Every finding on record at Grane Hospice Care Inc

Based on review of policy and procedure, medical records (MR) and staff (EMP) interview it was determined the agency failed to ensure documentation on the plan of care of the medical supplies and appliances necessary to meet the needs of the patient for one (1) of nineteen (19) medical records (MR18). --- Based on review of policy and procedure, medical records (MR) and staff (EMP) interview it was determined the agency failed to ensure documentation on the plan of care of the medical supplies and appliances necessary to meet the needs of the patient for one (1) of nineteen (19) medical records (MR18). Findings included: Review of the policy and procedures was conducted on 10/20/2023 at approximately 9:55 AM which revealed, DURABLE MEDICAL EQUIPMENT AND SUPPLIES...PURPOSE To ensure that equipment and supplies are provided for hospice patients based on assessed health care needs...PROCEDURE...3. Those supplies required for optimal comfort, care, and management of the hospice patient will be obtained from the hospice stock supplies or approved company if the patient is on Medicare, Medicaid, or private insurance hospice benefit...5. The hospice Medicare, Medicaid, or private benefit patient will not be billed for equipment or supplies that are related to the terminal illness and necessary to carry out the plan of care..." A review of MR18, Start of Care (SOC) 6/12/2023, was conducted on 10/24/2023 at approximately 9:00 AM. The ";HOSPICE CERTIFICATION AND PLAN OF CARE," list ";Diagnoses...8. Z93.3 COLOSTOMY STATUS...HOSPCIE AGENCY TO PROVIDE ROUTINE LEVEL OF CARE FOR PALLIATION AND MANAGEMCNT OF TERMINALILLNESS AND RELATED CONDITION IN COORDINATION WITH THE INTERDISCIPLINARY GROUP...Functional Limitations: ENDURANCE; AMBULATION; FOLEY CATHETER; COLOSTOMY..." The plan of care did not include any documentation of ostomy supplies to be provided for health care needs. An exit interview was conducted with the administrator, vice president of operations, human resource manager, and senior director of compliance, via conference call, on 10/27/2023 at approximately 10:30 AM which confirmed the above findings.

Based on review of agency policy and procedure, observation (OBV), and staff (EMP) interviews, the agency failed to ensure a system of integration with all disciplines providing care and services in all settings related to patient plan of care for one (1) of four (4) patient observations that were conducted (OBV4). Findings included: Review of the policy and procedures was conducted on 10/24/2023 at approximately 2:00 PM which revealed, Policy ";THE PLAN OF CARE...PURPOSE To ensure that an individualized plan of care is completed that complies with accepted standards of care and regulatory issues. POLICY A written individualized patient and family/caregiver plan of care will be established and maintained for each individual admitted to the hospice program. The care provided to the patient must be in accordance with the plan of care...PROCEDURE 1. The Case Manager (or admitting registered nurse) will complete the initial assessment and will initiate the development of the plan of care after the consent forms are signed...11. As needed, the patient and family/caregiver will receive written instructions regarding treatments or aspects of care that will be the responsibility of the patient and family/caregiver to provide or follow through with. 12. The written plan of care will contain, but will not be limited to, the following...S. Drugs and treatments (including allergies) ...13. All appropriate hospice staff will have access to the plan of care. 14. Care provided to the patient will be in accordance with the plan of care." A patients home visit, (OBV4) MR4, was conducted on 10/23/2023 at approximately 1:30 PM. Start of Care was 10/14/2023. A (agency) three ring binder was available. Upon review of the binder no plan of care (POC), medication list or POLST was available for review. The surveyor requested EMP1 review the binder. No POC, medication list or POLST was available per EMP1. An exit interview was conducted with the administrator, vice president of operations, human resource manager, and senior director of compliance, via conference call, on 10/27/2023 at approximately 10:30 AM which confirmed the above findings.

Based on review of agency policy and procedure, observation (OBV), and staff (EMP) interviews, the agency failed to ensure two (2) of four (4) employees followed infection control policy and procedure during observations for bag technique conducted during (OBV1 and OBV3). Findings included: Review of the policy and procedures was conducted on 10/24/2023 at approximately 2:00 PM which revealed, " BAG TECHNIQUE POLICY No. 7-016.1 ...POLICY As part of the infection/exposure control plan, hospice personnel will consistently implement principles to maximize efficient use of the patient's care supply bag when used in caring for patients. PROCEDURE...Bag Technique 1. The bag will be placed on a clean surface (i.e. a surface that can be easily disinfected) in the car and in the home...5. The bag will contain a designated clean and dirty area. The clean area contains unused or cleaned supplies/equipment, and the dirty area is designated for contaminated materials (i.e., used equipment, etc.). 6. When the visit is complete, reusable equipment will be cleaned using alcohol, soap and water, on other appropriate solution, hands will be washed, and equipment and supplies will be returned to the bag..." A visit was conducted to (OBV1) MR1 residence on 10/23/2023 at 8:35 AM revealed: EMP3 provided direct patient care. EMP3 removed items from open nursing/supply bag and placed the bag on a clean chuck/barrier another chuck/barrier was laid adjacent to the chuck/barrier the nursing/supply bag was located on. This area was being used for clean supplies. The following equipment was observed being used during treatment stethoscope and blood pressure monitor. After patient use EMP3 placed the stethoscope and blood pressure monitor back to the same location on the chuck/barrier prior to cleaning the equipment. A visit was conducted to (OBV3) MR3 residence on 10/23/2023 at 8:35 AM revealed: EMP5 provided direct patient care. EMP5 removed items from open nursing/supply bag and placed the bag on a clean chuck/barrier. This area was being used for clean supplies. The following equipment was observed being used during treatment stethoscope, pulse oximeter, thermometer, blood pressure monitor. The reusable items were placed back onto the same chuck/barrier prior to cleaning the equipment. An exit interview was conducted with the administrator, vice president of operations, human resource manager, and senior director of compliance, via conference call, on 10/27/2023 at approximately 10:30 AM which confirmed the above findings.