropped them into her bag without allowing for dry time. Findings were discussed with the Director of Patient Care Services upon return to the office.

Observed in Record Review. In 2 of 9 patient records reviewed, for active patients, it was noted by the nurse surveyor that the hospice aide care plan did not include all of the information for the hospice aide to effectively provide care. For RRHV#2, the patient was to have a shower every visit, however per patient/daughter request the CHHA was only showering the patient once a week and performing a chair bath on the first visit of the week and only getting her hair washed once a week, not every visit. The care plan had not been updated to reflect the changes. RRNHV#5, the patient was on oxygen continuously and there were no instructions to indicate if the patient’s oxygen could be removed for her bed bath. Additionally, for both CHHA care plans, PRN visit orders were included. Findings were verified by the Director of Patient Care Services.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the nurse surveyor that for RRHV#2 the CHHA did not provide care according to the hospice aide plan of care. The CHHA plan of care had that the patient was to get a shower every visit, however the CHHA assisted the patient to take a shower once a week and provided a chair bath the other visit. Additionally, she only washed the patient’s hair once a week, not every visit as indicated in the care plan. Finding was discussed with the Director of Patient Care Services upon return to the office.

Observed in Record Review. In 2 of 9 patient records reviewed, for active patients, it was noted by the nurse surveyor that Hospice Aide Supervisory visits were not documented the required every fourteen days per regulation. For RRHV#1, there were no documented Hospice Aide Supervisory visits for fifteen days and for RRNHV#5 there were no documented Hospice Aide Supervisory visit for sixteen days. Findings were verified with the Director of Patient Care Services.

Observed in HR File Review. In 2 of 9 HR files reviewed, it was noted by the nurse surveyor that for the HR#8 and HR#9, Hospice Volunteers both had a job description for patient care, but neither performed patient care. They did not have a written job description for the bereavement or office work they were doing. They were both interviewed, and they understood their roles in the volunteer program. Finding was verified by the Director of Patient Care Services and the Human Resource Manager.

Observed in Patient Home. In 2 of 3 home visits conducted, it was noted by the surveyor that the medication profile was inaccurate. During RRHV#1, the skilled nurse performed a medication reconciliation with the board and care staff. She had stopped giving the patient her Cranberry Extract with Vitamin over two weeks ago. Additionally, was giving a different dose of Acetaminophen Extra Strength than what was on the medication profile. For RRHV#2 with the hospice aide, a medication reconciliation was not done, however the patient’s daughter volunteered the information that she was giving her mother medication for a yeast infection. The prescription was filled almost a month ago and was not on the current. medication profile or updated on the patient’s home list. Findings

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the nurse surveyor that backup oxygen cylinders were not properly stored. During RRHV#2 it was noted that the patient’s backup G tank was secured in a stand but stored in the garage surrounded and covered by clutter where it was unable to be accessed and not safely stored. Findings were discussed with the Director of Patient Care Services upon return to the office.