Every finding on record at Harbor Hospice of Gulf Coast LP

Observed in Patient Home. In 1 of 3 home visits conducted, with a nurse it was noted that the hospice nurse failed to conduct a medication assessment. For example during RRHV#1 the nurse asked the patient and patient's wife if there had been any changes to the medications, but did not complete a medication assessment. This was confirmed and discussed with the DON and Clinical Manager present.

Observed in Record Review. In 4 of 14 patient records reviewed, it was noted that the written plan of care was not based on goals, time frames, settings, and service required to meet goals. For example, in RRNHV#1 the foley catheter goal stated to change 16Fr foley catheter per order.In RRHV#3 goals were not individualized, Mrs. -- recognizes energy limitations and understands/uses energy conservation techniques. In RRNHV#9 Patient will be free of preventable complications In RRNHV#8 goal Anxiety managed with lorazepam 1mg every 6 hours as needed This was confirmed and discussed with the DON and Clinical Manager.

Observed in Record Review. In 1 of 14 patient records reviewed, it was noted that the plan of care did not include all services needed for management of the illness. For example, in RRNHV#1 the patient's foley catheter order was incomplete, foley catheter order incomplete with no frequency to change the catheter and no indication of what to fill the balloon with or how many CCs to fill the balloon with. This was confirmed and discussed with the DON present.

Observed in Patient Home. In 1 of 2 home visits conducted, with patient's who had aide services it was noted that care was not provided according to hospice plan of care. For example, during RRHV#2 the patient with lower extremity edema reported that the aide had clipped her toe nails a couple weeks ago and this was not a task for the aide on the plan of care/aide assignment. This was confirmed and discussed with the DON and Clinical Manager present.

Observed in Patient Home. In 1 of 4 home visits conducted, it was noted that the nurse did not follow the organization's bag technique policy. For example during RRHV#4 the nursing bag was placed on a barrier on the patient's floor in the middle of a walkway area. There were 2 clean dry surfaces, a table to one side of the walkway and a counter to the other side, that the nurse could have used. The patient's home had 2 dogs who walked on the barrier to sniff the bag and equipment. Also during the visit, multiple people attempted to walk around the equipment and, due to the placement of the barrier, bag and equipment, ended up having to step over the bag, equipment, barrier area.  The organization's policy included that the bag should be placed on a clean dry surface. This was confirmed and discussed with the DON and Clinical Manager present.

Observed in Record Review. In 2 of 2 patient records reviewed, for bereavement care it was noted that the bereavement care plans did not include specific, individualized interventions. For example, in RRBR#1 and RRBR#2 the goals and interventions were identical/not individualized for both patients. Survivor will be knowledgeable of bereavement services and, when needed, will use available support to achieve a more positive grief outcome. This was confirmed and discussed with the DON present.

Observed in Patient Home. In 2 of 3 home visits conducted, that included medication assessment it was noted that the medication list was discovered to be inaccurate. For example in RRHV#2 the patient reported using Reamdy Antifungal Medicated Powder to her excoriated skin folds and the nurse applied the powder during the visit, however the medication was not included on the patient's medication list. During RRHV#4 the patient reported using Benadryl for her allergies and the medication was sitting on the table and discussed with the nurse present, however it was not included on the patient's medication list. This was confirmed and discussed with the DON and Clinical Manager present.

Observed in Record Review. In 2 of 2 patient records reviewed, for live discharge it was noted that the discharge summary had not been provided to the patient's attending physician. For example, in RRDC#1 there was no documentation that the agency had provided the physician with the discharge summary after a discharge to the community. In RRDC#2 there was no documentation that the agency had provided the physician with the discharge summary after the patient revoked hospice services.  This was confirmed and discussed with the DON present.

Observed in Patient Home. In 2 of 3 home visits conducted, that included oxygen in the home it was noted that the staff did not provide education on the safe storage of oxygen cylinders in the home. For example, in RRHV#1 there were 6 E tanks and 2 M6 tanks stored in an enclosed closet and 5 of the 6 E tanks and both M6 tanks were free standing. Also in this home there were 2 additional M6 tanks stored in the enclosed patient's car outside, in the southern Texas heat in the summer with the temperature in the 90s. In RRHV#3 there was 1 E tank free standing in the dining area of the home. In both cases the staff did not evaluate the safe storage of the oxygen or re-educate about safe storage of oxygen. This was confirmed and discussed with the DON and Clinical Manager present.

Observed in Patient Home. In 1 of 2 home visits conducted, the surveyor noted that the organization failed to reassess potential medication problems. For example, during HV#2 the hospice nurse failed to conduct a medication assessment. This was confirmed with the Administrator present.

Observed in Record Review. In 10 of 13 patient records reviewed, the surveyor noted that the written plan of care was not based on the patient’s goals and the time frames, settings, and services required to meet those goals. For example; RR#4 and RR#2 the POC was not individualized, record RR#4 12 of 12 goals had the same time frame and RR#2 11 of 11 goals had the same time frames. For example, the POC goals in records RR#6, RR#8, and RR#9 time frames were in the past and continued as active goals. For example, POC goals in records RR#1 and RR#3 were not measurable; will have adequate support and symptoms managed at a comfortable level. This was discussed with the Regional Administrator present.

Observed in Record Review. In 9 of 13 patient records reviewed, the surveyor noted that the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions. For example, records HV#2, HV#3, RR#1, RR#2, and RR#4 included 9 MSW as needed visits, but did not include a reason to complete these as needed visits. For example, record RR#8 included skilled nurse as needed visits, but did not include a reason to complete these as needed visits. For example, record RR#7 included MSW and Chaplain as needed visits, but did not include reasons to complete these as needed visits. For example, records RR#9 and RR#10 included Chaplain as needed visits, but did not include a reason to complete these as needed visits. This was confirmed with the Administrator present.

Observed in Record Review. During record review the surveyor noted that the plan of care did not include medications and treatment necessary to meet the patient’s needs. For example, record HV#1 the hospice nurse note stated that the patient was using Tylenol as needed and had started Paxlovid, but no dose, route or frequency order was found in the plan of care or supplemental orders. For example, record RR#10 included Baclofen and Trazodone on the plan of care, but no route the patient should take them. For example, record RR#1 the nurses notes stated that they used condom catheters for patient comfort, however condom catheters were not included on the plan of care and there was no record of a supplemental order for the use of these catheters. This was confirmed with the Administrator.

Observed in HR File Review. In 1 of 8 HR files reviewed, the surveyor noted that the Bereavement Coordinator did not have a competency documented since their initial competency over three years ago. This was confirmed with the Regional Administrator present.

Observed in Patient Home. In 2 of 3 home visits conducted, the surveyor noted that the staff did not take action to minimize safety risks. For example, in HV#1 the patient's oxygen cylinders (4 E-tanks and 4 small tanks) were stored in a closet with door closed. These tanks were free standing on the top shelf in the closet. Example 2, in HV#3 the patient had 2 E-tanks, 1 stored on a stand and the other free standing next to the stand. These safety issues were not addressed during the visits and education was not found in the patient records. This was confirmed with the Administrator present.