Every finding on record at Girdner's Professional Home Hospice, Inc.

Based on record review and interviews, the IDG failed to revise and update the re-certification plan of care based on the patient's comprehensive assessment and progress towards goals for one (#10) of seven (#1, #3, #4, #8, #10, #14 and #15) re-certification records reviewed. --- Patient #10 Review of the POC for recertification period 03/28/23 to 05/26/23 included orders for "SN to provide care on SN visits and educate caregiver of wound care of decubitus wound to bilateral buttocks 3XW..." and "SN to perform, provide instructions/reinforce to patient/caregiver, procedure of wound care to surgical wound umbilicus...". Additional orders included "Home Health Aide services to assist with ADL's and Personal Care Needs". Further review of the wound care record failed to provide evidence of current wound care by the SN as the surgical wound was inactivated by the RN on 10/25/22 and the decubitus wounds were inactivated on 11/10/22 and 11/18/22. In addition, no current HHA Visit Notes were identified as the HHA services were discontinued prior to this re-certification period. During an interview on 05/25/23 at 08:45 AM, the Clinical Manager confirmed the POC for Patient #10 was not updated by the IDG regarding wound care and HHA services.

Based on home visit observations and interview, the RN failed to follow accepted standards of practice for hand hygiene during the skilled procedure observed for one (#3) of one (#3) skilled nursing visits. --- Patient #3 During a home visit on 05/24/23 at 10:35AM, the RN was observed during the removal and replacement of a foley catheter. The RN failed to sanitize her hands before donning gloves and after removal of gloves throughout the procedure. Further review of the agency Hand Hygiene procedure and aseptic technique procedures instruct staff to "Doff gloves, perform hand hygiene, don gloves". During an interview on 05/25/23 at 08:45 AM, the Clinical Manager confirmed the requirement for staff to perform hand hygiene before and after glove changes and the RN failed to follow accepted standards of practice for Patient #3.

Based on record review and interview, the RN failed to update the Aide Care Plan with patient specific instructions for two (#4 and #6) of seventeen (#1 - #9 and #11 - #18) records reviewed with orders for Home Health Aide services. --- Patient #4 During a home visit on 05/24/23 at 11:10AM, Patient # 4 stated due to the wounds on his feet, he could not walk or stand in the shower and the Aide was providing a bed bath for him. Further review of record for certification period 04/05/23 - 07/03/23 revealed orders for Home Health Aide visits two times a week for one week, three times a week for twelve weeks and 1 time a week for 1 week with instructions on the Aide Care Plan for the Aide to provide a shower every visit. SN Visit Notes revealed bilateral heel wounds were present 05/11/23 and RN Supervisory Aide visits were conducted 05/16/23 and 05/23/23 with no changes to the Aide Care Plan instructions regarding bathing. Patient #6 Review of record for certification period 03/14/23 - 06/11/23 revealed orders for Home Health Aide visits two times a week for one week and three times a week for twelve weeks. The Aide Care Plan contained instructions for the Aide to provide a shower every visit and transfer patient from bed/chair. SN Visit Notes indicated a decline in Patient #6 as bed bound with imminence of death. RN Supervisory Aide visits were conducted weekly on 05/02/23, 05/08/23, 05/16/23 with no changes to the Aide Care Plan instructions regarding bathing or transfers. During an interview on 05/25/23 at 08:45, the Clinical Manager confirmed the RN failed to update the Aide Care Plan instructions for Patients #4 and #6.