Every finding on record at Harbor Hospice of Victoria, LP

Observed in Record Review. In 1 of 1 patient records reviewed, for discharge due to extended prognosis, it was noted by the nurse surveyor that the patient/patient’s representative was not issued a Notice of Medicare Non-coverage (NOMNC) at least two days prior to of discharge as required. For RRDC#1, the signed NONMC was dated the day of discharge. Finding was verified and discussed with the Regional Director, Administrator, and Director of Nursing.

Observed in Record Review. In 3 of 13 patient records reviewed, for active patients with a hospice aide, it was noted by the nurse surveyor that the hospice aide care plans did not include the information necessary for the hospice aide to effectively care for the patients. For RRHV#2, RRNHV#7, and RRNHV#10, the patients all had wound dressings, the hospice aide care plans did not inform the hospice aide about the dressings nor what to do/report if they were soiled or dislodged. There also were no instructions to notify the skilled nurse if there was a change in the patients' condition. Additionally, for RRNHV#7, the patient was quadriplegic and two hospice aides were assigned to perform care together at each visit, however the aide care plan did not give any indication of this nor any special instructions. Findings were discussed and verified with the Regional Director, Administrator, and Director of Nursing.

Observed in Record Review. In 2 of 13 patient records reviewed, for active patients with a hospice aide, it was noted by the nurse surveyor that hospice aide supervisory visits were not documented no less frequently than every fourteen days. For RRHV#4, hospice aide supervisory visits were seven days late (twenty-one days apart), For RRNHV#1, hospice aide supervisory visits were two days late (sixteen days apart). Findings were verified with the Regional Director, Administrator, and Director of Nursing.

Observed in Patient Home. In 2 of 3 home visits conducted, in a facility, it was noted by the nurse surveyor that for RRHV#2 and RRHV#3, the patients’ facility binders did not contain, the patients’ hospice election forms. Findings were verified by the Director of Nursing who was present on the visits.

Observed in Patient Home. In 2 of 3 home visits conducted, the Surveyor noted medication discrepancies between the electronic medical record (EMR) and what the patient or caregivers (PCG) reported administering. For example: in HV #1, the Pt had AZO and Dissa-Peer that she had been self administering; however, these medications had not been included in the EMR. During HV #2, the patient had been self administering Astragalus and Preservision (Areds 2) and the medications had not been included on the EMR. The same patient also had Dulcolax 10mg rectal suppository with patient instructions to take 1 by mouth. This was validated with the Director of Nursing present during the visits.