Every finding on record at Harbor Hospice of East Houston, LP

Observed in Record Review. In 5 of 14 patient records reviewed, Confirmed by the Regional Director . It had been identified that the medication profile had contained duplicate as needed medications for the same purpose. Example During review of HOSrrhv#2 the medication profile Hydrocodone 10mg/325mg 1 tab po prn q 12 hours for pain. This medication had been listed in triplicate with different order dates but all remained active. Also, Morphine concentrate 100mg/ml 0.5ml po q 2hours prn for pain. HOSrrhv#3 had documented Acetaminophen 325mg 2 tabs po q 6 hours for pain and Hydrocodone 5/325mg 1 tab q 8hours prn for pain.

Observed in Record Review. In 2 of 14 patient records reviewed, During review of Hospice records and confirmed by the Regional Director. It had been identified that the bereavement risk assessment had not been completed. Example : During review of HOSnhv#1 and HOShv#4 the bereavement risk had not been completed at the start of care.

Observed in Record Review. In 4 of 14 patient records reviewed, During review of patient records it had been identified that the plan of care had not been individualized with measurable goals based on the patient assessed needs. Example: During review of HOSnhv#1, HOSnhv#2, HOSnhv#3 the plan of care had documented an MSW goal stating that the continuity of care will be maintained as appropriate to patient needs. It had not been individualized to the patient assessed needs nor had been measurable. The RN goal had documented that patient and son will demonstrate effective use of O2. The oxygen had been ordered and placed in home but had not been utilizing the O2. This had been confirmed by the Regional Director. Review of HOShv#2 the RN goal had documented that the patient will agree with the plan of care. The patient will receive level of care as appropriate.

Observed in Record Review. In 8 of 14 patient records reviewed, During review of patient records and confirmed by the Regional Director. It had been identified that the updated plan of care had not documented the progress to goals. Example: During review of HOSnhv#2 it had documented that the patient would understand appropriate use of pain medications. The target date remained at 1 year previous to the current plan of care. HOSnhv#1, HOSnhv#4 the target date for goals had been 1 to 2 years prior to the current updated plan of care.

Observed in Record Review. In 1 of 2 live Hospice discharge records reviewed and confirmed by the Regional Director. The discharge summary of care had been incomplete. Example: During review of HOSd/c#2 the summary only stated that the patient had been hospitalized for care , but had not documented the summary of the care that had been provided to the patient.

Observed in Record Review. In 1 of 3 patient records reviewed, The HCO did not ensure the patient/family initial bereavement assessment was not completed. For example, the surveyor noted on HV #1/RR #1, the initial bereavement risk assessment was not completed as part of the comprehensive assessment. Regulations require an initial comprehensive assessment, including a bereavement risk assessment be completed when a patient elects hospice services. These findings were reviewed, discussed, and confirmed with the Administrator/DON and Quality Director.

Observed in Record Review. In 6 of 9 patient records reviewed, The HCO did not ensure patient care plan goals were attainable, measurable, realistic, and appropriately timed. For example, the surveyor noted on HV #1/RR #1, HV #2/RR #2, HV #3/RR 3, RR #4, RR #5, and RR #9, the patient’s care plan goals included statements such as: Patient/caregiver will demonstrate improved nutritional status. Counseling regarding adjustment issues and disease progression to enhance care plan, Increased services at home, Patient/caregiver verbalize understanding and adhere to measures to maintain adequate nutrition/hydration, Patient will be free of preventable complications, Family/caregiver effective in care management and knows to call hospice for questions and concerns, These stated goals are not realistic, and do not contain information that can be accurately measured to assist organizational staff in determining whether the patient is progressing towards achieving their goals. These findings were reviewed, discussed, and validated with the Administrator/DON and Quality Director.

Observed in Record Review. In 3 of 3 patient records reviewed, The HCO failed to ensure the interdisciplinary group review/update the patient’s plan of care at least every 15 days. For example, the surveyor noted on HV #1/RR #1, HV #2/RR #2, and HV #3/RR #3, documentation of the interdisciplinary group review of the patient plan of care was not present in the patient’s health records. Standards require the hospice interdisciplinary group review and revise the patient’s plan of care as frequently as required, but no less than every 15 calendar days. These findings were reviewed, discussed, and confirmed with the Administrator/DON and Quality Director.

Observed in Record Review. In 2 of 8 patient records reviewed, The HCO staff failed to provide patient care at the ordered frequency. For example, the surveyor noted on RR #4 the aide visit frequency on the 01/27/2023 Plan of Care order was three times a week. Visits were made two times during the week of 01/29/2023 through 02/04/2023. And, on RR #9, aide visit frequency on the Plan of Care for 11/09/2022-02/06/2023 was three times a week. Between 09/11/2022 and 10/29/2022 the aide visited from four to five times a week. There was no communication documentation or physician orders, addressing the deviations. Standards require patient care be provided according to the patient’s individualized plan of care. These findings were reviewed discussed and validated with the organization’s Administrator/DON and Quality Director.

Observed in Patient Home. In 1 of 2 home visits conducted, The HCO’s staff did not follow the organization's bag technique policy. For example, on HV #1/RR #1, the surveyor observed the registered nurse cleaning the thermometer with a sanitizing wipe. The organization's Bag Technique Policy No. 9-014.1 requires the thermometer be clean with soap and water. These findings were reviewed, discussed, and validated with the Administrator/Don and Quality Director. Observed in Patient Home. In 1 of 3 home visits conducted, The HCO staff failed to complete hand hygiene as required by the organization's policy. For example, on HV #1/RR #1, the surveyor noted the registered nurse performed hand washing with the soap bar that was in the patient’s bathroom. The organization’s hand hygiene policy requires hand washing with soap and water be completed with paper towels and liquid soap. If not available, waterless hand washing products are to be used. These findings were reviewed, discussed, and validated by the Administrator/DON and Quality Director.

Observed in Record Review. In 3 of 8 patient records reviewed, The organization did not ensure the registered nurse complete hospice aide supervisory visits as required. For example, the surveyor noted there were no documentation of supervisory visits on HV for #1/RR #1 08/03/2021-09/24/2021 and 04/12/22-05/03/2022, HV #2/RR #2 between 01/17/2023- 02/02/2023, and RR #8 between 01/06/2022-02/02/2022. Standards require the registered nurse supervise the hospice aide during an on-site visit to the patient’s home no less frequently than every 14 days. These findings were reviewed, discussed, and validated by the Administrator/DON and Quality Director.

Observed in Individual Tracer. In 1 of 3 home visits conducted, The organization failed to ensure there was 24-hour service availability during afterhours. For example, the surveyor noted on interview with family of HV #3/RR #3, the family member reported having telephoned the organization afterhours on Monday, February 6, 2023, to request a visit for the patient. The family member stated no live person answered. The call eventually went to voicemail, but the recording stated the voicemail was full. The family stated it was necessary to text one of the nurse’s personal cell phone number in order to receive service. Standards require the hospice organization make covered services available 24 hours a day, to meet the needs of the patient and family. The findings were discussed and acknowledged by the Administrator/DON and Quality Director.