Every finding on record at Green Valley Hospice & Palliative Care, LLC

Observed in Record Review. In 6 of 12 patient records reviewed, it was noted that the plan of care did not include care, treatment, or services based on patient needs. For example, the only issues documented on the plan of care was from the social worker related to emotional support needs. There were no nursing issues documented on the plan of care. In another example, in review of record #1, #3, #5 and record review #7 and in record review for home visit #1 there were no nursing issues documented on the plan of care. Also in review of review #3 there were no issues identified on the plan of care for this patient who was having blood sugars monitored BID for two weeks. In another example, it was noted in record review for home visit #1 that the plan of care had not been updated to include recent issues with constipation. In another example, in review of record for home visit #2 it was noted that the plan of care had not been updated to include issues of cellulitis with new antibiotic as well as knee wound and application of una boots bilaterally. This was discussed with the DPCS.

Observed in HR File Review. In 3 of 3 HR files reviewed, for hospice aides it was noted that there was no documentation of the required areas of competency being evaluated by direct observation of an RN with either a patient or psuedo patient as required. This was confirmed by the administrator.

Observed in HR File Review. In review of the HR file for contracted Medical Director it was noted that the initial competency was not evaluated as part of orientation. For example, the contract was entered in June 2019 and the first documentation of competency evaluation was January 2020. This was confirmed by the administrator.

Observed in Tracer Visit. In 4 of 12 patient records reviewed, it was noted that the record did not contain all information to reflect the patient's care, treatment, or services. For example in review of record for home visit #2 where medication reconciliation was reviewed it was noted that the hospice medication list and the skilled nursing facility list had multiple discrepancies. For example, the SNF medication sheet contained three medications that were not on the hospice list including Benadryl, Tylenol ES and Artificial Tears. Additionally, there were discrepancies in dosage for ASA, Morphine, Lorazepam and discrepancies in frequency for Keflex and Losartan. In another example, it was noted in review of record for home visit #1 that the chaplain did not document any information or update at the most recent IDG meeting and did not sign the document indicating participation. In review of record #2 the RN did not document any information or update at the most recent IDG meeting and did not sign the document indicating participation. In another example, it was noted in record review #3 that the narrative portion of the SN note was blank on five visit notes from 8/17-8/29/23. This was confirmed by the DPCS and the administrator.

Observed in HR File Review. In 4 of 10 HR files reviewed, it was noted that for two LVN records and one Medical Director record the licensure verification at time of renewal was not done prior to expiration. Additionally, in a hospice aide HR file there was no documentation of the date when the verification was done. At the time of survey all were found to be current. This was discussed with HR staff and the administrator.