Every finding on record at Generous Home Care Management LLC

Observed in Record Review. In 1 of 11 patient records reviewed, it was noted that the comprehensive assessment was not completed within 5 days after the hospice election. For example, in record review for home visit #2 it was noted that the MSW did not see the patient until 28 days following admission. There was no additional documentation to indicate the delay in evaluation. This was discussed with the DON and administrator.

Observed in Record Review. In 11 of 11 patient records reviewed, it was noted in all hospice records that the plan of care did not contain goals which were specific, reflected the patient goals or that were measurable or timed. For example, in record review #1, 2, 3 and 4 all of the goals were stated to be achieved by the end of the certification period. In another example, goals were not measurable in record review #1 and were stated as pt depression will be controlled by the end of certification period or pt. anxiety will be controlled by the end of the certification period. Additionally in record review #1 and record review for home visit #3 the patient's stated pain goal was documented on admission as 0/10 however the plan of care indicated a pain goal of 3/10. In another example, in record review for home visit #3 all goals were stated to be achieved in the certification period including those related to oxygen safety teaching, and relief of shortness of breath. This was discussed with the hospice ADON.

Observed in Record Review. In 1 of 11 patient records reviewed, it was noted by the hospice surveyor that in record review #1 there was no visit frequency for the hospice aide either on the plan of care or any IDG meeting notes. This was discussed with and confirmed by the hospice DON.

Observed in Record Review. In 2 of 11 patient records reviewed, it was noted by the hospice surveyor that in record review for home visit #3 it was noted that there were no orders for new medications lactulose, and docusate and no order to discontinue Senna. In another example, in review of record for home visit #1 it was noted that the patient had a wound and wound care was being provided but there was no order. This was discussed with Leadership.

Observed in Record Review. In 2 of 11 patient records reviewed, it was noted that the hospice plan of care was not updated to reflect the patient status. For example, in review of record for home visit #2 the patient had developed two wounds on her back and there were no problems, goals or interventions documented on the plan of care. In another example, in record review for home visit #3 it was noted that the plan of care had not been updated when the PICC line was removed and when the biliary drain was removed. The care plan reflected that those issues were still in progress on the plan of care. This was discussed with the hospice DON.

Observed in Record Review. In 2 of 11 patient records reviewed, it was noted by the hospice surveyor that in record review #2 the hospice aide was ordered five times per week however the aide was seeing the patient twice per week. In another example, in review of record for hospice home visit #1 it was noted that the chaplain was ordered once per month however in the first week of care two visits were made. This was discussed with and confirmed by the hospice administrator.

Observed in Tracer Visit. In 1 of 3 home visits conducted, it was noted by the hospice surveyor that the LVN who was visiting the patient had never seen the patient prior to today's visit. She stated that she had not received any report from either the field RN or the hospice DON prior to providing care. This was discussed with administrator.

Observed in Tracer Activities. In discussion during the data session as well as review of documents it was noted by the hospice surveyor that the organization failed to have an effective, ongoing, organization wide, data-driven quality assessment and performance improvement program. For example, in 2019 and 2020 the performance improvement projects were completed with an improvement 50% of the records and stated that no further follow up was needed. The palliative outcomes reviewed for 5 quarters indicated no issues however there was not documentation of numerator or denominator for indicators such as pain management or anxiety, etc. Lastly all documents review related to chart audits, infections, falls, etc indicated no need for follow up and no issues or trends noted however there were consistently high incidents in the raw data with no documentation of any extensive review to identify trends or patterns. This was discussed with the organization's owner, DON, Administrator.

Observed in Record Review. In 2 of 8 patient records reviewed, it was noted in review of record for hospice home visit #1 that the aide plan of care stated the patient was to have a bed bath however during the visit the caregiver stated that the aide has been giving the patient a shower for weeks. In another example, in record review for hospice home visit #2 it was noted that the aide care plan was incomplete and inaccurate. For example, the aide care plan indicated that the patient had grab bars, hospital bed and bedside commode however none of these were noted in the home. Additionally oxygen was present in the home but was not noted on the aide care plan. Lastly, the areas for supplies and activity were blank on the aide plan of care and shave was assigned every visit however the patient was noted to have a beard approximately 12 inches long. . This was discussed with the administrator.

Observed in Record Review. In 4 of 11 patient records reviewed, it was noted by the hospice surveyor that the supervisory visits for the hospice aide were not documented as performed at least every 14 days. For example, in record review #1, record review #3 and #4 there were 15 days between supervisory visits, in record review #2 there were 17 days between supervisory visits. This was discussed with and confirmed by the hospice administrator.

Observed in Tracer Activities. The governing body/leadership did not ensure that the following Conditions of Participation were met as determined through observations, documentation, and staff interviews: - §418.56, 418.104, 418.100. This was discussed with the organization's Administrator.

Observed in Record Review. In 9 of 11 patient records reviewed, it was noted that the initial certification of terminal illness did not contain any current subjective or objective medical findings. For example, the only thing documented in the physician narrative section was a list of diagnosis of the patient. Some examples are in record review #5 the following was the only documentation, COPD, Covid Pneumonia, Hypotension and Malnutrition, and in record review #3 the following was the only documentation, COPD and wheelchair bound, in record review #4 the following was the only documentation, Alzheimer, HTN, Asthma and Neuropathy. This was discussed with the hospice DON.

Observed in Record Review. In 5 of 11 patient records reviewed, it was noted by the hospice surveyor that the medication profile in the patient record did not contain all of the current medications. For example, in record review #1 the initial nursing evaluation as well as SN notes the nurse documented that the patient was taking Tylenol and Ibuprofen for pain relief however neither of these medications were on the medication profile. In record review #3, the initial nursing evaluation as well as SN notes the nurse documented that the patient was taking Tylenol #3, regular Tylenol and Naprosyn for pain relief however none of these medications were on the medication profile. In another example, in record review for hospice visit #1 it was noted that there was no medication profile in the patient record. In another example, in record review for home visit #2 it was noted that the medication sheet was not updated when Senna was discontinued and Lactulose and Docusate were ordered. Additionally in this record the MSW note for 3/24/22 stated in one paragraph that the home was cluttered and smelled of smoke and in the next paragraph that the home was clean and free of odors. In another example, review of record for home visit #1 the initial assessment stated the patient had a foley catheter 16 French, 5-30 cc balloon. The patient never had a foley catheter per the caregiver once she was home. Additionally for this patient it was noted that the patient was receiving a shower however every aide visit note stated that a bed bath was given and the care plan was not updated to reflect the change. Lastly in the same chart the medication sheet in the home which was hand written did not contain two medications the patient was taking including Lorazepam and Docusate. In review of record for hospice visit #2 it was noted that the MSW evaluation documented that the patient was unconscious, however it was also documented that he was sleeping. In another subsequent MSW note the documentation indicated that the patient was sleeping but also that he was alert and oriented. During review of record for home visit #3 it was noted that the medication sheet did not reflect what the patient was actually taking. For example, the patient was taking Docusate but this medication was not on the medication profile and Amoxicillin which was ordered on 2/27/22 for a ten day course was still on the medication profile although it had been discontinued. In hospice record review #2 the medication profile stated Humulog Insulin 100 units/ml and the medication profile listed a dose of 2 ml which was incorrect and under the instructions sliding scale insulin dosages were documented. In another example, in record review for hospice home visit #2 it was noted that the dose for Lantus insulin was stated as 0.08 ml on the medication sheet. This was confirmed by and discussed with the hospice DON.This was discussed with and confirmed by the hospice ADON.

Observed in HR File Review. In 2 of 6 HR files reviewed, it was noted by the hospice surveyor that the primary source licensure was not run prior to expiration at time of renewal. For example, the hospice Medical Director license was run 13 days after expiration and the hospice DON was run 5 days after expiration. This was confirmed by HR staff member.