Every finding on record at Helping Hands Hospice, Inc

Based on clinical record review and staff interview it was determined the hospice agency failed to ensure each patient had an individualized plan of care based on the patients' diagnosis and problems identified in the comprehensive assessment for two (2) of (11) clinical records in the survey sample (Clinical record #'s 3 and 5). --- The findings:Eleven (11) clinical records were reviewed in the agency on 11/29/2022 with read only access. Clinical records #12 and #13 were selected and reviewed for bereavement services only. 1. The clinical record for patient #3 was reviewed for the certification period of 11/14/2022 through 02/11/2023. The care plan contained a primary diagnosis of unspecified diastolic congestive heart failure. The SN (Skilled Nurse) comprehensive assessment documented the patient with an irregular heartbeat, bilateral lower extremities edema and cool extremities. In addition, the patient is taking an anticoagulant (medication that slows down the bodys process of making clots). The plan of care contained orders for weekly coagulation checks weekly. The plan of care failed to contain problems and other interventions related to cardiovascular. 2. The clinical record for patient #9 was reviewed for the recertification period of 10/17/2022 through 12/15/2022. The care plan contained a primary diagnosis of chronic obstructive pulmonary disease with acute exacerbation. The care plan contained DME (durable medical equipment) to include oxygen concentrator and oxygen portable tank. In addition, the medication list contained orders for oxygen 2 liters nasal cannula. The plan of care failed to contain problems and other interventions related to respiratory. The lack of ensuring specific interventions related to the patient's primary diagnosis was confirmed during record review by the Director of Nursing and again acknowledged during the exit conference by the Administrator on 11/30/2022.

Based on clinical record review and staff interview it was determined that the agency failed to specify the location for a port-a- cath (a port placed beneath the skin for access to a patient's vein for a prolonged period of time for medication use) for one (1) of one (1) clinical records with a port-a-cath reviewed in the survey sample: (Clinical record #7). --- The findings:Eleven (11) clinical records were reviewed in the agency on 11/29/2022 with read only access. Clinical records #12 and #13 were selected and reviewed for bereavement services only. The clinical record for patient #7 was reviewed for the time frame of 11/10/2022 to 02/07/2023. The plan of care contained an order that read as follows: "SN (Skilled Nurse) to provide sterile PAC (port-a-cath therapy that delivers fluid and medications directly into a vein) care as follows: Clean PAC with betadine and alcohol or Chloraprep type solution; access using sterile technique with non-coring needle; flush with 10 ml of normal saline followed by 5 ml of heparin". The plan of care order failed to specify the site for the IV access site. During the record review of 11/29/2022 the Director of Nursing acknowledged that the agency failed to include the location site of the port-a-cath, and again acknowledged the above noted findings with the Administrator during the exit conference on 11/30/2022.

Based on clinical record review and the agency staff interviews, it was determined the agency failed to ensure the hospice interdisciplinary group (IDG) revised each individualized plan of care as frequently as the patient's condition required in six (6) of (11) clinical records reviewed in the survey sample (Clinical record #s 1, 4, 5, 7, 10, and 11). --- The findings:Eleven (11) clinical records were reviewed in the agency on 11/29/2022 with read only access. Clinical records #12 and #13 were selected and reviewed for bereavement services only. The agency's IDG meetings consisted of the patient problems and outcomes toward goals. No discussions or coordination was documented in the meetings. 1. The clinical record for patient #1 was reviewed for the recertification period of 10/12/2022 through 12/22/2022. The clinical record contained SN (Skilled Nurse) notes of the patient exhibited pain on 11/16/2022 and ordered Tramadol 50 mg every 12 hours for pain indication. In addition, on 11/23/2022 the SN ordered Lorazepam 0.25 ml sublingual every 4 hours as needed for anxiety or agitation. On 11/29/2022 at 9:50 AM, this MFI (Medical Facilities Inspector) asked the Administrator where was the IDG discussion/narrative/coordination notes. The Administrator stated " The SN documents in their narratives but if they don't put it in the coordination plan (update to nursing care plan) then it does not pull over to the IDG meeting. The agency failed to revise the plans of care as needed to reflect the patient's condition in change of pain and agitation. 2. The clinical record for patient #4 was reviewed for the recertification period of 11/14/2022 through 01/22/2023. The clinical record contained SN (Skilled Nurse) notes of the patient exhibited red eyes with crusty yellow drainage on 11/14/2022 and ordered Polytrim ophthalmic solution for conjunctivitis. In addition, on 11/23/2022 the SN ordered an E kit (emergency comfort care kit that includes a small supply of medications to rapidly treat symptoms). The agency failed to revise the plans of care as needed to reflect the patient's condition in change of the patient's eyes and symptom management. 3. The clinical record for patient #5 was reviewed for the recertification period of 10/25/2022 through 01/22/2023. The clinical record contained SN (Skilled Nurse) notes of the patient with a burning sensation with urination on 10/25/2022 and ordered Augmentin 10 ml every 8 hours for a urinary tract infection on 11/01/2022. The IDG's problem list contained pain, neurological, and nutrition with progress toward these goals for the IDG meetings of 10/28/2022, 11/11/2022, and 11/25/2022 with no mention of the urinary tract infection. The agency failed to revise the plans of care as needed to reflect the patient's condition in change of urinary symptom. 4. The clinical record for patient #7 was reviewed for the recertification period of 11/10/2022 through 02/07/2023. The clinical record contained SN (Skilled Nurse) notes of the patient with increased anxiety on 11/18/2022 and ordered Lorazepam 0.25 ml sublingual every 4 hours as needed for anxiety or agitation. The IDG's problem list contained pain, cardiovascular, and nutrition with progress toward these goals for the IDG meetings of 11/11/2022, and 11/25/2022 with no mention of the agitation. The agency failed to revise the plans of care as needed to reflect the patient's condition in change of agitation. 5. The clinical record for patient #10 was reviewed for the certification period of 08/04/2022 through 11/10/2022. The clinical record contained SN (Skilled Nurse) notes of the patient with wounds upon admission to hospice, however on 08/16/2022 the SN documented multiple new wounds. On 09/12/2022 the clinical record contained SN notes of the patient with white patches on the tongue and Magic Mouth was was ordered. The IDG's problem list contained pain, cardiovascular, and respiratory with progress toward these goals for the IDG meetings of 08/19/2022, 09/02/2022 and 09/16/2022 with no mention of the multiple new wounds or tongue issue. On 11/29/2022 at 12:20 PM this MFI asked the Director of Nursing where are the discussion/coordination notes in the IDG meetings. The Director of Nursing stated, "It's not that we don't do it during IDG, we just didn't document it". The agency failed to revise the plans of care as needed to reflect the patient's condition in change of new wounds and tongue issues. 6. The clinical record for patient #11 was reviewed for the certification period of 08/01/2022 through 10/29/2022. The clinical record contained SN (Skilled Nurse) notes of the patient with a weeping rash under the stomach on 08/03/2022. In addition, the SN ordered the patient Augmentin 500 mg twice a day for urinary tract infection. On 09/12/2022 the clinical record contained SN notes of the patient with white patches on the tongue and Magic Mouth was was ordered. The IDG's problem list contained pain, personal care, and nutrition with progress toward these goals for the IDG meetings of 08/05/2022 and 08/19/2022 with no mention of the rash or urinary tract symptoms. The agency failed to revise the plans of care as needed to reflect the patient's condition in change of new rash and urinary symptom The Administrator and the Director of Nursing acknowledged these finding during the exit review of 11/30/2022.