Every finding on record at Helping Hands Hospice of South Carolina LLC

Based on record reviews and interview, the hospice failed to ensure a Registered Nurse individualized the patient Plan of Care (POC) through use of excessive Pro Re Nata (PRN) visits for 10 of 11 patient visit schedules. (Patient #1, #3, #4, #5, #6, #7, #8, #9, #10 and #11). The findings include: On 7/11/2022 at 1:55 PM, review of Patient #1's POC dated 4/21/2022 revealed Skilled Nursing (SN) visits 2 times a week for 13 weeks with 10 PRN visits. On 7/13/2022 at 1:55 PM, the Administrator revealed "It should not be that many. They (staff) know that." On 7/13/2022 at 11:05 AM, review of Patient #3's POC dated 5/19/2022 revealed SN visits 2 times a week for 10 weeks with 10 PRN visits. On 7/13/2022 at 2:52 PM, the Administrator revealed "It should not be that many. They (staff) know that." On 7/13/2022 at 10:27 AM, review of Patient #4's POC dated 7/1/2022 revealed SN visits 1 week 1, 2 times a week for 8 weeks 1 week 1 with 8 PRN visits. On 7/13/2022 at 2:42 PM, the Administrator revealed "It should not be that many. They (staff) know that." On 7/13/2022 at 9:50 AM, review of Patient #5's POC dated 5/18/2022 revealed SN visits 2 times a week for 13 weeks with 10 PRN visits. On 7/13/2022 at 2:27 PM, the Administrator revealed "It should not be that many. They (staff) know that." On 7/13/2022 at 9:26 AM, review of Patient #6's POC dated 7/1/2022 revealed SN visits 3 week 1, 2 times a week for 12 weeks with 8 PRN visits. On 7/13/2022 at 2:22 PM, the Administrator revealed "It should not be that many. They (staff) know that." On 7/13/2022 at 9:01 AM, review of Patient #7's POC dated 6/19/2022 revealed SN visits 1 time a week for 9 weeks with 9 PRN visits. On 7/13/2022 at 1:07 PM, the Administrator revealed "It should not be that many. They (staff) know that." On 7/13/2022 at 8:41 AM, review of Patient #8's POC dated 6/28/2022 revealed SN visits 1 time a week for 9 weeks with 10 PRN visits. On 7/13/2022 at 1:51 PM, the Administrator revealed "It should not be that many. They (staff) know that." On 7/11/2022 at 11:08 AM, review of Patient #9's POC dated 1/22/2022 revealed SN visits 2 times a week for 3 months with 7 PRN visits. On 7/13/2022 at 3:02 PM, the Administrator revealed "It should not be that many. They (staff) know that." On 7/12/2022 at 1:49 PM, review of Patient #10's POC dated 2/18/2022 revealed SN visits 1 week 1, 2 times a week for 12 weeks 2 week 1 with 10 PRN visits. On 7/13/2022 at 2:53 PM, the Administrator revealed "It should not be that many. They (staff) know that." On 7/12/2022 at 2:31 PM, review of Patient #11's POC dated 2/3/2022 revealed SN visits 1 week 1, 3 week 1,2 times a week for 11 weeks with 8 PRN visits. On 7/13/2022 at 3:17 PM, the Administrator revealed "It should not be that many. They (staff) know that."

Based on record reviews and interview, the hospice staff failed to update, revise, and maintain an accurate individualized Plan of Care (POC) for 7 of 11 patients. (Patient #1, #3, #4, #5, #6, #7 and #8) The findings include: Patient #1 On 5/16/2022 at 11:59 AM, review of Patient #1's POC dated 4/21/2022-7/20/2022 by the Registered Nurse (RN) dated 4/19/2022 revealed target dates for Goal: Pain Management had no update for the patient's present episode and Maintain clean, safe environment by Hospice Aide had no update for the patient's current episode. On 7/13/2022 at 11:05 AM, review of Patient #3's POC dated 5/19/2022 to 7/17/2022 revealed target dates for Goal: Pain Management by Interdisciplinary Team (IDT) dated 3/19/2022 and Maintain clean, safe environment by Hospice aide dated 3/19/2022 had no updates for the patient's current episode. On 7/13/2022 at 10:27 AM, review of Patient #4's POC dated 7/1/2022 to 8/29/2022 revealed target dates for Medical Social Worker (MSW) goals for Patient/caregiver relief from anxiety dated 10/03/2022 which was past the end date of this episode. On 7/13/2022 at 9:50 AM, review of Patient #5's POC dated 5/18/2022 to 8/15/2022 revealed Hospice Aide: Promote Skin integrity, promote safe personal hygiene with target date of 5/17/2022. Skilled nurse: Patient/family will express satisfactory control of symptoms target date 5/17/2022. Chaplin: Patient/caregiver will demonstrate adequate coping skills regarding loss target date of 8/23/2022 which was past the date of this episode. On 7/13/2022 at 9:26 AM, review of Patient #6's POC dated 7/01/2022 to 9/28/2022 revealed Hospice Aide: Maintain clean, safe environment with target date of 10/01/2022, IDT: Maintenance of respiratory baselines as evidenced by breathing at optimal level within disease parameters dated 10/02/2022 that were past the end date of this episode. On 7/13/2022 at 9:01 AM, review of Patient #7's POC dated 6/19/2022 to 8/17/2022 revealed Skilled Nurse: Patient will demonstrate understanding of appropriate use of meds(medications) for pain management target date 9/17/2022 which was past the end date of this episode. Hospice Aide: Maintain safe, clean environment target date 2/18/2022 had not been updated with current episode. On 7/13/2022 at 8:41 AM, review of Patient #8's POC dated 6/28/2022 to 8/26/2022 revealed Hospice Aide: Maintain safe, clean environment target date 3/29/2022, MSW: Family/caregiver with acknowledge support from hospice team with two target dates of 3/02/2022 and 4/16/2022, Skilled Nurse: Patient will demonstrate understanding of appropriate use of meds for pain management target date 3/29/2022, and Chaplin: Patient will achieve spiritual comfort target date 9/24/2022 which was past the end date of the current episode. On 7/13/2022 at 1:07 PM to 2:52 PM, in an interview and record review with the Administrator, he/she reported "They should be changing the target dates with each episode. We need to do some education."

Based on observations and interview, two of two Registered Nurses (RN) failed to sanitize electronic devices and retractable tape measures after patient use. (RN #1 and RN #2) The findings include: Home observation visit for Patient #1 on 7/11/2022 from 12:25 PM to 1:20 PM revealed RN #1 failed to sanitize the electronic device used for charting and the retractable tape measure after patient use. On 7/11/2022 at 1:15 PM, RN #1 verified the findings. Home observation visit for Patient #2 on 7/12/2022 from 9:56 AM to 10:42 AM revealed RN #2 failed to sanitize the electronic device used for charting and the retractable tape measure after patient use. On 7/12/2022 at 10:40 AM, RN #2 verified the findings.

Based on review of the hospice personnel file and interview, the hospice failed to provide its Bereavement Coordinator with training specific to grief and loss. The finding includes: On 7/13/2022 at 12:41 PM, the hospice's Bereavement Counselor revealed he/she started employment in October 2022. The Bereavement Counselor stated, "I worked in the hospital as a Chaplin. I not have had any training from the hospice related to bereavement. I just do what they tell me to do." On 7/14/2022 at 8:48 AM, review of the Bereavement Counselor's personnel file revealed no training specific to grief or loss.

Based on record reviews and interview, the hospice failed to provide documentation of follow through for 1 of 11 patient's choice for spiritual counseling. (Patient #11) The finding includes: On 7/12/2022 at 2:31 PM, review of Patient #11's chart revealed a Chaplin assessment visit on 2/3/2022. Patient #11 requested Rabbi visits. There was no documentation in Patient 11's record that the patient was visited by a rabbi. On 7/13/2022 at 3:17 PM, the Administrator reported "I'm sure we got one. She (Chaplin) didn't document it."

Based on observations, record reviews, and interview, the hospice Registered Nurse (RN) failed to prepare written patient specific care instructions for the Hospice Aide for 11 of 11 patients receiving aide services. (Patient #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, and #11) The findings include: On 7/11/2022 at 1:55 PM, review of Patient #1's Plan of Care (POC) dated 4/21/2022 revealed Hospice Aide(HA) instructions: Elimination " ...give SSE (Soap Suds Enema) as directed by RN. SSE task is not within the scope of practice for HAs. Hygiene: "shave" and "shave safety razor". Patient #1 was observed with a a full beard. The instructions on the POC did not indicate the frequency for all tasks assigned. On 7/13/2022 at 10:45 AM, review of Patient #2's Plan of Care (POC) dated 6/24/2022 revealed HA instruction: Elimination " ...give SSE as directed by RN. SSE task is not within the scope of practice for HAs. Hygiene: "Bath: Bed, Bath: Complete, Bath: Shower, Bath: Shower Chair". The POC did not indicate the frequency for all tasks assigned. On 7/13/2022 at 11:05 AM, review of Patient #3's Plan of Care (POC) dated 5/19/2022 revealed HA instruction: Elimination " ...give SSE as directed by RN. SSE task is not within the scope of practice for HAs. The POC did not indicate the frequency for all tasks assigned. On 7/13/2022 at 10:27 AM, review of Patient #4's Plan of Care (POC) dated 7/1/2022 revealed HA instruction: Elimination " ...give SSE as directed by RN. SSE task is not within the scope of practice for HAs. Hygiene: "Bath: Bed, Bath: Complete, Bath: Shower, Bath: Shower Chair". The POC did not indicate the frequency for all tasks assigned. On 7/13/2022 at 9:50 AM, review of Patient #5's Plan of Care (POC) dated 5/18/2022 revealed HA instruction: Elimination " ...give SSE as directed by RN. SSE task is not within the scope of practice for HAs. The POC did not indicate the frequency for all tasks assigned. On 7/13/2022 at 9:26 AM, review of Patient #6's Plan of Care (POC) dated 7/01/2022 revealed HA instruction: Elimination " ...give SSE as directed by RN. SSE task is not within the scope of practice for HAs. Hygiene: "Bath: Complete, Bath: Shower, Bath: Shower Chair". The POC did not indicate the frequency for all tasks assigned. On 7/13/2022 at 9:01 AM, review of Patient #7's Plan of Care (POC) dated 6/19/2022 revealed HA instruction: Elimination " ...give SSE as directed by RN. SSE task is not within the scope of practice for HAs. The POC did not indicate the frequency for all tasks assigned. On 7/13/2022 at 8:41 AM, review of Patient #8's Plan of Care (POC) dated 6/28/2022 revealed HA instruction: Elimination " ...give SSE as directed by RN. SSE task is not within the scope of practice for HAs. The POC did not indicate the frequency for all tasks assigned. On 7/11/2022 at 11:08 AM, review of Patient #9's Plan of Care (POC) dated 1/22/2022 revealed HA instruction: Elimination " ...give SSE as directed by RN. SSE task is not within the scope of practice for HAs. The POC did not indicate the frequency for all tasks assigned. Patient #9 expired on 3/9/2022. On 7/12/2022 at 1:49 PM, review of Patient #10's Plan of Care (POC) dated 2/18/2022 revealed HA instruction: Elimination " ...give SSE as directed by RN. SSE task is not within the scope of practice for HAs. The POC did not indicate the frequency for all tasks assigned. Patient #10 expired on 5/17/2022. On 7/12/2022 at 2:31 PM, review of Patient #11's Plan of Care (POC) dated 2/03/2022 revealed HA instruction: Elimination " ...give SSE as directed by RN. SSE task is not within the scope of practice for HAs. The POC did not indicate the frequency for all tasks assigned. Patient #11 was discharged on 5/03/2022 as no longer hospice appropriate. On 7/13/2022 from 1:07 PM until 3:17 PM, the Administrator verified the findings and stated, "We should have used a frequency for the instructions".

Based on observations, record reviews, and interview, the Hospice Aide (HA) failed to provide documentation of services included in the patient's Plan of Care (POC) for 6 of 11 applicable patients. (Patient #3, #5, #6, #7, #8 and #10) The findings include: On 7/13/2022 at 11:05 AM, review of Patient #3's Plan of Care (POC) dated 5/19/2022 revealed HA instructions: Hygiene: Bath, Shower Chair; Hygiene: Shampoo, Hygiene: Shave, safety razor, Safety: Oxygen Precautions, Home Management: Change patient linen, make bed. Observation visit on 7/12/2022 at 11:07 AM revealed HA performing Bed Bath, but no shampoo, shave, or change of bed linen was completed. Patient's daughter reported no oxygen in the house. No documentation evidence of refusal or communication with Registered Nurse (RN) to change the patient's POC for this visit. Interview with the Administrator on 7/13/2022 at 2:42 PM, the Administrator reported "They should be calling the nurse with updates." On 7/13/2022 at 9:50 AM, review of Patient #5's Plan of Care (POC) dated 5/18/2022 revealed HA instruction: Elimination: Incontinent Care, Home Management: Change patient linen, make patient bed, Hygiene: Bath, Perineal care, shampoo. Review of the HA visit note dated 5/26/2022 revealed "Interventions: Safety/Fall Precaution DONE, Elimination: Assist to Commode DONE, Hygiene: Encourage to wear glasses/hearing aid DONE. No evidence of refusal or communication with RN to change the patient's POC for this visit. On 7/13/2022 at 2:27 PM, the Administrator reported "They should be calling the nurse with updates." On 7/13/2022 at 9:26 AM, review of Patient #6's Plan of Care (POC) dated 7/01/2022 revealed HA instruction: Hygiene: Bath, Complete, Bath, Shower, Bath, Shower Chair. Review of the HA visit note dated 7/26/2022 revealed "Interventions: Hygiene, Bath, Shower DONE. Review of the HA narrative note dated 7/6/2022 revealed "Refusing to shower." There was no evidence of refusal or communication with RN to change the patient's POC for this visit. On 7/13/2022 at 2:22 PM, the Administrator reported, "That is odd. She may have hit the wrong button." On 7/13/2022 at 9:01 AM, review of Patient #7's Plan of Care (POC) dated 6/19/2022 revealed HA instruction: Hygiene Bath: Shower chair, Shampoo. Review of the HA's narrative note dated 6/23/2022 had no documentation for bath or shampoo performed or refused. There was no documentation of communication with the RN to change the POC for this visit. During an interview on 7/13/2022 at 1:07 PM, the Administrator reported "They should be calling the nurse with updates." On 7/13/2022 at 8:41 AM, review of Patient #8's chart revealed HA visit note for 6/28/2022 showed"Patient not feeling well. No care wanted. She just wanted to talk and rest." There was no evidence of communication with the RN to report patient condition. Interview on 7/13/2022 at 1:51 PM with Administrator, the Administrator reported "They should be calling the nurse with updates." On 7/12/2022 at 1:49 PM, review of Patient #10's Plan of Care (POC) dated 2/18/2022 revealed HA instruction: Hygiene: Bath, shower chair. Review of the HA visit note dated 5/03/2022 showed "Intervention: Activity, Ambulate only with assistance. Review of the HA's narrative note revealed "Changed client linen and spent time with patient." There was no evidence of communication with the RN to report patient condition. Review of the HA visit note dated 5/09/2022 revealed Intervention: Hygiene: Bath, shower chair DONE. Review of the HA's narrative note revealed "Complete bed bath and dressed patient." There was no evidence of communication with RN to report patient condition. Interview on 7/13/2022 at 2:53 PM, Administrator reports "they should be calling the nurse with updates".

Based on record reviews and interview, the Hospice staff failed to assess 3 of 11 patients for volunteers at the patient's Start of Care (SOC). (Patient #2, #4 and #10) The finding includes: On 7/13/2022 at 10:45 AM, review of Patient #2's chart revealed no documentation the patient was offered a volunteer at the patient's SOC on 6/24/2022. On 7/14/2022 at 8:35 AM, the Administrator confirmed the finding. On 7/13/2022 at 10:27 AM, review of Patient #4's chart revealed no documentation the patient was offered a volunteer at the patient's SOC on 7/1/2022. On 7/14/2022 at 8:35 AM, the Administrator confirmed the finding. On 7/12/2022 at 1:49 PM, review of Patient #10's chart revealed no documentation the patient was offered a volunteer at the patient's SOC on 2/18/2022. On 7/14/2022 at 8:35 AM, the Administrator confirmed the finding.