Every finding on record at Health at Home Hospice - Austin, LLC

Observed in Tracer Activities. It was noted by the RN surveyor during review of the volunteer orientation materials that the organization did not provide initial education and training in emergency management to volunteers that was consistent with their roles and responsibilities in an emergency. This was reviewed with RN Survey Readiness, Volunteer Coordinator and HR Manager.

Observed in Record Review. In 1 of 19 patient records reviewed, it was noted by the nurse surveyor that the patient was not fully informed of their rights as that for RRNHV#3, the payment section was blank on the hospice consent form. Finding was verified by the Director of Clinical Services and the Regional Director of Survey Readiness.

Observed in Record Review. In 14 of 14 patient records reviewed, for active patients, the nurse surveyor noted that the goals were not measurable or individualized. For Example “Home safety measures will be effective while patient is on hospice AEB no falls with serious injury and safe use of oxygen”. 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, most time frames for completion were at the end of life. Additionally, goal completion dates were not updated to reflect changes from certification period to certification period. Finding was confirmed by the Regional Director of Survey Readiness.

Observed in Record Review. In 2 of 14 patient records reviewed, for active patients, it was noted by the nurse surveyor that PRN frequencies were not qualified. For RRHV#3, the SW frequency was increased, however, there was no reason given for making the 2 PRN visits that were ordered. For RRNHV#3, there were several orders to change the RN frequency, however there was no reason given for making the 2 prn visits. Finding was confirmed by the Regional Director of Survey Readiness.

Observed in Record Review. In 1 of 14 patient records reviewed, for active patients, it was noted by the nurse surveyor during patient home visit and subsequent record review for RRHV#4 that patient had oxygen in the home and there was no order in the medical record. In addition, patient was taking Centrum multivitamins and there was no order in the medical records. Finding was discussed with RN clinical supervisor and RN for survey readiness.

Observed in Record Review. In 1 of 14 patient records reviewed, for active patients, it was noted by the nurse surveyor that the hospice aide care plans did not contain all of the information for the hospice aide to effectively provide care. For RRNHV#1, the patient was on continuous oxygen however, there were no instructions to indicate if the patient’s oxygen could be removed during the shower or not. Findings were verified by with the Director of Clinical Services and the Regional Director of Survey Readiness

Observed in Patient Home. In 1 of 4 home visits conducted, the nurse surveyor during the patient caregiver interview was informed that the aide applied Nystatin during some of the aide visits. In addition, it was reported the aide clipped the patient's toe nails when the care plan clearly stated that was not allowed. This was reviewed with the RN Supervisor and RN Survey Readiness.

Observed in Record Review. In 2 of 14 patient records reviewed, it was noted by nurse surveyor that the medication profile in the patient's medical record did not reflect what the patient was taking. For RRHV#4, patient was taking Aspirin 81mg PO daily, the medication profile had Aspirin 325mg PO daily. In addition, medication profile indicated patient was taking Memantine, the patient's wife/primary caregiver reported he had stopped taking over one month prior. Findings discussed with RN clinical supervisor and RN survey readiness. For RRHV#2, patient was no longer utilizing dermal cleanser as there were no more wounds but it was still listed in the medication profile.

Observed in Patient Home. In 1 of 4 home visits conducted, it was noted by the nurse surveyor for RRHV#4, only one out of four oxygen tanks were secured. There was no documentation of education on oxygen safety. Finding was discussed with RN clinical supervisor and RN Survey readiness.

Observed in Patient Home. In 1 of 4 home visits conducted, it was noted by the nurse surveyor that for RRHV#3, the Hospice did not provide the nursing facility with the certificate of terminal illness, the election of benefit nor a current list of medications. When asked, they had no clear process to do so and had been told that it was not necessary. Findings were validated by the Clinical Supervisor who was on the visit and discussed with the Director of Clinical Services and the Regional Director of Survey Readiness.

It is required that hospice aides are assigned to a specific patient by a Registered Nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by joint clinical record review and interview. 2 of 11 (18%) applicable records in which an aide was accepted revealed the agency RN failed to provide specific instructions for the hospice aide. Record #74361: (start of care: 1/26/2018, Diagnosis: Chronic Obstructive Pulmonary Disease): The patient had a physician order, effective 11/20/2018, for continuous oxygen at 2-4 liters per nasal cannula. The hospice aide care plan (current aide care plan, effective 7/28/2021) did not indicate the patient was on oxygen or provide directions indicating if the aide could or could not remove it for care. The hospice aide visit frequency was three times per week, and the aide was assigned the task of giving the patient a bed bath with each visit. Record #32696: (start of care: 12/18/2021, Diagnosis: Multiple Myeloma): The patient had a physician order, effective 12/20/2021, for continuous oxygen at 2 liters per nasal cannula. The hospice aide care plan (current aide care plan, effective 12/18/2021) did not indicate the patient was on oxygen or provide directions indicating if the aide could or could not remove it for care. The hospice aide visit frequency was for two times per week, and the aide was assigned the task of showering the patient with each visit. During an interview with the Director of Clinical Services (completed on 1/26/2022 at 1500), she stated that the RN’s were supposed to be putting oxygen on the aide care plans. They should be specific regarding removing or not removing the oxygen for care.