Every finding on record at Harbors Home Health and Hospice

Based on record review and interview, the agency failed to ensure bereavement risk assessments were completed as part of the initial comprehensive assessment for 2 of 15 patients (#102, #108). This failure has the potential to delay or overlook the needs of the patient's family and others in their ability to cope with the patient's death. Findings included: 1. Document review of the agency's policy titled, "Bereavement Assessment," (last revised: May 2019) showed that the bereavement assessment is completed by the social worker, chaplain, or hospice registered nurse upon the admission. 2. Record review of the patient charts for 2 of 15 patients (#102, #108) showed: a. Patient #102 signed the Election statement on 03/04/22 and was admitted on this day. Documentation of the initial bereavement risk assessment was not present in the patient's record. There was no documentation to explain the absence of the bereavement risk assessment. b. Patient #108 signed the Election statement on 04/19/22 and was admitted on this day. Documentation of the initial bereavement risk assessment was not present in the patient's record. There was no documentation to explain the absence of the bereavement risk assessment. 3. Surveyor #1 interviewed the agency's Chief Operations Officer (Staff #113) on 05/17/22 at 2:00 PM regarding the lack of bereavement risk assessments. Staff #117 acknowledged the issues with the missing initial bereavement assessments. .

Based on record review and interview, agency failed to follow the plan of care as ordered by the physician for 5 of 15 patients (Patient #101, #102, #104, #107, and #110). Failure to follow the plan of care, as ordered by the physician, could place the patient at risk of worsening symptoms of existing diagnoses. Findings included: 1. Document review of agency's policy titled, "The Plan of Care," (last revised: July 2018) showed the plan of care is followed based on the physician's medical orders. 2. Record review of records for 5 of 15 patients (Patient #101, #102, #104, #107, and #110) showed: a. Patient #101 was admitted on 09/09/21 with a primary diagnosis of Alzheimer's Dementia. On 09/22/22, the physician ordered Skilled Nursing (SN) services for 2 times per week for 10 weeks. The week of 09/26/22, the patient received 1 of 2 SN visits. The week of 10/03/22, the patient received no SN visits. The week of 10/17/22, the patient received 1 of 2 SN visits. The week of 11/21/22, the patient received 1 of 2 SN visits. There was no documentation in the record to explain the missed SN visits, nor was there documentation that the physician had been notified of the missed SN visits. b. Patient #102 was admitted on 03/04/22 with a primary diagnosis of Prostate cancer. On 03/04/22, the physician ordered SN services for 2 times per week for 12 weeks. The weeks of 03/06/22, 03/13/22, 03/20/22, 03/27/22, and 04/03/22, the patient only received 1 of 2 SN visits. There was no documentation in the record to explain the missed SN visits, nor was there documentation that the physician had been notified of the missed SN visits. c. Patient #104 was admitted on 04/15/22 with a primary diagnosis of Lung Cancer with Brain metastasis. On 04/18/22, the physician ordered SN services for 2 times per week for 12 weeks. The weeks of 04/17/22 and 04/24/22, the patient only received 1 of 2 SN visits. There was no documentation in the record to explain the missed SN visits, nor was there documentation that the physician had been notified of the missed SN visits. d. Patient #107 was admitted on 04/01/22 with a primary diagnosis of Esophagus Cancer. On 04/01/22, the physician ordered SN services for 2 times per week for 12 weeks. The weeks of 04/03/22, 04/10/22, and 05/08/22, the patient only received 1 of 2 SN visits. There was no documentation in the record to explain the missed SN visits, nor was there documentation that the physician had been notified of the missed SN visits. e. Patient #110 was admitted on 12/09/21 with a primary diagnosis of Amyotrophic Lateral Sclerosis. On 12/09/21, the physician ordered SN services for 2 times per week for 12 weeks. The weeks of 12/12/21, the patient only received 1 of 2 SN visits. There was no documentation in the record to explain the missed SN visits, nor was there documentation that the physician had been notified of the missed SN visits. 3. On 05/17/22 at 9:00 AM, Surveyor #1 interviewed the agency's Chief Operations Officer (Staff #113) of lack of documentation and notification to the physician of the missed visits. Staff #113 acknowledged the findings and stated that they were not aware of the issues. .

Based on record review and interview, the agency failed to follow state requirements that included the following: to perform an initial or annual Tuberculosis (TB) screening for 11 of 11 staff (#101, #102, #103, #104, #105, #106, #107, #108, #109, #110, #111)(Item #1); and failed to do annual performance with on-site evaluations for 10 of 15 staff (#107, #108, #109, #110, #111)(Item #2). Failure to perform a TB Screening on staff place patients and staff at risk of exposure to infectious diseases, and failure to complete an annual performance evaluation place patients at risk of receiving care from unqualified staff; and failure to conduct annual staff performance evaluations may result in unmet employee training needs. Reference: WAC 246-335-625 Personnel, contractor, and volunteer policies. The applicant or licensee must develop and operationalize personnel, contractor, and volunteer policies and procedures that describe: (14) Infection control practices, communicable disease testing, and vaccinations. Policies and procedures must include, at minimum: (c) Tuberculosis (TB) infection control program. Key elements include, but are not limited to: (i) Conducting a TB risk assessment for all new employees upon hire. Agencies must use a tuberculosis risk assessment form provided by the department. Based on risk assessment results, determine the agency's responsibility to conduct TB testing of new employees. If TB testing is required, follow the department's tuberculosis risk assessment form testing recommendations; (ii) Conducting an annual assessment of new TB risk factors for all employees. Agencies must use a tuberculosis risk assessment form provided by the department. Based on risk assessment results, determine agency's responsibility to conduct TB testing of employees. Retesting should only be done for persons who previously tested negative and have new risk factors since the last assessment (15) Annual performance evaluations of all personnel and volunteers providing direct patient care, including on-site observation of care and skills specific to the care needs of patients; Findings included: Item #1 - TB Screening 1. Document review of agency's document titled, "Tuberculosis Exposure Control Plan," (Dated April 2019) showed all personnel will be tested for TB in accordance with federal, state, and/or local regulations. 2. Personnel record review of 11 staff showed: a. Staff #101 hired on 02/19/21. The record failed to contain a completed {DOH}-approved initial or annual TB risk assessment. b. Staff #102 hired on 03/22/22. The record failed to contain a completed {DOH}-approved initial or annual TB risk assessment. c. Staff #103 hired on 03/31/20. The record failed to contain a completed {DOH}-approved initial or annual TB risk assessment. d. Staff #104 hired on 03/16/19. The record failed to contain a completed {DOH}-approved initial or annual TB risk assessment. e. Staff #105 hired on 06/26/17. The record failed to contain a completed {DOH}-approved initial or annual TB risk assessment. f. Staff #106 hired on 11/03/17. The record failed to contain a completed {DOH}-approved initial or annual TB risk assessment. g. Staff #107 hired on 06/27/19. The record failed to contain a completed {DOH}-approved initial or annual TB risk assessment. h. Staff #108 hired on 06/02/16. The record failed to contain a completed {DOH}-approved initial or annual TB risk assessment. i. Staff #109 hired on 03/07/08. The record failed to contain a completed {DOH}-approved initial or annual TB risk assessment. j. Staff #110 hired on 01/01/16. The record failed to contain a completed {DOH}-approved initial or annual TB risk assessment. k. Staff #111 hired on 06/18/18. The record failed to contain a completed {DOH}-approved initial or annual TB risk assessment. 2. Surveyors #1 interviewed the Chief Compliance Officer/Human Resources (Staff #112) on the missing initial and annual TB risk assessment on staff. Staff #112 acknowledged the findings and stated that they currently have all their staff complete the TB risk assessment. Item #2 - Annual Performance Evaluations 1. Personnel record review of 5 staff showed: a. Staff #107 was hired on 06/27/19. The staff file lacked documentation of an annual evaluation with on-site observation of care and skills specific to the care needs of patients. b. Staff #108 was hired on 06/02/16. The staff file lacked documentation of an annual evaluation with on-site observation of care and skills specific to the care needs of patients. c. Staff #109 was hired on 03/07/08. The staff file lacked documentation of an annual evaluation with on-site observation of care and skills specific to the care needs of patients. d. Staff #110 was hired on 01/01/16. The staff file lacked documentation of an annual evaluation with on-site observation of care and skills specific to the care needs of patients. e. Staff #111 was hired on 06/18/18. The staff file lacked documentation of an annual evaluation with on-site observation of care and skills specific to the care needs of patients. 2. Surveyor #1 interviewed the agency's Chief Compliance Officer/Human Resources (Staff #112) on the missing staff evaluations. Staff #112 acknowledged the findings and stated that they are currently working on making corrections.