Every finding on record at Hands of Mercy Hospice, LLC

Based on review of the hospice's Emergency Preparedness Program (EPP) and interview, the hospice failed to provide documentation of an all hazards approach to potential disaster and emergency situations. The finding includes: Review of the hospice's EPP on 3/31/2022 at 1:18 PM revealed the hospice had no documentation of a risk assessment for all potential disasters and emergencies where the hospice is vulnerable. On 3/31/2022 at 2:10 PM, the Administrator, Office Manager and Registered Nurse(RN) #1 reported, "Tornadoes are our highest risk". RN #1 reported "We need to look at all potential emergencies."

Based on review of the hospice's Emergency Preparedness Program (EPP) and interview, the hospice failed to include all employees and vendors in the hospice's EPP communication plan call list. The finding includes: Review of the hospice's EPP Plan on 3/31/2022 at 1:18 PM revealed the hospice had no call list for staff, physicians, vendors or volunteers. On 3/31/2022 at 2:10 PM, the Administrator, Office Manager, and Registered Nurse (RN) #1 verified the finding.

Based on review of the hospice's Emergency Preparedness Program (EPP) and interview, the hospice failed to include contact information for emergency officials in all the counties of South Carolina where the hospice is licensed to serve. The finding includes: Review of the hospice's EPP Plan on 3/31/2022 at 1:18 PM revealed the hospice's EPP had no documentation of communication with every county where the hospice is licensed and serves patients which is every county in the state. On 3/31/2022 at 2:10 PM, the Administrator, Office Manager, and Registered Nurse #1 verified the finding.

Based on record reviews and interview, the hospice had no documentation for completion of the patient's comprehensive assessment by the Interdisciplinary Team (IDT) within 5 days of the patient's Election of Care (EOC) for 3 of 11 patient charts reviewed. (Patient #1, #6 and #8). The findings include: Patient #1 On 3/29/2022 at 3:30 PM, review of Patient #1's chart revealed the patient was admitted and assessed by Registered Nurse (RN) on 12/15/2021, assessed by the Licensed Medical Social Worker (LMSW) on 12/16/2021, and assessed by the Chaplin on 12/20/2021. There was no documentation in the patient's chart of a collaborative meeting of core members within the 5 day time frame of the patient's EOC. The first IDT meeting was held on 12/28/2021. On 3/30/2022 at 3:35 PM, RN #1 verified the finding. Patient #6 On 3/29/2022 at 2:24 PM, review of Patient #6's chart revealed the patient was admitted and assessed by an RN on 7/23/2018, assessed by the LMSW on 7/25/2018, and assessed by the Chaplin on 7/25/2018. There was no documentation in the patient's chart of a collaborative meeting of core members within the 5 day time frame of the patient's EOC. The first IDT meeting was held on 8/1/2018. On 3/31/2022 at 10:44 AM, RN #1 verified the finding. Patient #8 On 3/29/2022 at 12:42 PM, review of Patient #8's chart revealed the patient was admitted and assessed by an RN on 11/16/2021, assessed by the LMSW on 11/17/2021, and assessed by the Chaplin on 11/19/2021. There was no documentation in the patient's chart of a collaborative meeting of core members within the 5 day time frame of the patient's EOC. The first IDT meeting was held on 11/30/2021. On 3/31/2022 at 10:19 AM, RN #1 verified the finding.

Based on observations and chart review, the hospice Registered Nurse (RN) failed to provide an accurate updated medication profile in the patient's home for 2 of 3 patients observed during home visits. (Patient #2 and Patient #11) The findings include: Patient #2 During a surveyor attended home visit to Patient #2's home on 3/28/2022 at 12:08 PM, observations during the medication overview with the caregiver revealed discrepancies between the hospice medication profile and the actual medications the patient takes in the home. Review of the hospice medication profile revealed: Gabapentin 300 mgs (milligrams) capsule by mouth once a day at bedtime. The patient's Care Giver (CG) reported the Gabapentin was discontinued. Metoprolol Tartrate 25 mgs, 1 tablet by mouth twice a day. The patient's CG reported the Metoprolol was discontinued. Cephalexin 250 mgs tablet by mouth, take 4 tablets as needed prior to procedure. The patient's CG reported the Cephalexin was discontinued. Preservision Areds-2 250 mgs -90 mgs -40 mgs -1 mg capsule by mouth, take 2 capsules daily. The patient's CG reported the Preservision was discontinued. Vitamin B-1 100 mgs tablet by mouth, take 1 tablet daily. The patient's CG reported the Vitamin B-1 was discontinued. Bupropion HCL(Hydrochloric) SR(Slow Release) 100 mgs tablet by mouth, take 1 capsule daily. The CG reported the Bupropion was discontinued. Calcium 500 mgs chewable tablet, take 1 tablet daily. The patient's CG reported the Calcium 500 mgs was discontinued. On 3/31/2022 at 9:40 AM, RN #1 verified the finding. Patient #11 During a surveyor attended home visit to Patient #11's home on 3/28/2022 at 1:07 PM revealed discrepancies between the hospice medication profile and the actual medications the patient takes in the home. The hospice medication profile revealed: Cipro 500 mgs tablet by mouth, take 1 tablet twice a day. Patient #11 reported he/she no longer takes Cipro 500 mgs. Rosuvastatin 10 mgs tablet by mouth, take 1 daily. Patient #11 reported Rosuvastatin was discontinued "long ago". On 3/28/2022 at 2:16 PM, RN # 2 confirmed the findings.

Based on record reviews and interview, the hospice failed to provide documentation of an initial bereavement risk assessment included in the patient's comprehensive assessment for 2 of 11 patients. (Patient #3 and #5) The findings include: Patient #3 On 3/29/2022 at 11:32 AM, review of Patient #3's chart revealed there was no documentation of an initial bereavement risk assessment. On 3/31/2022 at 10:58 AM, Registered Nurse (RN) #1 verified the finding. Patient #5 On 3/30/2022 at 1:48 PM, review of Patient #5's chart revealed there was no documentation of an initial bereavement risk assessment. On 3/29/2022 at 3:02 PM, RN #1 verified the finding.

Based on observations, patient chart reviews, and interview, the hospice Registered Nurse (RN), Certified Nurse Assistant (CNA), and the Licensed Medical Social Worker (LMSW) failed to follow care and services regarding wound care and visit schedules for 2 of 11 patient charts. (Patient #8 and #10) The findings include: Patient #8 On 3/29/2022 at 12:42 PM, review of Patient #8's chart revealed the patient was admitted to hospice services on 11/16/2021 with an ordered RN visit schedule for 5 visits for 1 week. Review of the Skilled Nurse (SN) visits showed visits dated 11/16/2021, 11/17/2021, 11/18/2021, and 11/19/2021. The SN failed to follow the schedule for ordered 5 visits per week as listed in the patient's POC. The LMSW ordered visit schedule at Start Of Care(SOC) was 1 visit every month with documented visits dated 11/18/2021 and 11/30/2021 which was more than 1 visit a month. Physician orders increased CNA visits starting 11/18/2021 for 5 visits per week. Documentation showed CNA visits dated 11/17/2021, 11/18/2021 and 11/19/2021 which was not 5 visits that week. Documentation showed CNA for the week of 11/21/2021 were dated 11/22/2021, 11/23/2021, 11/24/2021 and 11/26/2021 which was not 5 times that week. There was no documentation for the visit missed dated 11/25/2021. Documentation of CNA visits for the week dated 11/28/2021 showed the CNA visits dated 11/30/2021, 12/1/2021, 12/2/2021, 12/3/2021 which was only four visits for that week. There was no documentation of a missed visit for 11/29/2021. On 3/31/2022 at 10:19 AM, RN #1 reveals "11/25/2021 was Thanksgiving and the family may have requested that day off for the aide, but there should be a missed visit note." Patient #10 During a surveyor attended home visit to Patient #10's home on 3/28/2022 at 3:05 PM, observations revealed the patient had multiple wounds of the Right Lower Extremity (RLE). Observations of the patient's wound care and review of the patient's plan of care revealed the the wound care was not conducted in accordance with the patient's plan of care. The patient's plan of care showed "Hospice nurse to perform wound care to stasis wounds of right lower extremity. Utilizing clean technique-cleanse with normal saline and dry. Cover with ABD pad and change every day and PRN (as needed). Instruct caregiver in wound care." Observations of the Skilled Nurse showed the SN applied Aquacel Silver to cover the wounds on the patient's RLE, used wound cleanser so the dressings would adhere to the patient's skin, covered some of the wounds with bordered gauze and 4 x(by) 4 gauze, applied an ABD over the tibia RLE, and wrapped the RLE with ace bandage from toes to mid-calf. Observations showed wounds on the patient's left lower extremity (LLE), but observed no assessments or care for the wound on the LLE. On 3/30/2022 at 2:42 PM, RN #1 revealed "We should be doing measurements and need to look at that left leg. The sister (caregiver) wants to use old wound care supplies, and then start the new wound care (orders)."

Based on observations and interview, 2 of 2 Registered Nurses (RN #1 and #2) and 1 Certified Nurse Assistant (CNA #1) failed to follow accepted principles for Infection Control in the provision of patient care for 3 of 3 patients observed. (Patients #2, #10 and #11). The findings include: Patient #2 During a surveyor attended home visit to Patient #2's home on 3/28/2022 at 12:08 PM, observations showed CNA #1 failed to change the patient's bath water and failed to change gloves after performing the patient's perineal care. Patient #2 was incontinent of loose stool. CNA #1 documented with hand held electronic device, had the patent's caregiver sign the hand held electronic device, but failed to clean and/or sanitize the hand held electronic device before placing the hand held electronic device under his/her arm when leaving the patient's home. On 3/31/2022 at 9:40 AM, RN #1 reported, "Need to change the water and gloves. Need to clean the tablet." Patient #10 During a surveyor attended home visit to Patient #10's home on 3/28/2022 at 3:05 PM, observations showed RN #1 using a retractable tape measure to assess the patient's abdominal circumference, retracted the tape measure without sanitizing the tape measure, failed to perform hand hygiene after touching his/her face and mask 4 times, reached into his/her uniform pocket without gloves to retrieve the cell telephone, and replaced the cell telephone without sanitizing the equipment or hands. RN #1 charted on the hand held electronic device, the caregiver signed the hand held electronic device, but RN #1 failed to sanitize the hand held electronic device before placing it into the nurse equipment bag and exiting the patient's home. During interview on 3/30/2022 at 2:42 PM, RN #1 verified the finding. Patient #11 During a surveyor attended home visit to Patient #11's home on 3/28/2022 at 1:07 PM, observations showed RN #2 failed to perform hand hygiene after touching his/her face, hair, and mask 7 times, failed to change gloves or perform hand hygiene prior to sanitizing equipment used in the provision of patient care, failed to sanitize the hand held electronic device after the caregiver signed device, and failed to sanitize the electronic hand held device before placing it into the nurse equipment bag and exiting the patient's home. On 3/31/2022 at 10:01 AM, RN #1 reported "We need some education."

Based on record reviews and interview, the hospice Registered Nurse (RN) failed to provide updated assessments regarding wound care for 6 of 6 patients with wounds. (Patient # 1, #2, #5, #6, #9 and #10) The findings include: Patient #1 On 3/29/2022 at 3:30 PM, review of Patient #1's chart revealed the patient was admitted to hospice care on 12/15/2021 with a Stage 2 wound on the left buttock. There was no documentation in the patient's chart for measurements of the wound by the RN. On 3/29/2022 at 3:30 PM, RN #1 reported "We need to have wound measurements", and verified the finding. Patient #2 During a surveyor attended home visit to Patient #2's home on 3/28/2022 at 12:08 PM, observations revealed Patient #2 had wounds of the left lower back and coccyx. There was no documentation in the patient's chart for measurements of the wounds or assessment of the wounds. On 3/31/2022 at 9:40 AM, RN #1 verified the finding. Patient #5 On 3/29/2022 at 3:02 PM, review of Patient #5's chart revealed the patient reported a fall on 3/8/2022 with subsequent skin tears that were reported to the RN on 3/11/2022 . There was no assessment, wound measurements, or care documented in the patient's chart for the skin tears. On 3/30/2022 at 1:48 PM, RN #1 verified the finding. Patient #6 On 3/29/2022 at 3:02 PM, review of Patient #6's chart revealed the patient has wound care to the left heel wound. There was no documentation for wound measurements the week of 3/6/2022. On 3/31/2022 at 10:44 AM, RN #1 revealed "It looks like the Licensed Practical Nurse (LPN) saw the patient that week. She should be getting wound measurements." Patient #9 On 3/29/2022 at 1:20 PM, review of Patient #9's chart revealed documentation of Stage 2 pressure ulcer of coccyx. There was no documentation of wound measurements for the week of 10/17/2021. On 3/31/2022 at 10:20 AM, RN #1 revealed "It looks like the Licensed Practical Nurse (LPN) saw the patient that week. She should be getting wound measurements." Patient #10 During a surveyor attended home visit to Patient #10's home on 3/28/2022 at 3:05 PM, Observations revealed Patient #10 had multiple wounds of the right lower extremity(RLE). Patient #10 was admitted on 2/20/2022 and seen by a SN on 2/20/2022, 2/21/2022, 2/22/2022, 2/25/2022, 2/28/2022, 3/8/2022, 3/10/2022, 3/14/2022, 3/23/2022 and 3/25/2022. The only wound measurements were obtained on 3/25/2022. On 3/30/2022 at 2:42 PM, RN #1 verified the finding and reported, "I can't believe they are not measuring".

Based on personnel file review and interview, the hospice failed to provide evidence of education or training in grief and loss for the bereavement coordinator providing bereavement services to the hospice's patients and their families. The finding includes: During an interview with the bereavement counselor on 3/30/2022 at 9:22 AM, the bereavement counselor reported that he/she had not received specific grief and loss training other than the normal annual training and personal history. Review of the bereavement coordinator's personnel files on 3//30/2022 at 2:05 PM, the facility had no documentation for the training for the hospice's bereavement counselor.

Based on patient chart reviews and interview, the Registered Nurse (RN) failed to provide patient specific instructions for the Certified Nurse Aide's (CNA) assignments for 10 of 11 patients receiving ordered aide services. (Patient #1, # 2, #3, #5, #6, #7, #8, #9, #10 and #11) The findings include: Patient #1 On 3/29/2022 at 3:30 PM, review of Patient #1's chart revealed orders for CNA services 3 times a week. Review of the "CNA Care Plan Assignment" showed "instructs Shampoo weekly, Nail Care weekly, and Ear Care weekly". The CNA Care Plan Assignment was not specific for which day(s) to perform the tasks or specific about what ear care was required. On 3/29/2022 at 3:30 PM, RN #1 verified the finding but was unable to define what tasks are included in ear care. Patient #2 On 3/29/2022 at 10:03 AM, review of Patient #2's chart revealed ordered CNA services 5 times a week. Review of "The CNA Care Plan Assignment" showed "instructs Assist with feeding every visit." On 3/28/2022 at 12:08 PM, CNA #1 reported "Caregiver always feeds the patient before I get here." The "CNA Care Plan Assignment" also showed "instructs Shampoo once a week and hair care weekly", but was not specific for which day(s) to perform either of the tasks. On 3/31/2022 at 9:40 AM, RN #1 verified the finding. Patient #3 On 3/29/2022 at 11:32 AM, review of Patient #3's chart revealed ordered CNA visits 5 times a week. Review of "The CNA Care Plan Assignment" showed "instructs Shampoo weekly and Bathing-Shower 3 times a week." The CNA assignment was not specific for which day(s) to perform the tasks. On 3/31/2022 at 10:58 AM, RN #1 reported "It is not clear." Patient #5 On 3/29/2022 at 3:02 PM, review of Patient #5's chart revealed ordered CNA visits 3 times a week. Review of "The CNA Care Plan Assignment" showed "instructs Shampoo weekly, Hair Care weekly and Change linens weekly." The CNA assignment was not specific for which day(s) to perform the tasks. The assignment had vital sign parameters that require physician notification by the Skilled Nurse. On 3/30/2022 at 1:48 PM, RN #1 reported "CNAs don't do vital signs at visits. This should not have populated in the assignment." Patient #6 On 3/29/2022 at 3:02 PM, review of Patient #6's chart revealed ordered CNA visits 3 times a week. Review of "The CNA Care Plan Assignment" showed "instructs only Bathing-Bed bath." The assignment was not specific for which day(s) to perform the tasks. There were no other instructions for care. On 3/31/2022 at 10:44 AM, RN #1 revealed "There should be more care instructions." Patient #7 On 3/29/2022 at 1:54 PM, review of Patient #7's chart revealed ordered CNA visits 5 times a week. Review of "The CNA Care Plan Assignment" showed "instructs Shampoo 1X(time) weekly, Skin Care 1X weekly, Hair Care 1X weekly, Oral Care 1X weekly, and Bathing-Shower 1X week as requested, and Tidy Bathroom 1X weekly." The CNA assignment was not specific for which days to perform the tasks. On 3/30/2022 at 3:17 PM, RN #1 reported "It is not clear." Patient #8 On 3/29/2022 at 12:42 PM, review of Patient #8's chart revealed ordered CNA visits 5 times a week. Review of "The CNA Care Plan Assignment" showed "instructs Bathing-Bed Bath every visit as tolerated, Shampoo twice weekly as tolerated, Bathing-Shower Twice weekly as tolerated, may give bed bath instead, and Change linens every visit as needed." The CNA assignment was not specific for which days to perform the tasks. On 3/31/2022 at 10:15 AM, RN #1 reported "It is not clear." Patient #9 On 3/29/2022 at 1:20 PM, review of Patient #9's chart revealed ordered CNA visits 5 times a week. Review of "The CNA Care Plan Assignment" showed "instructs Bathing-Bed Bath 3X(times) weekly, Change Linens Once weekly as tolerated, and Tidy Patient area and bathroom 3-5Xs weekly." The CNA assignment was not specific for which days to perform the tasks. On 3/31/2022 at 10:20 AM, RN #1 reported "It is not clear." Patient #10 On 3/30/2022 at 11:55 AM, review of Patient #10's chart revealed the patient was ordered CNA visits 3 times a week. Review of "The CNA Care Plan Assignment" showed "instructs Shaving weekly." The CNA's assignment was not specific for which day to perform the task. The assignment had vital sign parameters that require physician notification by Skilled Nurse On 3/30/2022 at 2:42 PM, RN #1 reported "CNAs don't do vital signs at visits. This should not have populated in the assignment." Patient #11 On 3/29/2022 at 12:11 PM, review of Patient #11's chart revealed the patient was ordered CNA visits 3 times a week. Review of "The CNA Care Plan Assignment" revealed "instructs Bathing-Bed Bath weekly as tolerated, Shampoo weekly as tolerated, Hair Care weekly as tolerated, Skin Care weekly as tolerated, Change Linens Weekly and Wash linens weekly." The CNA's assignment was not specific for which day to perform the tasks. On 3/31/2022 at 10:01 AM, RN #1 verified the finding.