Every finding on record at Harbor Hospice of Longview LP

Observed in Record Review. In 10 of 10 patient records reviewed, for all active records, the nurse surveyor noted that the goals were not measurable or individualized. For example, “Peripheral edema will be reduced or resolved,” and “Optimal activity level achieved and maintained within baseline respiratory and energy parameters”. There were no short-term goals at start of care to address issues of immediate needs such as understanding medication management, symptom management, pain management, or safety. Additionally, time frames for completion were set for one year from admission. Finding was verified by the Administrator/Director of Nursing.

Observed in Record Review. In 4 of 10 patient records reviewed, for active patients it was noted by the nurse surveyor that the patient's plan of care did not include all services to meet the patient’s needs. For RRHV#2, the patient was no longer receiving wound care, however the order was still active. For RRHV#3, the patient had treatment orders for Oxygen 2-4 liters per nasal cannula, however there were no specific parameters provided. For RRNHV#1, the patient had two medications for pain, Tramadol and Norco, both were to be taken PRN every six hours for pain, however, it was unclear when to take which medication. For RRNHV#7, The patient was on four different as needed pain medications: Acetaminophen, Ibuprofen, Hydrocodone with Acetaminophen and Morphine Concentrate, however it was unclear when to take which medication when. Additionally, there was no caution as to what the maximum dose of Acetaminophen per day was. Findings were verified by the Administrator/Director of Nursing.

Observed in Record Review. In 1 of 10 patient records reviewed, it was noted by the nurse surveyor that the plan of care was not being followed. For RRHV#1, the patient had an order for oxygen 3 liters, BNC, however, he was receiving 4.5 liters of oxygen BNC continuously. Finding was verified by the Administrator/Director of Nursing.

Observed in Patient Home. In 2 of 3 home visits conducted, it was noted by the nurse surveyor that the staff failed to follow acceptable practice and agency policy when performing patient care. During RRHV#1, the hospice aide washed her hands numerous times in the patient’s sink then touched things in the room or the patient, applied gloves without hand sanitizing, removed gloves without hand sanitizing and repeated the process. She did not have hand sanitizer with her to supplement the handwashing with soap and water. The hospice aide also went in and out of her bag without hand sanitizing and stuffed the dirty trash bag from the patient room into the side pocket of her bag. During RRHV#3, the registered nurse then set up her barriers, (a used plastic grocery bag) and set her bag inside of it on a very small area on the patient’s side table. She then set her computer down on top of the patient’s tissue box (without a barrier). The skilled nurse went in and out of her bag without hand sanitizing and donned and doffed gloves without hand sanitizing on several occasions while assessing the patient. She then cleaned her equipment with a Sani Wipe which she dropped on the floor once and kept on cleaning with it. She then put her clean equipment up next to her bag just inside the barrier, falling out onto the side table to dry. Findings were verified by the Administrator/Director of Nursing who was present on the visits.

Observed in Record Review. In 5 of 8 patient records reviewed, for active patients it was noted by the nurse surveyor that the hospice aide care plan did not contain all the necessary or current information. For RRHV#1, the patient is on continuous oxygen, the hospice aide care plan did not have any information regarding what the hospice aide was supposed to do with the oxygen during the patient’s shower/bath. For RRHV#2, and RRNHV#4, the patients both had feeding tubes and nothing was noted on the aide care plan regarding her responsibilities surrounding the care of the tube or precautions to take. For RRHV#3, as the patient’s condition has declined over the past two weeks, she is no longer getting into the shower and the hospice aide is giving the patient a bed bath, however the aide care plan was not updated until one day ago. Additionally, the patient is now on continuous oxygen and the care plan was not updated to address what the aide should do with it during the bath. For RRNHV#1, the patient had a dressing to her sacral area and the aide care plan did not have any information regarding what the aide's responsibility regarding the dressing was. Findings were discussed with the Administrator/Director of Nursing.

Observed in Tracer Activities. It was noted by the nurse surveyor that the organization did not have any documented cost savings achieved using volunteers for 2024 and year to date 2025. The hospice has not had any volunteers since last quarter 2023 despite recruitment attempts. Finding was verified by the Interim Volunteer Coordinator and the Administrator/DON.

Observed in Tracer Activities. It was noted by the nurse surveyor that volunteers did not provide at least 5% of the total patient care hours of all paid hospice employees and contract staff for 2024 and year to date 2025. The hospice has not had any volunteers since last quarter 2023 despite documented recruitment attempts. Finding was verified by the Interim Volunteer Coordinator and the Administrator/DON.

Observed in Record Review. In 1 of 10 resident records reviewed, it was noted by the surveyor that the electronic medical record (EMR) medication profile was inaccurate. During RRHV#3, it was noted that verbal orders had been given by the physician to discontinue Metoprolol Succinate and start two comfort medications (Ativan and Morphine), however, the medication profile was not updated by the nurse until six days after the order was given. Findings were verified with the Administrator/Director of Nursing.

Observed in Patient Home. In 1 of 2 home visits conducted, it was noted by the nurse surveyor that for RRHV#3 two backup E-tanks were secured in stands in the back of a closet, under clothes in a back bedroom. Finding was verified by the Administrator/Director of Nursing who was present on the visit.

Observed in Patient Home. In 1 of 2 home visits conducted, it was noted by the nurse surveyor that for RRHV#1, the Facility staff where the patient was residing could not produce any information from the hospice that was the patient’s most recent updated plan of care, the election form or any advance directives, the physician’s certification and recertification of the patient’s terminal illness, and any hospice medication information. Several nurses and the DON of the facility were asked, and they stated they had not seen a binder. They did know how to contact the Hospice staff and how to access them after hours. The hospice Administrator/Director of Nursing who was present during the visit thought that all the required information had been provided.

Observed in Competency Session. In 3 of 9 Human Resource files, the organization did not ensure that emergency preparedness training for staff was provided at least every two years. For example, a review of Human Resource files for Social Worker, Spiritual Counselor and Hospice Aide #1 revealed no documented evidence of emergency preparedness training for 2021. This observation was reviewed with the Administrator / Director of Nursing.

Observed in Record Review. In 1 of 13 patient records, the organization did not ensure that the comprehensive assessment included all required information. For example, during a review of the recertification assessment for RR#11, it was noted that a falls risk assessment was not completed. This observation was reviewed with the Administrator / Director of Nursing.

Observed in Record Review. In 3 of 13 patient records reviewed, it was noted that the organization did not ensure that the plan of care goals included specific assessed needs and outcome measures for specific care activities. For example, during a review of the initial comprehensive assessment for RR#8, the patient was identified as at risk for falls. The plan of care did not include interventions to maintain patient safety, strategies to prevent injury, and a goal statement to evaluate response to care, treatment and services related to fall prevention interventions.Example #2: A review of the medical record for RR#9, revealed that the patient’s primary diagnosis was Parkinson's Disease. The plan of care did not include a goal statement and patient care interventions related to the primary diagnosis of Parkinson's Disease. In addition, a review of the initial comprehensive assessment, revealed the patient was identified as at risk for falls. The plan of care did not include interventions to maintain patient safety, strategies to prevent injury, and a goal statement to evaluate response to care, treatment and services related to fall prevention interventions. Example #3: A review of the medical record for RR#11, revealed that the initial comprehensive assessment identified that the patient was at risk for falls. The plan of care did not include interventions to maintain patient safety, strategies to prevent injury, and a goal statement to evaluate response to care, treatment and services related to fall prevention interventions. This observation was reviewed with the Administrator / Director of Nursing.

Observed in Record Review. In 1 of 13 patient records reviewed, it was noted that the organization did not ensure that its policy related to patient transfer to other service providers was implemented. For example, a review of the medical record for RR#6, revealed that during week ten of the first benefit period the patient was transferred to a hospital emergency room. The hospice surveyor was not able to validate that the following requirements were completed: The receiving service provider was provided with the reason for the patient's transfer, a summary of care, treatment, or services the organization provided to the patient; and the patient's progress towards goals. This observation was reviewed with the Administrator / Director of Nursing.