Every finding on record at Glowing Smile Hospice

Observed in Record Review. In 3 of 5 patient records reviewed, The organization failed to ensure a patient specific assessment and reassessment that identified the patient's need for hospice care and services. For example: on review of RRHV#3 the initial assessment noted the patient to have a stated pain level of 3 that was greater than the tolerable level of 0-1. There was no documentation of any reassessment of the patient's pain to follow up since admission to date of survey, 4 days after admission. In RRDC#4 the patient's pain on admission was rated a 3/10 where the tolerable level was documented to be 1. Similarly the pain level for RRDC#5 on admission was documented to be 4/10 with a tolerable level of 1 per the care plan, yet there had been no follow up or reassessment of the patient's pain until the next regularly scheduled visit 7 days post admission. These observations were reviewed with the DPCS and the Administrator.

Observed in Record Review. In 1 of 5 patient records reviewed, the organization failed to ensure the patient record was complete and accurate. For example: on review of RRHV#2 the narrative of the initial admission comprehensive assessment by the RN contained the same narrative of RRHV#1 to include description of 72 yr old female, and the pronoun she utilized throughout the documentation, when RRHV#2 was a 77 year old male. In discussion with the DPCS it was explained that the patients are husband and wife with the same last name and the narrative for RRHV#1 was mistakenly uploaded to the wrong record before printing.

Observed in Record Review. In 5 of 5 patient records reviewed, the organization failed to develop an individualized written plan of care for each patient that reflected patient and family goals and intervention based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. In all 5 records reviewed, the goals, while measurable and time bound, were the same for each patient and not individualized to the patient needs based on the assessment. This observation was reviewed with the Administrator, and DPCS.

Observed in Record Review. In 3 of 5 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRHV#1 and RRHV#2 the patients were documented to be diabetic with blood glucose monitoring by the patient/family however there were no orders for blood glucose monitoring included in the plan of care. In RRHV#3 the documentation noted that the RN performed wound care yet there were no orders for wound care noted in the patient's plan of care. These observations were reviewed with the DPCS and Administrator.

Observed in Patient Home. In 3 of 3 home visits conducted, the organization failed to ensure the hospice make available nursing, physician, and medications 24 hours a day, and make all other covered services available on a 24 hour basis when necessary. For example: upon review of the admission packet with patient handbook in the patient home of RRHV#1, RRHV#2and RRHV#3 it was noted that information in the handbook presented to the patient noted the hospice was not an emergency service, and to call 911 in case of emergency. There was an education sheet that listed various symptoms and to call 911 in the instance of occurrence such as chest pain and bleeding. Upon discussion with the Administrator and DPCS it was explained that the patients were given information for home health and not hospice. Further, upon attempting to contact the organization via listed phone number with multiple attempts, the call went to voicemail and noted that voicemail was full. These observations were reviewed with the DPCS and Administrator.

Observed in Record Review. In 5 of 5 patient records reviewed, the organization failed to ensure the patient record contain all information to reflect the patient's care, treatment, and services. For example: in the patient records reviewed RRHV#1, RRHV#2, RRHV#3, RRDC#4, and RRDC#5 there was no history and physical noted on the patient record to detail the patient's medical history prior to hospice referral and admission. This observation was reviewed with the DPCS and Administrator.