Every finding on record at Grace Hospice, Inc.

Observed in Record Review. In 1 of 16 patient records reviewed, it was noted in RRNHV #6 that the MSW did not make a visit within the first 5 days of care and there was no documentation to support a delay in service or declination. This was confirmed by the administrator.

Observed in Record Review. In 1 of 16 patient records reviewed, it was noted that the plan of care scope and frequency of visits did not differentiate between in person and telehealth visits made by the MSW. This was noted in record review for home visit #2 and was discussed with the administrator. Observed in Record Review. In 1 of 16 patient records reviewed, it was noted in RRNHV#3 that there was no order for RN visit frequency as provided. For example, the plan of care stated an order for RN one time per month and 1 PRN visit however the RN has been visiting twice weekly for the past three weeks. This was confirmed by the administrator. Observed in Record Review. In 16 of 16 patient records reviewed, it was noted that on every plan of care and for all disciplines ordered there were PRN visits without indication. This was discussed with and confirmed by the administrator.

Observed in Record Review. In 4 of 16 patient records reviewed, it was noted that not all of the goals on the plan of care were measurable. For example, in review of record for HV#1 the following examples of outcomes were noted :Pt will achieve and maintain optimal skin integrity as disease progresses, Optimal control of nausea/vomiting, patient comfort within 2 weeks. In record review #2 the following goals were documented in the plan of care, Optimal level of oxygenation within the benefit period, Optimal level of safety and mobility, Optima level of nutrition and hydration. This was also noted in record review #6 and #7. This was discussed with and confirmed by the administrator and DON.

Observed in Record Review. In 1 of 16 patient records reviewed, it was noted in record review for home visit #4 that an incomplete order for foley catheter which was documented as 16 fr with no balloon sized stated. This was discussed with the administrator and DON.

Observed in Record Review. In 1 of 16 patient records reviewed, it was noted that care was not provided according to the plan of care. For example, in record review for home visit #3 it was noted that there were no MSW visits made in the past 8 months however the orders were for a visit to be made at time of recertification. This was confirmed by and discussed with leadership.

Observed in Patient Home. In 3 of 4 home visits conducted, it was noted that accepted standards of practice for infection control including hand hygiene and cleaning and disinfecting of equipment were not followed. For example, during home visit #1 the RN was observed changing her gloves three times during the visit and not performing hand hygiene prior to donning new gloves. In home visit #2 the LVN was observed using the patient's liquid soap at the sink, had no paper towels and immediately poured hand sanitizer into her wet hands and then was observed flapping her hands to dry them. At the end of the visit she was observed washing her hands in the sink, then using a paper towel to pick up the hemorrhoidal cream tube and then drying her hands with the same paper towel. During the visit she did not perform hand hygiene following two glove changes and before donning new gloves. Lastly the LVN was observed cleaning her blood pressure cuff and machine with a product that did not contain any alcohol, Clean Care with Green Tea wipes. In home visit #3, another LVN was observed touching the faucet after washing hands, not performing hand hygiene between glove changes before donning new gloves twice during the visit and Flapping to dry hands after using hand gel. This was discussed with all nursing leadership and DON and Administrator.

Observed in HR File Review. In 1 of 2 HR files reviewed, for hospice aides it was noted that there was no documentation of competency evaluation for the tasks requiring observation. The employee who was hired 7 months ago had completed a self assessment however there was no documentation by an RN of the performance of the hands on tasks. This was discussed with the DON and administrator.

Observed in Record Review. In 1 of 16 patient records reviewed, it was noted that the RN who prepared the assignment for the hospice aide did not include all care instructions. For example, in review of record for hospice home visit #4 it was noted that the pt. had a G-tube with dressing as well as a sacral wound. There were no instructions for the aide on these issues. Additionally the pt was on continuous oxygen via NC but this was not addressed on the assignment sheet. This was discussed with nursing leadership.

Observed in Record Review. In 1 of 16 patient records reviewed, it was noted that in the hospice aide documentation in three of three notes reviewed there were tasks that were not completed as assigned. For example in record review for home visit #2, foot care, nail care were assigned by the registered nurse but these tasks were not completed and there were no comments indicating patient refusal or other reason. This was confirmed by the administrator.

Observed in Document Review. In 5 of 9 contracts reviewed, it was noted that the contracts did not contain a stipulation that the outside agency will complete criminal background checks on contracted employees who provide direct patient care or have access to patient records. This was noted in a therapy contract, 2 pharmacy contracts, 2 SNF contracts and 1 GIP contract. This was discussed with the administrator.

Observed in Record Review. In 13 of 13 patient records reviewed, the care plan goals were not consistently measurable and did not consistently have time frames. The following goals without time frames were documented in patient records: Patient will have elimination needs met to provide much comfort as possible, optimal control of nausea/vomiting, patient will have adequate food and fluids as tolerated or desired, the patient will have increased comfort/satisfaction from pain/discomfort as exhibited by verbal and non-verbal communication, patient will experience decreased episodes of respiratory distress, patient will have bladder elimination as regularly as possible and needs are met to provide much comfort, patient will have optimum level of oxygenation, patient will have optimum peripheral circulation.

Observed in HR File Review. In 3 of 9 HR files reviewed, primary source verification had not been completed prior to expiration of licenses/certifications. The LVN's license expired 4/30/21 and was not verified until 6/10/21. The aide's certification expired 7/27/21 and the verification document was not dated so the surveyor was unable to determine when it was verified. And finally the MSW's license expired 10/31/2020 and was not verified until 12/31/2020.