Every finding on record at Harmony Hospice, LLC

Based on record review and interview the agency failed to have a policy and procedure on how to integrate state and federally designated health care professional volunteers to address surge needs. Findings: --- There was no documented evidence, and the agency presented no documented evidence, of a plan to integrate state and federally designated health care professional volunteers to address surge needs. In an interview on 10/10/2024 at 10:38 a.m., S1Administrator indicated the agencys plan had not been updated with volunteer roles and how to integrate state and federally designated health care professional volunteers as required.

Based on record review and interview, the agency failed to ensure the chaplain completed an assessment within 5 calendar days of election for 1 (Patient #3) of 14 (Patient #1, Patient #2, Patient #3, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, Patient #10, Patient #11, Patient #12, Patient #13, and Patient #14) sampled patients reviewed for comprehensive assessment within 5 days of the election of hospice services. Findings: --- Review of Patient #3s record revealed Patient #3 elected hospice services on 07/29/2024. Further review of Patient #3s record revealed the chaplains assessment was not conducted/completed until 08/05/2024. There was no documented evidence, and the agency presented no documented evidence, the chaplain had completed an assessment within 5 days of the election of hospice services. In an interview on 10/10/2024 at 1:19 p.m., S1Administrator indicated the chaplains initial assessment was not completed within 5 calendar days of the election of hospice services as required.

Based on record reviews and interview, the agency failed to conduct an initial bereavement assessment for 6 (Patient #2, Patient #3, Patient #6, Patient #8, Patient #11, and Patient #12) of 14 (Patient #1, Patient #2, Patient #3, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, Patient #10, Patient #11, Patient #12, Patient #13, and Patient #14) sampled patients reviewed initial bereavement assessments. Findings: --- Patient #2 Review of Patient #2s record revealed Patient #2 was admitted to the agency on 07/05/2024. Further review revealed no documented evidence, and the agency presented no documented evidence, an initial bereavement assessment was completed with Patient #2s family and other individuals during the comprehensive assessments by the interdisciplinary group. Patient #3 Review of Patient #3s record revealed Patient #3 was admitted to the hospice on 07/30/2024. Further review revealed no documented evidence, and the agency presented no documented evidence, an initial bereavement assessment was completed with Patient #3s family and other individuals during the comprehensive assessments by the interdisciplinary group. Patient #6 Review of Patient #6s record revealed Patient #6 was admitted to the hospice on 06/14/2024. Further review revealed no documented evidence, and the agency presented no documented evidence, an initial bereavement assessment was completed with Patient #6s family and other individuals during the comprehensive assessments by the interdisciplinary group. Patient #8 Review of Patient #8s record revealed Patient #8 was admitted to the hospice on 08/02/2024. Further review revealed no documented evidence, and the agency presented no documented evidence, an initial bereavement assessment was completed with Patient #8s family and other individuals during the comprehensive assessments by the interdisciplinary group. Patient #11 Review of Patient #11s record revealed Patient #11 was admitted to the hospice on 07/31/2024. Further review revealed no documented evidence, and the agency presented no documented evidence, an initial bereavement assessment was completed with Patient #11s family and other individuals during the comprehensive assessments by the interdisciplinary group. Patient #12 Review of Patient #12s record revealed Patient #12 was admitted to the hospice on 01/25/2024. Further review revealed no documented evidence, and the agency presented no documented evidence, an initial bereavement assessment was completed with Patient #12s family and other individuals during the comprehensive assessments by the interdisciplinary group. In an interview on 10/10/2024 at 1:09 p.m., S1Administrator indicated the agency did not completed the initial bereavement assessments for the above mentioned patients as required.

Based on record reviews and interviews, the agency failed to ensure patients received hospice care and services per their plan of care for 5 (Patient #2, Patient #3, Patient #4, Patient #10, Patient #11) of 14 (Patient #1, Patient #2, Patient #3, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, Patient #10, Patient #11, Patient #12, Patient #13, and Patient #14) sampled patients reviewed for care and services. Findings: --- Patient #2 Review of Patient #2s Plan of Care for certification period of 07/05/2024 through 10/03/2024 revealed, in part, Patient #2 was to receive hospice aide services twice a week. Review of Patient #2s record revealed no documented evidence, and the agency presented no documented evidence, Patient #2 received any hospice aide services for the weeks of 09/02/2024 thorough 09/08/2024, and 09/09/2024 through 09/15/2024. In an interview on 10/10/2024 at 1:18 p.m., S1Administrator indicated the hospice aide failed to provide services per the plan of care for the above mentioned time period as required. Patient #3 Review of Patient #3s Plan of Care for certification period of 07/30/2024 through 10/27/2024 revealed, in part, Patient #3 was to receive hospice aide services twice a week. Review of Patient #3s record revealed the week of 08/19/2024 through 08/25/2024 only one hospice aide visit was documented on 08/20/2024. Further review revealed no documented evidence of hospice aide visits were conducted the weeks of 08/26/2024 through 09/01/2024, 09/02/2024 through 09/08/2024, and 09/09/2024 through 09/15/2024. There was no documented evidence, and the agency presented no documented evidence, hospice aide visits were conducted as required. In an interview on 10/10/2024 at 1:19 p.m., S1Administrator indicated the hospice aide failed to provide to services per the plan of care for Patient #3 for the above mentioned time period as required. Patient #4 Review of Patient #4s Plan of Care for certification period of 07/26/2024 through 10/23/2024 revealed, in part, Patient #4 was to receive hospice aide services three times a week for the week of 09/02/2024 and the week of 09/09/2024. Review of Patient #4s record revealed the week of 09/02/2024 through 09/08/2024 revealed the only hospice aide services documented was dated 09/04/2024 and 09/06/2024, and the week of 09/09/2024 through 09/15/2024 the only hospice aide services documented was dated 09/09/2024 and 09/13/2024. There was no documented evidence, and the agency presented no documented evidence, hospice aide services were provided three times a week per Patient #4s plan of care. In an interview on 10/10/2024 at 1:37 p.m., S1Administrator indicated the agency had no documented evidence of three hospice aide visits had been completed per Patient #4s plan of care for the above mentioned dates as required. Patient #10 Review of Patient #10s Plan of Care for certification period of 06/28/2024 through 09/25/2024 revealed, in part, Patient #10 was to receive chaplain services once a month. Review of Patient #10s record revealed no documented evidence, and the agency presented no documented evidence a chaplain visit had been completed the month of July 2024. In an interview on 10/10/2024 at 2:15 p.m., S1Administrator indicated the agency had no documented evidence a chaplain visit had been completed for Patient #10 for the month of July 2024. Patient #11 Review of Patient #11s Plan of Care for certification period of 07/31/2024 through 10/28/2024 revealed, in part, Patient #11 was to receive skilled nursing services twice a week. Review of Patient #11s record revealed the only skilled nurse visit documented for the week of 08/12/2024 through 08/18/2024 was on 08/13/2024, and the only skilled nurse visit documented for the week of 08/19/204 through 08/25/2024 was on 08/20/2024. There was no documented evidence, and the agency presented no documented evidence, two skilled nurse visits were conducted as required for the weeks of 08/12/2024 through 08/18/2024 and 08/19/204 through 08/25/2024. In an interview on 10/10/2024 at 2:24 p.m., S1Administrator indicated the agency had no documented evidence the skilled nurse provided services twice a week to Patient #11 for the above mentioned dates as required.

Based on records review and interview, the agency failed to ensure all infections were included in the agencys infection control surveillance records for 3 (Patient #1, Patient #8, and Patient #14) of 3 (Patient #1, Patient #8, and Patient #14) sampled patients identified as having infections. Findings: --- Patient #1 Review of Patient #1s Physician Order dated 09/24/2024 revealed an order for Bactrim DS (double strength) (a medication used to treat infections) 500 milligrams (mg) one tablet by mouth twice a day for possible urinary tract infection (bladder infection). Patient #8 Review of Patient #8s Focused Note dated 08/15/2024 revealed, in part, Patient #8 has a strong urine odor and the urine in his brief was dark in color. Review of Patient #8s Physician Order dated 08/15/2024 revealed an order for Bactrim DS 860mg one tablet by mouth twice a day. Patient #14 Review of Patient #14s Focus Note dated 02/22/2024 revealed, in part, Patient #14 had displayed signs of a urinary tract infection and Cipro (a medication used to treat infections) 500mg one tablet by mouth twice a day was ordered. Review of the agencys infection control and surveillance binder revealed no documented evidence, and the agency presented no documented evidence, the above mentioned patient infections were included in the agencys surveillance documentation for infections. In an interview on 10/09/2024 at 2:50 p.m., S2Director of Nursing (DON) indicated anytime a patient had signs of an infection or a new antibiotic was started on a patient, an infection report was to be completed and the staff are to monitor the patient for resolution of the infection. S2DON indicated there was no system in place to ensure nurses were completing the infection control reports as required, and confirmed the above mentioned patient infections were not included in the agencys infection surveillance documentation.

Based on record reviews and interviews, the agency failed to ensure the nurse assessed wounds weekly for 3 (Patient #6, Patient #7, and Patient #8) of 3 (Patient #6, Patient #7, and Patient #8) sampled patients with wounds reviewed for weekly wound care measurements. Findings: --- Review of the Wound Ostomy and Continence Nurses Society's Guidelines revealed assessment and documentation of wound status, which includes comprehensive clinical data demonstrating evidence of progress in healing or failure to heal. Comprehensive wound assessment includes: dimensions and depth; presence, location and depth of any sinus tracts or undermining areas; status and characteristics of the wound bed; volume, color, and odor of exudates; evidence of infection in surrounding tissues. Further review revealed when recorded over time this information can be used to track the progress of wound healing. Patient #6 Review of Patient #6s Plan of Care for certification period of 09/12/2024 through 12/10/2024 revealed Patient #6 had severe venous insufficiency. Review of Patient #6s Routine Nursing Note dated 09/16/2024 revealed, in part, Patient #6 had a right lower extremity wound. Further review revealed no documented evidence, and the agency presented no documented evidence, a wound care assessment had been completed on Patient #6 by S11Registed Nurse (RN). Review of Patient #6s Nursing Notes dated 09/18/2024, 09/23/2024, 09/26/2024, 09/30/2024, and 10/04/2024 revealed no documented evidence, and the agency did not present any documented evidence, of a weekly wound care assessment with documentation of wound care measurements and wound characteristics were completed. In an interview on 10/08/2024 at 10:17 a.m., S11RN indicated he had not assessed or measured Patient #6s lower extremity wound for the above mentioned dates. In an interview on 10/10/2024 at 1:46 p.m., S1Administrator indicated the nurses should assess wounds weekly. Patient #7 Review of Patient #7s Plan of Care for certification period of 09/16/2024 through 12/14/2024 revealed, in part, Patient #7 had a sacral (area of the middle buttock) stage III (wound caused by pressure which extends through the subcutaneous tissue). Review of Patient #7s record revealed no documented evidence, and the agency presented no documented evidence, Patient #7s wound was measured weekly since 09/16/2024. In an interview on 10/08/2024 at 10:17 a.m., S11RN indicated he had not assessed or measured Patient #7s sacral wound for the above mentioned dates. In an interview on 10/10/2024 at 1:57 p.m., S1Administrator indicated the nurse should have assessed Patient #7s wound weekly. Patient #8 Review of Patient #8s Plan of Care for certification period of 07/30/2024 through 10/27/2024 revealed Patient #8 had a stage III pressure wound of the left heel. Further review revealed Patient #8 was to have skilled nursing services twice a week. Review of Patient #8s record for the period of 07/30/2024 through 10/04/2024 revealed the only documented evidence of wound care measurements and assessments was dated 09/02/2024 with the left heel wound measuring 4.5 centimeters (cm) long by 3.8 cm wide and 0.001 cm deep. There was no documented evidence, and the agency presented no documented evidence, Patient #8s wound was assessed and measured as required. In an interview on 10/10/2024 at 2:07 p.m., S1Administrator indicated the nurse should have assessed and documented wound measurements and wound characteristics at least weekly. S1Administrator further indicated there was no documented evidence, and the agency presented no documented evidence, that the above mentioned wound for Patient #8s wound was assessed and measured weekly as required

Based on record review and interview, the agency failed to have documented evidence of the cost savings achieved through the use of volunteers. Findings: --- There was no documented evidence, and the agency presented no documented evidence, of any volunteer services provided within the last year, nor calculations of the amount of total patient care hours provided by paid hospice employees. In an interview on 10/09/2024 at 2:16 p.m., S1Administrator indicated the agency had not had any volunteers since March or April of 2024, and when they did it was just for a few hours. S1Administrator further indicated the agency did not have documentation of volunteer services provided prior to April 2024 and had not calculated the cost savings as required.

Based on record review and interview, the agency failed to ensure volunteers provided services in an amount that was five percent or greater of the total patient care hours of all paid hospice employees. Findings: --- There was no documented evidence, and the agency presented no documented evidence, any volunteer services were provided within the last year, nor calculations of the amount of total patient care hours provided by paid hospice employees. In an interview on 10/09/2024 at 2:16 p.m., S1Administrator indicated the agency had not had any volunteers since March or April of 2024, and when they did it was just for a few hours. S1Administrator further indicated the agency did not have documentation of volunteer services provided prior to April 2024; therefore, had nothing to present as to the level of volunteer services provided.

Based on record reviews and interviews, the agency failed to ensure: 1. A criminal background check was completed (S3Medical Director); and, 2. A criminal background check was completed for all states which the employee lived or worked in the past 3 years (S1Administrator and S2Director of Nursing [DON]). This deficient practice was identified for 3 (S1Administrator, S2DON, and S3Medical Director) of 7 (S1Administrator, S2DON, S3Medical Director, S4Social Worker, S6Nurse Practitioner, S7Licensed Practical Nurse [LPN], and S8Registered Nurse [RN]) sampled licensed personnel reviewed for criminal background checks. Findings: --- 1. Review of S3Medical Directors personnel file revealed a hire date of 01/03/2024. Further review of S3Medical Directors personnel file revealed no documented evidence, and the agency presented no documented evidence, that the agency had completed a criminal background check on S3Medical Director. In an interview on 10/09/2024 at 1:55 p.m., S1Administrator indicated the agency had not obtained a criminal background check on S3Medical Director as required. 2. S1Administrator Review of S1Administrators personnel file revealed a hire date of 12/11/2023. Further review of S1Administrators personnel file revealed S1Administrators personal drivers license had an address as residing in the state of Mississippi. Review of S1Administrators Criminal Background Check dated 12/11/2023 revealed the criminal background check was only completed for the state of Louisiana. There was no documented evidence and the agency presented no documented evidence of S1Administrator had a criminal background check completed for the state of Mississippi. In an interview on 10/09/2024 at 12:24 p.m., S1Administrator indicated she had lived in Louisiana for only 2 years, and lived in the state of Mississippi prior. Review of S2DONs personnel file revealed a hire date of 01/08/2024. Further review of S2DONs personnel file revealed S2DONs address was listed as identified S2DON as residing in the state of Mississippi. Review of S2DONs Criminal Background Check dated 01/08/2024 revealed the criminal background check was only completed for the state of Louisiana. There was no documented evidence and the agency presented no documented evidence of S2DON had a criminal background check completed for the state of Mississippi. In an interview on 10/09/2024 at 12:25 p.m., S2DON indicated she currently resided in the state of Mississippi. In an interview on 10/09/2024 at 12:24 p.m., S1Administrator confirmed both her (S1Administrator) and S2DONs criminal background checks were only completed for the state of Louisiana.

Based on record review and interview the agency failed to: 1. Provide chaplain services per the plan of care for 1 of 10 sampled patients reviewed for chaplain services (Patient #1); and 2. Provide hospice aide services per the plan of care for 1 of 10 sampled patients reviewed for hospice aide services (Patient #4) in a total sample of 13. Findings: Patient #1 Review of Patient #1's Plan of Care for certification period of 07/13/2021 to 09/10/2021 and 11/10/2021 to 01/08/20222 revealed Patient #1 was to receive chaplain services once a month and as needed. Review of Patient #1's record revealed no documented evidence and the agency presented no documented evidence of Patient #1 having received chaplain services in October or November 2021. In an interview on 12/01/2021 at 1:30pm, S1Administrator/DON (Director of Nursing) stated the agency could not locate any documented evidence of Patient #1 having received chaplain services in either October or November 2021. Patient #4 Review of Patient #4's Plan of Care for certification period of 11/04/2021 to 02/01/2022 revealed Patient #4 was to receive hospice aide services three times a week. Review of Patient #4's Physician Orders dated 11/22/2021 revealed an order to change Patient #4's hospice aide visit frequency to once a week. Review of Patient #4's record revealed no documented evidence and the agency presented no documented evidence of Patient #4 having received any hospice aide services. In an interview on 12/01/2021 at 1:40pm, S1Administrator/DON stated the agency could not present any documented evidence as to why Patient #4 did not receive hospice aide services as required.

Based on record review and interview the agency failed to ensure staff monitored wound healing by assessing and documenting wound status weekly per professional standards for 3 of 7 sampled patients (Patient #6, Patient #7 and Patient #10) reviewed for wound care in a total sample of 13. Findings: Review of the Wound Ostomy and Continence Nurses Society's Guidelines revealed, in part, assessment and documentation of wound status, which includes comprehensive clinical data demonstrating evidence of progress in healing or failure to heal. Comprehensive wound assessment includes: dimensions and depth; presence, location and depth of any sinus tracts or undermining areas; status and characteristics of the wound bed; volume, color, and odor of exudates; evidence of infection in surrounding tissues. Further review revealed when recorded over time this information should be used to track the progress of wound healing. Patient #6 Review of Patient #6's Plan of Care for certification period of 09/27/2021 to 12/25/2021 revealed Patient #6 was to receive skilled nursing care twice a week. Review of Patient #6's Wound Report revealed Patient #6 had an unstageable wound (wound wear the base of the wound is unable to be viewed) to the distal (end or tip) right foot, stage three wound (wound extending to the fat tissue layer) to the right plantar (underneath) foot, and stage two wound (open wound exposing the second layer of the skin) to the plantar foot (left or right not identified). Further review revealed no documented evidence of the skilled nurse having assessed and documented on the progress of Patient #6's since the last assessment completed on 10/26/2021. Patient #7 Review of Patient #7's Plan of Care for certification periods of 06/16/2021 to 09/13/2021 and 09/14/2021 to 12/12/2021 revealed Patient #7 was to receive skilled nursing care once a week. Review of Patient #7's Wound Report revealed Patient #7 had an unstageable wound to the medial (inner) right buttock. Further review revealed no documented evidence of the skilled nurse having assessed and documented on the progress of Patient #7's wound since the last assessment completed on 06/16/2021. Patient #10 Review of Patient #10's Plan of Care for certification periods of 08/20/2021 to 11/17/2021 and 11/18/2021 to 02/15/2022 revealed Patient #7 was to receive skilled nursing care once a week. Review of Patient #7's Wound Report revealed Patient #7 had a stage two wound to the anterior (front) left fifth (finger furthest from the thumb) finger, wound with eschar (dead tissue) to the buttock, wound with eschar to the left lower back, wound with eschar to the left foot, stage two wound to the left fifth toe (toe furthest away from the big toe), and wound with eschar to the left hip. Further review revealed no documentation of the progress of Patient #10's wounds since the last assessment completed on 08/20/2021. In an interview on 12/01/2021 at 3:36pm, S1Administrator/DON (Director of Nursing) stated the nurses were not measuring the wounds weekly and should have been. S1Administrator/DON stated one of the nurses had relied on the wound care nurses at the residential facilities for assessment and treatment of the wounds and should have been assessing the wound weekly herself.

Based on record review and interview the agency failed to ensure a hospice aide did not provide services to a client until the registered nurse had provided written patient care instructions for 1 of 9 sampled patients (Patient #6) reviewed for hospice aide services in a total sample of 13. Findings: Review of Patient #6's record revealed Patient #6 received hospice aide services on 11/17/2021, 11/19/2021, 11/22/2021, 11/23/2021, 11/24/2021, 11/25/2021, and 11/26/2021. There was no documented evidence and the provider did not present any documented evidence of have written patient care instructions provided by the registered nurse prior to Patient #6 receiving hospice aide services on 11/17/2021, 11/19/2021, 11/22/2021, 11/23/2021, 11/24/2021, 11/25/2021, and 11/26/2021. In an interview on 12/02/2021 at 1:45pm, S1Administrator/DON (Director of Nursing) stated the nurse was new and did not know how to initiate the Hospice Aide care plan, but the agency should have ensured this was done prior to hospice aide services beginning.