Every finding on record at Harbor Hospice 27, LP

Observed in Patient Home. In 1 of 3 Hospice home visits observed and confirmed by the Administrator. Medications had not been reconciled to include all medications the patient had been taking. Example: During observation of HOSrrhv#1 the patient had several prescribed eye drops to include Dorzolamide 2 x day and Brimonidine 3x day on his side table that he had been utilizing for his glaucoma for a several years. The medications had not been documented within the medication profile at the start of care or during subsequent visits.

Observed in Record Review. In 5 of 14 patient records reviewed, Confirmed by the Administrator. It had been identified that the Hospice plan of care goals had not been measurable. Example: During review of HOSrrhv#1, HOSrrhv#2 , HOSrrhv#3 and HOSrrnhv#4 , all goals were to be achieved by the end of the certification to include all had documenting that the patient/caregiver will achieve a tolerable pain level in 3 months. During review of HOSrrnhv #5 The spiritual plan of care goal had documented that patient/family will identify plan for time of death by end of certification

Observed in Record Review. In 1 of 14 Hospice patient record reviews and confirmed by the Administrator . The plan of care had not documented care or treatment related to the assessed needs. Example: During review of HOSrrnhv#2 and confirmed by the Director. Nursing assessment had documented that the patient with a brain tumor had suffered seizures and had medication to control. The patient had an elbow wound with wound care provided . Neither assessed needs had been documented on the plan of care with interventions to be provided.

Observed in Patient Home. In 1 of 3 Hospice home visits observed and confirmed by the Administrator. Medications had not been reconciled to include all medications the patient had been taking. Example: During observation of HOSrrhv#1 the patient had several prescribed eye drops to include Dorzolamide 2 x day and Brimonidine 3x day on his side table that he had been utilizing for his glaucoma for a several years. The medications had not been documented within the plan of care at the start of care or during subsequent visits.

Observed in HR File Review. In 1 of 1 Hospice Aide personnel file reviewed and confirmed by the Administrator . The competence evaluation had not documented direct observation of the aides performance to include safe techniques in personal hygiene and grooming for a bed, sponge, or shower per organization policy and law and regulation.

Observed in HR File Review. In 4 of 6 HR files reviewed, Confirmed by the Administrator. Hospice had not documented direct observation or demonstration per organization policy and procedure. Policy had stated that staff clinical skills were to be demonstrated and documented as demonstrated. Example: The clinical skills for the RN, LVN, MSW, Chaplain had documented that skills had been assessed and documented verbally.

Observed in Record Review. The organization did not assess the patient’s pain. During review of patient record 12 it was noted that the location of the patient's pain was not documented. This was confirmed by the Administrator.

Observed in Record Review. The hospice did not conduct and document a patient-specific comprehensive assessment and care planthat identifies the patient’s need for hospice care and services. During review of patient record 5 it was noted that the patient had a peritoneal drain for ascites and this was not documented on the initial assessment. This was confirmed by the administrator.

Observed in Record Review. In 4 of 14 patient records reviewed, The plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including the following: - Interventions to manage pain and symptoms. During review of patient records 2, and 3 it was noted that no interventions for managing pain were documented even though the patients were assessed as having pain. In record 6 there were no interventions documented for the care of pressure ulcers and in record 10 interventions were not documented for managing nutrition. This was confirmed by the Administrator

Observed in Individual Tracer. The organization did not implement the infection prevention and control activities it has planned. During home visit 2 it was observed that the RN used hand sanitizer on her gloves rather than doffing and donning new gloves per organizational policy. This was discussed with the Administrator. Observed in Individual Tracer. The organization did not implement the infection prevention and control activities it has planned. During home visit 1 the aide did not cleanse her hands prior to entering the nursing bag on two occasions during patient care. This was discussed with the Administrator. Observed in Individual Tracer. The organization did not reduce the risk of infections associated with medical equipment, devices, and supplies. During home visit 2 it was observed tat the RN disinfected her equipment after use with Sani Cloths and placed them immediately back in the nursing bag. The manufacturer's guidelines require a 2 minute dry time. This was discussed with the Administrator.

Observed in Record Review. In 4 of 4 patient records reviewed, the plans of care did not include measurable outcomes for the established goals. This was validated by the DON.

Observed in Patient Home. During 1 of 1 home visits conducted, the registered nurse failed to follow agency policy for hand hygiene. For example, she wore the same gloves throughout her head to toe assessment; by not removing them prior to entering her clinical bag and by not changing them prior to cleaning her equipment. This was also observed by the DON who accompanied this surveyor on the visit.

Observed in Record Review. In 2 of 4 patient records reviewed, there was no documentation in clinical records HV#1 and RR#3 that the patient/caregiver had been educated on narcotic management and disposal when narcotics were first placed in the home as required by regulation. This was acknowledged by the DON.