Every finding on record at Heart 2 Heart Hospice Care, Inc.

Observed in Tracer Activities. The hospice had not defined when more in-depth assessments should be performed. In the chart for RRNHV#7, the patient was identified during the course of care to have mild to moderate depression and had an antidepressant ordered. It was confirmed with the QAPI Nurse that the organization had not defined when a more in-depth assessment of depression severity should be performed.

Observed in Record Review. In 2 of 14 patient records reviewed, the written plan of care was not based on the patient’s goals and the time frames, settings, and services required to meet those goals. In the chart for RRNHV#5, for the problem of family lacks coping skills, the goal of MSW will provide support to Pt and PCG to express feelings and emotions. is not a goal, rather an intervention. In the chart for RRNHV#8, the primary caregivers are monitoring the patient's blood sugars. There is no goal on the plan of care. This was discussed with the DPCS.

Observed in Record Review. In 3 of 14 patient records reviewed, the hospice plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions. In the chart for RRNHV#4, the nursing staff was documenting the patient's blood sugars. This treatment was not included on the hospice plan of care. In the chart for RRNHV#8, nursing notes that family is monitoring blood sugars. this is not on the plan of care. In the chart for RRNHV#7 the medication orders were unclear as there are two medications ordered q 6 hours prn for moderate pain with no further clarification for when to administer which medication. This was discussed with the DPCS.

Observed in Record Review. In 1 of 14 patient records reviewed, the plan of care revisions did not address the patient's progress toward goals. In the chart for RRNHV#8, the goal of no aspiration during the current benefit period has a target date of the last day of two benefit periods ago. The goal of oxygen saturation of 92% during the current benefit period has a target date more than 6 months prior to the date of the survey. This was discussed with the DPCS.

Observed in Record Review. In 1 of 14 patient records reviewed, the organization had not provided the patient with care, treatment, or services according to the patient's individualized plan of care. In the chart for RRNHV#5, the LVN documented the patient is using oxygen at 9-10 liters/minute. The order for oxygen is only up to 5 liters/minute. This was discussed with the DPCS.

Observed in Record Review. In 2 of 2 patient records reviewed, the hospice had not developed a bereavement plan of care that specified the type of bereavement services to be offered and the frequency of service delivery. In the charts for RRBR#13 and RRBR#14, the bereavement plan of care did not include the frequency of service delivery and simply stated Bereavement Letters / Material through out the first year. This was discussed with the DPCS and QAPI nurse.

Observed in HR File Review. In 1 of 1 HR files reviewed, the hospice aide competency evaluation did not include the following skills: appropriate and safe techniques in personal hygiene that included a shower bath. In the record for HR#3, there was no documented observation of a shower bath upon hire. It was confirmed with the Administrator that the aide had performed a shower bath on a hospice patient.

Observed in Record Review. In 3 of 13 patient records reviewed, in which aide services were ordered, the registered nurse who is a member of the interdisciplinary group and is responsible for hospice aide supervision had not prepared accurate written patient care instructions for the hospice aide. In the chart for RRHV#1, the aide assignment sheet instructed the aide to provide a shower with a chair. The patient's plan of care ordered the patient to be bed bound. In the chart for RRNHV#6, the patient is non-ambulatory yet the aide assignment is for a shower twice weekly with no adaptive equipment, like a shower chair. In the chart for RRNHV#9, the Aide plan of care had not been updated. In the most recent IDG meeting, the notes indicated the patient is now completely bed bound. The aide assignment indicated a shower was to be provided and had not been updated since the admission approximately 11 months prior to the survey. The aide continues to document that a shower is provided.This was discussed with the DPCS.

Observed in Record Review. In 3 of 14 patient records reviewed, the patient record did not contain information that reflected the patient's care, treatment or services. In the chart for RRNHV#5, the current medication list in the electronic medical record had not been updated. The list included Levaquin for seven days which was started more than six weeks prior to the survey. In the chart for RRNHV#7, there was a nursing visit note for a visit conducted 8 calendar days prior to the day of review without any documentation in the note. In the chart for RRNHV#9 there is a RN visit performed 6 calendar days prior to the day of review which included no documentation. Organizational policy required that clinical documentation must be submitted within 3 business days. This was discussed with the DPCS.