Every finding on record at Heart of Hospice of New Orleans, LLC

Based on record review and interview the agency failed to: 1. Ensure the skilled nurse provided care per the frequency in the plan of care (Patient #1 and Patient #12); and 2. Ensure the hospice aide provided care per the frequency in the plan of care (Patient #17 and Patient #19). This deficient practice was identified for 4 (Patient #1, Patient #12, Patient #17, and Patient #19) of 20 (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, Patient #14, Patient #15, Patient #16, Patient #17, Patient #18, Patient #19, and Patient #20) sampled patients reviewed for care and services per the plan of care. Findings: --- Patient #1 Review of Patient #1s Hospice Certification and Plan of Care for certification period of 01/19/2024 to 04/17/2024 revealed Patient #1 was to receive skilled nursing services once a week. Review of Patient #1s record revealed no documented evidence and the agency presented no documented evidence Patient #1 had received a skilled nurse visit the week or 02/04/2024 to 02/10/2024. Review of Patient #1s Physician Order dated 03/26/2024 revealed to increase skilled nurse visits to daily for three days due to signs of symptoms of a decline. Review of Patient #1s record revealed no documented evidence and the agency presented no documented evidence the skilled nurse visits were made on 03/27/2024 and 03/28/2024. In an interview on 04/12/2024 at 3:57 p.m., S1Director of Patient Care (DPC) indicated the agency had no documented evidence a skilled nurse had made a visit or documented a missed visit the week of 02/04/2024 to 02/10/2024, and/or visits made on 03/27/2024 and 03/28/2024. Patient #12 Review of Patient #12s Hospice Certification and Plan of Care for certification period of 02/11/2024 to 04/10/2024 revealed Patient #12 was to receive skilled nursing services twice a week for eight weeks. Review of Patient #12s record revealed no documented evidence and the agency presented no documented evidence skilled nurse visits were made the week of 02/18/2024 to 02/24/2024. Further review revealed the week 03/31/2024 to 04/06/2024) Patient #12 only received skilled nursing services on 04/04/2024. In an interview on 04/12/2024 at 4:01p.m., S1DPC indicated the agency had no documented evidence skilled nursing visits were completed per the plan of care. Patient #17 Review of Patient #17s Hospice Certification and Plan of Care for certification period of 06/28/2023 to 07/16/2023 revealed, in part, hospice aide to provide services twice a week effective 07/02/2023. Review of Patient #17s record revealed no documented evidence and the agency presented no documented evidence hospice aide visits were conducted the week of 07/02/2023 to 07/08/2023. In an interview on 04/12/2024 at 5:36 p.m., S1DPC indicated the agency had no documented evidence the hospice aide visits were conducted the week of 07/02/2023 to 07/08/2023 per the plan of care. Patient #19 Review of Patient #19s Hospice Certification and Plan of Care for certification period of 04/05/2023 to 05/27/2023 revealed Patient #19 was to receive hospice aide services once a week for one week then twice a week for the rest of the certification period. Review of Patient #19s record revealed the week of 04/09/2023 to 04/15/2023 only one hospice aide visit was made of 04/14/2023; and the week of 04/23/2023 to 04/29/2023 only one missed visit was documented on 04/28/2023 and no visits were made. In an interview on 04/12/2024 at 5:43 p.m., S1DPC indicated the agency had no documented evidence Patient #19s hospice aide visits were conducted per the plan of care for the weeks mentioned above.

Based on observation, record review, and interview, the agency failed to ensure the registered nurse followed infection control standards during wound care for 1 (Patient #20) of 2 (Patient #3 and Patient #20) sampled patients observed for wound care. Findings: --- Review of Patient #20s Hospice Certification and Plan of Care for the certification period of 03/20/2024 to 06/17/2024 revealed, in part, cleanse wounds to numerous sites daily with wound cleanser using aseptic technique, paint with betadine daily, and cover moist wounds with dressing. Further review revealed for finger amputations, apply xeroform (dressing used to promote wound healing) over suture lines and cover with gauze. Observation on 04/12/2024 at 9:28 a.m. revealed S2Registered Nurse (RN) washed his hands and applied two gloves to his right hand and one to his left hand. S2RN then used uncontained bandage scissors he retrieved from the top drawer of Patient #20s bedside table, to cut off the bandages to Patient #20s left and right hand. S2RN then, without removing his gloves, reached under his isolation gown into his shirt pocket and removed his cell phone. S2RN then, without removing his gloves or performing hand hygiene, removed Patient #20s left thumb bandage. With the same pair of gloves, S2RN then repositioned his eyeglasses and proceeded to clean the wounds to Patient #20s right and then left hand without changing gloves in between wounds. S2RN then placed the soiled bandage scissor directly on Patient #20s bed linen. S2RN then, without removing his gloves, grabbed his chair and pulled the chair closer to the bed. S2RN then dressed Patient #20s left and right hand amputation sites. S2RN did not remove his gloves or perform hand hygiene until the wounds to both Patient #20s left and right hands had been dressed and the soiled dressings had been disposed of. In an interview on 04/12/2024 at 11:20 a.m., S2RN confirmed the above findings and indicated the above observations were breaches in infection control guidelines. In an interview on 04/12/2024 at 11:31 a.m., S1Director of Patient Care (DPC) indicated the above mentioned observations during Patient #20s home visit were breaches in infection control practices.

Based on record review and interview, the agency failed to ensure the nurse measured the patients wounds weekly to monitor wound status for 3 (Patient #14, Patient #15, and Patient #17) of 5 (Patient #3, Patient #14, Patient #15, Patient #17, and Patient #20) sampled patients with wounds reviewed for weekly wound assessments. 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 #14 Review of Patient #14s Hospice Certification and Plan of Care for certification period of 02/26/2024 to 04/25/2024 revealed, in part, cleanse wounds to multiple decubiti, apply dressing, and change daily. Further review revealed Patient #14 was to receive skill nursing services three times a week for the first week then twice a week thereafter. Review of Patient #14s Wound Record Report revealed Patient #14 had the following wounds: unstageable (wound with tissue that obscures the base of the wound) pressure ulcer to the right shoulder; unstageable pressure ulcer to the left greater trochanter (area near the thigh bone); unstageable pressure ulcer to the right greater trochanter; unstageable pressure ulcer to the left shoulder; unstageable pressure ulcer to the left second toe; unstageable pressure ulcer to the left lower buttock; unstageable pressure ulcer to the right lower buttock; unstageable pressure ulcer to the left upper buttock; unstageable pressure ulcer to the right upper buttock; stage III (wound that is into the fat tissue) pressure ulcer to the right ear; unstageable pressure ulcer to the right flank (wound on the backside area); stage III pressure ulcer to the left ear; and unstageable pressure ulcer to the left ankle. There was no documented evidence and the agency did not present any documented evidence that wound care measurements were completed for the time period of 02/26/2024 to 04/10/2024 other than on 02/27/2024. In an interview on 04/12/2024 at 5:08 p.m., S1Diretor of Patient Care (DPC) indicated the agency did not have documented evidence Patient #14s wounds had been measured weekly. Patient #15 Review of Patient #15s Hospice certification and Plan of Care for certification period of 02/08/2024 to 03/04/2024 revealed Patient #15 was to receive skilled nursing services twice a week. Further review revealed Patient #15s facility staff was to perform wound care to multiple decubitus ulcers according to a coordinated plan of care. Review of Patient #15s Wound Record Report for certification period of 02/08/2024 to 03/04/2024 revealed Patient #15 had the following wounds, in part: unstageable pressure ulcer to the left proximal pretibial area (lower leg); unstageable pressure ulcer to the right distal pretibial area; stage III pressure ulcer to the sacrum (area of above the buttock); unstageable pressure ulcer to the left posterior heel; unstageable pressure ulcer to the right posterior heel; and unstageable pressure ulcer to the posterior right upper back. Further review revealed no documented evidence and the agency presented no documented evidence of wound care measurement had been obtained by the hospice nurse. In an interview on 04/12/2024 at 5:20pm, S1DPC indicated the agency did not have any wound care measurements documented and did not have documentation of coordinating with Patient #15s nursing facility to assess the wound. Patient #17 Review of Patient #17s Hospice Certification and Plan of Care for certification period of 06/28/2023 to 07/16/2023 revealed Patient #17 was to receive skilled nursing services twice a week for Patient #17s stage II (wound where the first layer of skin is open) sacral pressure ulcer. Review of Patient #17s Wound Record Report revealed no documented evidence and the agency presented no documented evidence of Patient #17s pressure ulcer to the sacrum had been measured weekly. In an interview on 04/12/2024 at 5:36 p.m., S1DPC indicated the agency had no documented evidence to present that Patient #17s sacral wound had been measured weekly.

Based on record review and interview the agency failed to ensure the registered nurse made an on-site visit every 14 days to supervise the hospice aide for 5 (Patient #1, Patient #3, Patient #12, Patient #14, and Patient #19) of 14 (Patient #1, Patient #2, Patient #3, Patient #7, Patient #8, Patient #10, Patient #12, Patient #13, Patient #14, Patient #15, Patient #16, Patient #17, Patient #19, and Patient #20) sampled patients with hospice aide services reviewed for supervisory visit. Findings: --- Patient #1 Review of Patient #1s Hospice Certification and Plan of Care for certification period of 01/19/2024 to 04/17/2024 revealed Patient #1 was to receive hospice aide services three times a week effective the week of 01/21/2024. Review of Patient #1s record revealed Patient #1 started receiving hospice aide services per the plan of care the week of 01/21/2024; however, the record revealed no documented evidence and the provider presented no documented evidence the registered nurse had completed any hospice aide supervisory visits during the certification period. In an interview on 04/12/2024 at 3:57 p.m., S1Director of Patient Care (DPC) indicated the agency did not have documentation of supervisory visits for hospice aides for the certification period of 01/19/2024 to 04/17/2024. Patient #3 Review of Patient #3s Hospice Certification and Plan of Care for certification period of 03/05/2024 to 05/03/2024 revealed Patient #3 was to receive hospice aide services once a week for one week, then twice a week for eight weeks. Review of Patient #3s record revealed Patient #3 received hospice aide services on 03/19/2024, 03/22/2024, 03/26/2024, 03/29/2024, 04/02/2024, and 04/05/2024. Further review revealed Patient #3 did not have a hospice aide supervisory visit conducted from 03/19/2024 through 04/04/2024. In an interview on 04/12/2024 at 4:10 p.m., S1DPC indicated hospice aide supervisory visits were not completed as required every 14 days. Patient #12 Review of Patient #12s Hospice Certification and Plan of Care for certification period of 02/11/2024 to 04/10/2024 revealed Patient #12 was to receive hospice aide services three times a week for eight weeks then once a week for one week. Review of Patient #12s record revealed Patient #12 received hospice aide services per the plan of care. Further review revealed Patient #12 did not receive a hospice aide supervisory visit for the time period of 02/12/2024 through 03/07/2024 and for the time period of 03/19/2024 through 04/10/2024. In an interview on 04/12/2024 at 4:10 p.m., S1DPC indicated hospice aide supervisory visits were completed as required. Patient #14 Review of Patient #14s Hospice Certification and Plan of Care for certification period of 02/16/2024 to 04/25/2024 revealed Patient #14 was to receive hospice aide services once a week for one week, then twice a week. Review of Patient #14s record revealed Patient #14 did not receive a hospice aide supervisory visit for the time period of 03/18/2024 through 04/04/2024. In an interview on 04/12/2024 at 5:08 p.m., S1DPC indicated Patient #14 did not receive hospice aide supervisory visits every 14 days as required. Patient #19 Review of Patient #19s Hospice Certification and Plan of Care for certification period of 04/05/2023 to 05/27/2023 revealed Patient #19 was to receive hospice aide services one a week for one week, then twice a week thereafter. Review of Patient #19s record revealed Patient #19 started receiving hospice aide services on 04/07/202; however, Patient #19 never received a hospice aide supervisory visit by a registered nurse. In an interview on 04/12/2024 at 5:43 p.m., S1DPC indicated Patient #19 did not receive hospice aide supervisory visits as required.

Based on observation, record review, and interview the agency failed to ensure the registered nurse (RN) changed her gloves between dirty and clean procedures for wound care for 1 (S1RN) of 1 nurses observed during wound care. Findings: --- Review of Patient #5s Physician Order dated 09/26/2022 revealed the skilled nurse was to cleanse Patient #5s right lower extremity stage 2 wound with wound cleanser, pat the wound dry, then swab the wound with betadine and cover with foam dressing twice a week and as needed. Observation on 09/29/2022 at 8:56am, revealed S1RN removed Patient #5s soiled bandage to the right lower extremity, cleaned Patient #5s wound, and applied a new bandage and did not change gloves. In an interview on 09/29/2022 at 9:10am, S1RN stated she should have changed her gloves between the dirty and clean wound care procedures, and confirmed she did not change her gloves during the wound care procedure.