Every finding on record at Harbor Hospice of Plano, LP

Observed in Tracer Activities. It was noted by the nurse surveyor that the Volunteer On-Boarding Training Program did not include initial training. Finding was validated by the Volunteer Coordinator.

Observed in Record Review. In 2 of 10 patient records reviewed, for active patients it was noted by the nurse surveyor that the comprehensive assessment was not completed within five calendar days of the election of the hospice benefit. For RRHV#1, the spiritual counselor completed his initial spiritual assessment six days after the patient had been admitted. For RRNHV#5, the spiritual counselor and social worker both completed their initial assessments thirteen days after admission. There was no documentation in the electronic medical record to indicate why the visits were not completed. Findings were discussed and verified with the Nurse Administrator and the Director of Nursing.

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, “Patient’s left hip DTI will continue healing process as evidenced by decreased need for dressing changes and wound bed decreasing in size throughout current cert period,” and “Patient will be able to make his needs known and verbalize communication during this cert period”. 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 either at the end of the certification period or none at all. Finding was verified by the Nurse Administrator and the Director of Nursing.

Observed in Record Review. In 1 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 needed services. For RRHV#1, the patient developed an additional sacral decubitus. The medical director verbal order for the change of wound care was not documented by the nurse and the plan of care was not updated to include the new orders. Finding was verified by the Nurse Administrator and the Director of Nursing. Observed in Record Review. In 1 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 needed services. For RRHV#1, the patient developed an additional sacral decubitus. The medical director order for the change of wound care and the plan of care was was not updated to include the new orders. Finding was verified by the Nurse Administrator and the Director of Nursing.

Observed in Record Review. In 1 of 10 patient records reviewed, for active patients, the nurse surveyor noted that the plan of care was not followed. For RRHV#1, the Chaplain visit was one time a month, however, it was almost two months before that patient was visited by the Chaplain after the initial comprehensive spiritual assessment. No documentation was noted to explain why visit was missed. Finding was discussed with the Nurse Administrator and the Director of Nursing.

Observed in Patient Home. In 3 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 in the patient’s sink then dried her hands on a cloth hand towel hanging on a rack by the sink. Later after using hand sanitizer, she double gloved so she could remove a pair after applying lotion to the patient. Additionally, her nails were beyond the recommended length for patient care staff per supervisor and the Dress and Appearance policy. During RRHV#2, the registered nurse washed her hands with soap and water, then set up her barriers, nursing bag and equipment, then gloved without hand sanitizing. During RRHV#3, the social worker held the patient’s hands in prayer and in providing presence several times during the visit and did not hand sanitize prior to leaving the patient’s room. Findings were verified by the Director of Nursing who was present on the visits.

Observed in Patient Home. In 1 of 3 home visits conducted, 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 had coccyx wound and a hip wound, however there was not anything on the hospice aide care plan regarding the hospice aide’s responsibility or what she should report regarding the wound and the dressings. Additionally, the hospice aide care plan had not been updated in over a year and now she is no longer getting into the shower two times a week but getting a bed bath five times a week instead of three times a week. For RRHV#2, the patient was on continuous oxygen when the patient was admitted, she is now on PRN oxygen, however, the hospice aide care plan did not have any information regarding what the hospice aide was supposed to do with the oxygen during the bath. Findings were discussed with the Director of Nursing.

Observed in Tracer Activities. It was noted by the nurse surveyor during the Volunteer Program Review that there was no documentation to support recruitment and retention activities. The Volunteer Coordinator stated that she did not know until yesterday that she was supposed to document her recruitment and retention activities. Finding was discussed with the Administrator and Nursing Director.

Observed in HR File Review. In 2 of 8 HR files reviewed, for active employees, it was noted by the nurse surveyor that for HR#1, (Nursing Director) and HR#3, (NP), neither had an initial competency evaluation completed at hire. Finding was verified by the Nursing Administrator.

Observed in Record Review. In 2 of 10 patient records reviewed, for active patients, it was noted by the nurse surveyor that for RRHV#2 and RRHV#5, the physician’s certificate of terminal illness (CTI) did not contain the required narrative. The CTI consisted of bullet points consisting of patient physical findings that did not demonstrate that the patient was hospice appropriate. Findings were validated by the Nurse Administrator and the Director of Nursing.

Observed in Record Review. In 2 of 3 patient records reviewed, reviewed for active patients who have had recertifications, it was noted by the nurse surveyor that for RRHV#1 and RRHV#3, the physician recertification does not clearly address in a narrative or plainly stated, how the patient continues to meet the criteria for terminal status. Finding was discussed and verified with the Nurse Administrator and the Director of Nursing.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the surveyor that the electronic medical record (EMR) medication profile was inaccurate. During RRHV#2, it was noted that the patient’s family had started giving her Calcium/Magnesium/Zinc/D3/K2 as a supplement po 1/1 daily, yet the medication profile in the medical record had not updated. Also, Desitin and Dyna-shield Skin Barrier Cream were used to prevent skin breakdown and were not on the EMR medication profile. Findings were reviewed with the Director of Nursing who was present on the home visits.

Observed in Record Review. In 1 of 1 patient records reviewed, for extended progress it was noted by the nurse surveyor that the Hospice did not have a process in place to ensure that a Notice of Medicare Non-Coverage (NOMNC) was signed by the patient or patient’s representative at least two days prior to a planned discharge as required. For RRDC#1 the patient did not have a signed NOMNC. The Director of Nursing was not aware that a NOMNC was needed for a discharge for extended prognosis. Lack of a process was discussed with the Director of Nursing and verified by the Nurse Administrator.

Observed in Record Review. In 1 of 5 patient records reviewed, the surveyor noted that in RR# 1, the Social Worker failed to complete the initial assessment within five days after the election of hospice and there was no documentation explaining why. This was validated with Director of Patient care Services.

Observed in Record Review. In 5 of 5 patient records reviewed, the hospice surveyor noted that the patient’s goals were not measurable and were not the time framed. For example the goals were documented as followed: HV #1 Pt/CG can identify achievable goals, alternative courses of action, RR# 1 Patient/caregiver verbalize understanding/demonstrate proper incontinence management, RR# 2 Patient/Family/PCG will express feeling of grief/loss. RR # 3 patient will establish trusting relationship with patient and family . This was confirmed with the Director of Patient Care Services.

Observed in HR File Review. In 1 of 1 patient records reviewed, The Surveyor noted that the job description for the bereavement coordinator did not require that the individual have experience in grief counseling. The job description required the individual to have Training in spiritual care by an accepted religious organization. According to the organization policy No 2-008.1 Bereavement services will provided by personnel who have received training and have experience dealing with grief .This was confirmed with the Director of Patient Care Services. Observed in HR File Review. In 1 of 1 HR files reviewed, In the employee record for the Chaplain/Bereavement Coordinator/ Bereavement counselor there was no documentation of proof that the person had experience or education in grief or loss counseling. According to the organization policy No 2-008.1 Services will provided personnel who have received training and have experience dealing with grief . This was validated by the Director of Patient Services.

Observed in Record Review. In 1 of 1 patient records reviewed, Hospice surveyor noted for HV#1, the hospice aide was not supervised every 14 days. The aide was supervised once during the certification period. This was validated by the Director of Patient Services.