Every finding on record at Harbor Hospice of Arlington LP

Observed in Record Review. The surveyor observed during HOSV1 that the patient had three decubiti , but in review of patient record , who had been admitted 9/4/2023, the surveyor observed no evidence that the wounds had been measured on admit or at any point to survey visit 1/30/2024. This was discussed and confirmed with organization leadership.

Observed in Record Review. In 4 of 14 patient records reviewed, the surveyor observed that the chaplain and social worker failed to complete their initial assessments within five days after the election of hospice. One record the patient was admitted 7/13/2022 and expired on 7/20/2022 and was only assessed by the nurse, a second patient was admitted 7/3/2023 assessment by social worker was on day 10 and chaplain day 7. The surveyor observed on two additional charts that a chaplain never completed an initial assessment and this issue was discussed and confirmed by hospice leadership.

Observed in Tracer Activities. the surveyor observed during record review that the patient had three medications ordered for pain : Tylenol , tramadol and morphine , but the indication for each on the plan of care (POC) was PRN pain. There had been no indications as to when to take what or even not to take two together.

Observed in Tracer Activities. the surveyor observed review of record associated with HOSV1 the patient had been admitted 9/2023 with home health aide (HHA) frequency order of 5 times a week, but the first two weeks the HHA only visited four times a week with no evidence of missed visit note. This issue was discussed and confirmed with organization leadership. Observed in Record Review. In 4 of 14 patient records reviewed, the surveyor observed that the frequency for staff had not been followed for example in 3/14 records the RN frequency had been written as 1D X multiple weeks with 3 PRN visits for symptom management , but the actual visit frequency that the RN observed was 1X week . In addition in 1/4 records the social worker frequency was 1X month for a patient admitted 9/4/2023, but the only visit documented for the social worker had been the initial assessment. In discussion with organization it was expressed that admit nurse had perhaps chosen the wrong drop down, but the error occurred on three records.

Observed in Record Review. In 3 of 14 patient records reviewed, the surveyor found that the home health aide (HHA) had missed visits that had not been reported to physician . In one record the surveyor observed 3 missed visits, in a second 5 missed visits and a third record had 4 missed visits without documentation that the missed visit provided notification to the physician.

Observed in Individual Tracer. the surveyor observed while providing wound care to the patient the SN changed gloves 8 times, but had not cleaned hands between any of the glove changes as required by organization policy. The issue was discussed and confirmed with organization leadership.

Observed in HR File Review. The surveyor observed that the hospice medical directors HR file ,who was providing clinical direction/orders to hospice staff did not have clinical competencies on file. This issue was discussed and confirmed with organization leaders.

Observed in Document Review. the surveyor noted that the hospice had not sent hospital a copy of the discharge document .

Observed in Record Review. In 1 of 2 patient records reviewed, the agency failed to document an initial bereavement assessment at admission as part of the comprehensive assessment. In RR#1 there was no documentation of an initial bereavement assessment at admission. This was validated with the administrator.

Observed in Record Review. In 1 of 2 patient records reviewed, the plan of care had no measurable and specific goals for nursing. In HV#1 in the initial plan of care, all nursing goals stated Will assess each visit and update at next IDT within 15 days. There were no individualized patient centered goals documented. This was validated with the administrator.

Observed in Record Review. In 1 of 2 patient records reviewed, the RN failed to document appropriate care instructions for the hospice aide. In HV#1 documentation indicated that the patient was bedbound on admission but the aide care plan called for a bed bath twice a week with a base frequency of 5 times per week. There was also a notation that the aide should do a bed bath if the patient refused a shower. A shower was not appropriate for a bedbound patient. In addition during a home visit the nurse stated that she had instructed to aide to use barrier cream and a foam dressing to protect the area where a pressure ulcer had formed. The aide care plan did not reflect this assignment. This was validated with the administrator.

Observed in Record Review. In 1 of 1 patient records reviewed, for patients discharged alive the agency failed to document providing a discharge summary to the patient's physician. In RR#1 the patient was discharged for an extended diagnosis. There was a discharge summary completed in the medical record but no documentation that it was sent or offered to the physician who would be providing care after the hospice discharge. This was validated with the administrator.