Every finding on record at Grane Hospice Care

Based on a review of clinical records (CRs), and staff interview, the agency failed to ensure that the individualized written plan of care included specific interventions for pain and /or symptom management for two (2) of nine (9) active clinical records reviewed (CR1, CR5) and one (1) of two (2) closed clinical record reviews (CR11). Findings Included: CR1 review 8/15/22 at approximately 12:15 PM. Start of Care 5/3/2022. Reviewed Plan of Care (POC) Certification period 8/1/2022 to 10/29/2022. Plan of Care revealed the following Orders: "...Frequency...SN (skilled nursing) 2WK13 (2 times a week for 13 weeks), revised MD order for SN visit once a week effective 8/7/22...Hospice Nurse to monitor pain level using pain scale each visit and report changes in pain level to physician...Hospice nurse to instruct patient/caregiver(s) on use of pain scale...Skilled nurse to provide instructions related to decubitus ulcer care..." CR1 revealed facility "Wound Record Report" that identified patient active wounds "...Sacral, Mid, [Unstageable]...Scapula, RT (right), [unstageable]...Order, effective date 8/4/22...Clean right scapula and sacral wounds with wound cleanse, pat dry, apply medical grade honey, cover with alginate and optifoam daily..." CR1 POC did not contain documentation of physician orders/treatments for patient pain management that specified individual patient pain level/pain scale assessment/instruction and/or what specific change in pain level would constitute notification to physician. CR1 POC did not contain documentation that specified individual assessments for identified active wounds to be performed by hospice staff and did not contain the specific wound care instruction(s) related to "...decubitus ulcer care..." and to whom the instructions were to be given to. POC did not contain documentation identifying the management of the patient wound care in the absence of hospice nursing staff. CR5 review 8/15/22 at approximately 12:20 PM. Start of Care 9/2/2021. Reviewed Plan of Care (POC) Certification period 7/29/2022 to 9/26/2022. Plan of Care revealed the following Orders: "...Hospice Nurse to monitor pain level using pain scale each visit and report changes in pain level to physician...Hospice nurse to instruct patient/caregiver(s) on use of pain scale..." CR5 POC did not contain documentation of physician orders/treatments for patient pain management that specified individual patient pain level/pain scale assessment/instruction and/or what specific change in pain level would constitute notification to physician. CR11 review 8/18/22 at approximately 9:45 AM. Start of Care 6/24/2022. Reviewed Plan of Care (POC) Certification period 6/24/2022 to 9/21/2022. Plan of Care revealed the following Orders: "...Frequency...SN (skilled nursing) 2WK13 (2 times a week for 13 weeks)...Skilled nurse to provide instructions related to decubitus ulcer care..." CR11 revealed facility "Wound Record Report" that identified patient active wounds "...Mid, Post - Sacral, Mid...Stage IV...6/24/22...LT (left) Heel...Stage IV..." CR11 POC did not contain documentation of physician orders/treatments for patient Sacral/Left heel wounds identified in the facility "Wound Record Report". POC did not contain documentation that specified individual assessments for identified active wounds to be performed by hospice staff and did not contain the specific wound care instruction(s) related to "...decubitus ulcer care..." and to whom the instructions were to be given to. POC did not contain documentation identifying the management of the patient wound care in the absence of hospice nursing staff. An exit interview was conducted on 8/18/22 at approximately 3:00 PM with the facility administrator (EMP1) directly, and the facility corporate vice presidents (EMP9, EMP11, EMP12), corporate compliance director (EMP10), and human resources manager (EMP12) via phone conference. Above findings were reviewed.

Based on review of clinical record (CR), home visit observation, and facility staff interview (EMP), the facility failed to ensure the monitoring of home medication supply expiration date(s) related to the palliation and management of the terminal illness and related conditions for one (1) of three (3) patient (CR6) home visits conducted. Findings included: During a patient (CR6) home visit observation conducted on 8/17/22 at approximately 11:30 AM, registered nurse (EMP8) reviewed patient emergency kit medications (EKIT) and confirmed the kit contained a labeled pharmacy medications expiration date of 3/22/2022. CR6 medication profile revealed the following active EKIT medications: Physician ordered 4/19/2021, Acetaminophen 650 mg (milligram) Rectal Suppository, 1 Suppository...Atropine 0.01%...Eye Drops, 2 Drops...Bisacodyl 10 mg Rectal Suppository, 1 Suppository...Haloperidol Lactate 2 mg/ml (milligrams/milliliter) Oral Concentrate, 1 mg...Lorazepam Intensol 2 mg/ml Oral Concentrate, 1 mg...Morphine Concentrate 20 mg/ml Oral Syringe, 10 mg... Facility failed to ensure hospice supplied patient EKIT home medications were monitored and replaced on/before pharmacy EKIT expiration date (3/22/22). An exit interview was conducted on 8/18/22 at approximately 3:00 PM with the facility administrator (EMP1) directly, and the facility corporate vice presidents (EMP9, EMP11, EMP12), corporate compliance director (EMP10), and human resources manager (EMP12) via phone conference. Above finding was reviewed.