Every finding on record at Hanover Hospice

Observed in Record Review. In 3 of 10 patient records reviewed, In (RRNHV#4) the surveyor noted that there were no measurable outcomes on POC for any of the goals listed. For example, the goals were maintain independence, have desired comfort level, understand and comply with O2. Also, there were no time frames for any goals or they were for the certification period. On (RRNHV#5) the goals were pain to acceptable level and was not measurable or timed. The assessment indicated that the patient developed a wound in March; however, the care plan was not updated to manage the wound and did not have a goal or interventions, only the order on file. In (RRNHV#7), the plan of care goals were all for the end of initial certification period and did not include short term goals for symptom management. For example the patient assessment indicated a nausea score of 8/10 and the patient was ordered Zofran; however, there was no goal that was measurable or short term to address the symptoms. This was confirmed with the director.

Observed in Individual Tracer. In 4 of 10 patient records reviewed, The surveyor noted (RRHV#1) that the medication orders were incomplete. There was no indication for use for Lidocaine patch prn, Percocet prn and Tylenol oral prn. Also, the patient was ordered three medications (Tylenol, Percocet and Morphine) for pain; however there was no information about in which order to give/take the analgesics. Also, on (RRHV#2) the plan of care orders for Acetaminophen, Miconazole, and Oxycodone-Acetaminophen prn, did not include an indication for use and there was no differentiation of when to give the two analgesics. In (RRHV#3) the orders for Acetaminophen and Bisacodyl prn did not include an indication for use. In (RRNHV#4) there was no indications for prn orders for Tylenol, Albuterol, Calcium Carbonate, Dulcolax supp., Fleet Enema, MOM, and Hydromorphone. Also, there was no frequency for the Dulcolax supp or the Fleet enema or sequence for administering the analgesic and constipation medications. This was confirmed with the director.

Observed in Individual Tracer. In 1 of 3 home visits conducted, The surveyor noted (RRHV#3), that the nurse prefilled the patient's medi-planner without referencing the medication profile, as ordered on the plan of care. This was confirmed with the director.

Observed in HR File Review. In 2 of 10 HR files reviewed, The surveyor noted that there was no evidence in the personnel file (HR#4MD) and (HR#5AMD) that competency was evaluated upon hire or in the last three years. This was confirmed with the director.

Observed in Individual Tracer. In 3 of 3 SNF patient records, The surveyor noted (RRNHV#4) that the plan of care did not identify which provider was responsible for performing the functions that had been agreed upon and included in the plan of care. There was no indication of who was to administer medications and treatments or the coordination of care needs between the hospice and the facility. Also, in (RRNH#6) there was no identification of which provider was to perform and assess wound care and administer medications. This was also the case for (RRNHV#9). This was confirmed with the director.

Observed in Tracer Activities. The organization's Emergency Operations Plan did not describe how the organization will inform state and local officials of any on-duty staff they are unable to contact. This was reviewed and validated with the Administrator.

Observed in Tracer Activities. The organization's Emergency Operations Plan did not describe how the organization will inform state and local emergency preparedness officials of patients the organization is/was unable to contact and/or patients in need of evacuation. This was reviewed and validated with the Administrator.

Observed in Tracer Activities. The organizations Emergency Operations Plan did not include arrangements with other organizations in the event that it cannot serve its own customers. The Surveyor noted that there was no alternate hospice provider identified. This was reviewed and validated with the Administrator.

Observed in Tracer Activities. The organization's Emergency Operations Plan did not address what the organization's role may be in the community response plan. This was reviewed and validated with the Administrator.

Observed in Tracer Activities. The organization did not provided written policies and state specific laws on Advance Directives. Identified during the review of the admission packet and patient home folder, there was no evidence of written information or education on Advance Directives. This was reviewed and validated with the Administrator and the Clinical Nurse Manager.

Observed in Record Review. The organization did not ensure the written plan of care was based on the patients' goals and time frames in accordance with the organizational policy - Interdisciplinary Care Planning/Coordination of Services, which states: Using the data obtained during the initial, comprehensive, and ongoing assessments, the interdisciplinary team members develop a list of patient problems and needs with corresponding goals and anticipated target dates for reaching those goals. Identified in 8 of 8 active patient records reviewed, there were no target dates or time frames specified to meet the patients' goals that were develped in the plans of care by the Interdisciplinary Team. This was reviewed and validated with the Administrator and the Clinical Nurse Manager.