Every finding on record at Healthaccess, Inc

Observed in Tracer Visit. In 1 out of 2 records, the organization did not conduct and document patient-specific reassessments that identified the patient’s need for hospice care and services. Example: In RRHV#1, the comprehensive reassessment for benefit period 3 did not include an accurate skin integrity assessment. The reassessment did not include the presence of a lower extremity wound noted within the physician's recertification notes and orders. Also within RRHV#1, wound measurements were not completed weekly per policy during weeks 1 and 2 of the third benefit period. This was confirmed with the Manager of Patient Care.

Observed in Tracer Visit. In 1 out of 2 records, the organization did not provide the patient with services according to the patient's individualized plan of care. Example: In RRHV#1, there was a missed chaplain visit during the month of August. Also in RRHV#1, there was 1 missed aide visit during the 10th week of benefit period 2. This was confirmed with the Manager of Patient Care.

Observed in Tracer Activities. Volunteer staff did not provide day-to-day administrative or direct patient care in an amount that equaled 5% of the total patient care hours of all paid hospice employees and contract staff. Example: YTD average .52%. Total number of active volunteers is 1. This was confirmed by the Volunteer Coordinator.

Observed in Tracer Visit. In 1 out of 3 home visits, the medication profile within the medical record was inaccurate. Example: In RRHV#3, the medication profile within the medical record did not have the following medication updates which were written in on the medication list within the home by the RN or reported by the primary caregiver: Cefalexin 250 mg tablet every day and Tylenol PM half a tablet every night. This was confirmed by the RN making the home visit.

Observed in Record Review. In 1 out of 2 discharges, the hospice did not provide the patient’s attending physician with a copy of the hospice discharge summary and, if requested, a copy of the patient’s clinical record. Example: In RRDC#1 where the patient revoked hospice services, the attending physician was not sent a copy of the hospice discharge summary. This was confirmed by the Manager of Patient Care.

Observed in Record Review. In 1 out 2 discharges/transfers, the organization did not inform the other service providers who will provide care, treatment, or services to the patient about the following: The reason for the patient’s discharge or transfer; A summary of care, treatment; or services it provided to the patient; and the patient’s progress toward goals. Example: In RRDC#2, the organization did not provide the receiving facility a transfer summary. This was confirmed by the Manager of Patient Care.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization did not plan the patient's care by ensuring the written plan of care was based on the patient's goals and the time frames, settings, and services required to meet the goals. In HOS HV#2, all of the skilled nursing goals were dated to be achieved by the end of the 90 day certification period. In HOS RR#5, the plan of care goals lacked time frames. This was reviewed and verified with the Manager of Patient Services.

Observed in Record Review. In 2 of 11 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including medications and treatment necessary to meet the patient's needs. In HOS RR#1, the patient's plan of care included Sodium Phosphates Fleets Enema as needed for constipation and Bisacodyl 10mg rectal suppository prn for constipation. There was no frequency of administration, and no clear indication for use (which prn medication to take when) included in the plan of care/orders. In HOS RR#4, for a two week period following the patient's admission to hospice from home health, there was no order in the plan of care for the wound care performed on the patient's sacral pressure wound. This was reviewed and verified with the Manager of Patient Services.

Observed in HR File Review. In 1 of 7 HR files reviewed, for the hospice staff, competence was not assessed and documented every three years, or as required by organization policy. In HR#7, there was no documentation of competencies in the last three years for the contracted Hospice Medical Director. This was reviewed and verified with the Administrator.

Observed in Record Review. In 1 of 2 hospice discharge/death records reveiwed, the organization did not ensure authorized staff documented in the patient record that the written policies and procedure for managing/disposing of controlled medications was provided and discussed. In HOS RR#5, it was noted the patient was admitted to hospice on MS Contin, and the policy for controlled medication disposal was provided to the patient/family in the Patient Admission Handbook. There was no documentation by the skilled nurse of the discussion/education regarding controlled medication disposal with the family following the patient's death less than 24 hours of admission to hospice. This was reviewed with the Manager of Patient Services.

Observed in HR File Review. In 1 of 12 HR files reviewed, the organization had not obtained a criminal background check on the applicant as required by law and regulation. A criminal background check was not documented in the file for HHRN#1 who also sees hospice patients for the organization. This was verified with the Administrator.