Every finding on record at Hestia Hospice & Family Care, LLC

Observed in HR File Review. In 2 of 11 HR files reviewed, ongoing education in emergency management training was not provided every 2 years in personnel file records HR#5 MSW, and HR#9 NP. This RFI was reviewed with and verified by the Hospice Director and Clinical Director.

Observed in Record Review. In 1 of 2 live discharge records reiviewed, the organization failed to provide services in accordance with licensure requirements, laws, and rules and regulations. In record RRDC#2 the patient was discharged for cause, but was not notified of the discharge in writing. This RFI was reviewed with and verified by the Hospice Director and Clinical Director.

Observed in Record Review. In 7 of 10 active patient records reviewed where oxygen was present, safety risk was not assessed as part of the patient-specific comprehensive assessment as required by the Provision of Care, Treatment, Services policy. This RFI was found in records RRHV#1, RRHV#2, RRHV#3, RRNHV#1, RRNHV#2, RRNHV#3, and RRNHV#10 and was reviewed with and verified by the Hospice Director and Clinical Director.

Observed in Record Review. In 4 of 14 active patient records reviewed, the initial comprehensive assessment was not completed within five calendar days after the election of the hospice benefit. In record RRHV#2, RRHV#3, RRHV#4, RRNHV#5 bereavement, medical social work, and/or spiritual assessments were not done within this time frame. This RFI was reviewed with and verified by the Hospice Director and Clinical Director.

Observed in Record Review. In 14 of 14 active patient records reviewed, most plan of care goals were not individualized and measurable. For example: Appropriate level of care will be established and adjusted based on the patient's needs throughout the hospice episode; need for hospice comfort kit; need for wound care; need for fall prevention guidance; need for skilled teaching regarding cardiopulmonary management; evaluate and develop plan of care; need for other disciplines to be involved in patient's care; to provide with comfort care and free from pain; will be admitted to hospice; keep patient comfortable and well palliated. Additionally, most did not identify completion target dates. This RFI was reviewed with and verified by the Hospice Director and Clinical Director.

Observed in Proficiency Testing. In 6 of 14 active patient records reviewed, the RN documented that the patient had multiple pressure ulcers but did not provide measurements and a description in record RRHV#1. In record RRHV#4 a sacral wound was not measured or described. In record RRNHV#6 the wounds were noted but not measured or described, and wound care was not ordered. This RFI was reviewed with and verified by the Hospice Director and Clinical Director. Observed in Record Review. In 7 of 14 active patient records reviewed, treatment and discharge orders were missing. In record RRNHV#3 the indwelling foley catheter was changed and barrier cream was applied to the patient without orders. In record RRNHV#4 an RN attempted to change an indwelling catheter but was not successful, so the patient was sent to an emergency department. There was no order to change the catheter. In record RRNHV#10 the RN documented that an oxygen concentrator, tank and cannula were delivered but there was no order. In RRDC#2 the patient was discharged for refusing 6 visits in 2 weeks. There was no order for discharge. This RFI was reviewed with and verified by the Hospice Director and Clinical Director.

Observed in Record Review. In 14 of 14 active patient records reviewed, interdisciplinary group meeting notes by all core services did not document patient decline, progress towards desired outcomes and goals, and plans for the following two weeks. This RFI was reviewed with and verified by the Hospice Director and Clinical Director.

Observed in Record Review. In 14 of 14 active patient records reviewed, plans of care were not revised to reflect changes in care, treatment, or services. Individualized patient plans were not updated throughout the benefit period, as well as subsequent benefit periods as evidenced by lack of revisions in visit frequencies, goals, and medication and treatment orders. This RFI was reviewed with and verified by the Hospice Director and Clinical Director. Observed in Patient Home. In 2 of 4 home visits conducted, care was not provided according to the hospice plan of care. At home visits RRHV#1 and RRHV#3 the patient was not using oxygen continuously as ordered. This RFI was reviewed with and verified by the Hospice Director and Clinical Director.

Observed in Record Review. In 1 of 14 active patient records reviewed, all disciplines did not collaborate in the care of the patient. In record RRNHV#3 the medical director was not notified at the time the hospice learned that the patient had gone to an emergency department. This RFI was reviewed with and verified by the Hospice Director and Clinical Director.

Observed in Record Review. In 4 of 13 active patient records reviewed where aide services were ordered, supervision was not always documented every 14 days in records RRHV#2, RRNHV#1, RRNHV#5, RRNHV#10. There were several instances of supervisory visits done every 15 days. This RFI was reviewed with and verified by the Hospice Director and Clinical Director.

Observed in Record Review. In 11 of 14 active patient records reviewed, the certificate of terminal illness did not include subjective and objective information to support a life expectancy of six months or less. In records RRHV#1, RRHV#2, RRHV#3, RRHV#4, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#6, RRNHV#7, RRNHV#9, and RRNHV#10 documentation lacked metrics or decline related to a terminal diagnosis. This RFI was reviewed with and verified by the Hospice Director and Clinical Director.

Observed in Patient Home. In 1 of 4 home visits where oxygen was present, cylinders were not stored safely. multiple secured and unsecured oxygen tanks were observed in the board and care home entry hallway. More secured and unsecured tanks were found in the patient’s closet along with 4 concentrators. All were covered with clothing and other items. The caregiver stated that she did not receive education on proper storage. This RFI was reviewed with and verified by the Hospice Director and Clinical Director.

Observed in Record Review. In 1 of 2 patient records reviewed, the organization did not respect the patient's right to revoke hospice care. In HOSRR #8, the Surveyor noted the staff documented the patient went to the hospital and revoked the hospice benefit; however, there was no revocation statement in the clinical record. There was no documentation of an attempt to get the revocation statement signed. This was confirmed by the Regional Director of Survey Readiness.

Observed in Record Review. In 1 of 3 home visits conducted, the Hospice RN did not consistently update the comprehensive assessment every 15 days. In HOSV# 3 the Registered Nurse visited every 15 days without completing an assessment. The documentation in the records reflected that the RN only completed a narrative note for a wound care visit . There was no documentation by the RN that she reassessed the patients or evaluated the response to care. This was confirmed by the Regional Director of Survey Readiness.

Observed in Record Review. In 13 of 13 patient records reviewed, the surveyor determined that goals, while measurable did not have any target dates for accomplishment. The record review associated with HOSV#1-3 and HOSRR#1-10 had multiple goals but none were measurable nor had any time frame defined as to when the goals were expected to be achieved. This was confirmed by the Regional Director of Survey Readiness.

Observed in Record Review. In 1 of 2 patient records reviewed, the nurse did not advise the physician of unanticipated changes to the plan of care. In HOSRR #6, the Hospice Surveyor noted in the nursing assessment that the patient had a fall, there was no documentation that the patient attending physician was notified of the fall. This was confirmed by the Regional Director of Survey Readiness

Observed in Record Review. In 1 of 10 patient records reviewed, the interdisciplinary group did not review and revise the plan of care as the condition required. In HOSRR #6, the Hospice Surveyor noted in the nursing assessment that the patient had a fall, however, the plan of care was not revised to include interventions to decrease fall risk. This was confirmed by the Regional Director of Survey Readiness.

Observed in Patient Home. In 1 of 3 home visits conducted, in HV#3, the Hospice Nurse Surveyor observed that staff had not used infection and control activities in response to the way suspected infections are spread. For example, the nurse used one pair of gloves to remove the dressing from the patient right foot then clean the wound, and dress the wound using the same glove. This was confirmed by the Regional Director of Survey Readiness. Observed in Patient Home. In 1 of 2 home visits conducted, during home visit #3 the surveyor noted the nurse did not follow infection control principles or agency policy, for example the during wound care the nurse used a pair of scissor to cut open the patient wound dressing but failed to cleansed the scissors before or after removing the wound dressing. This was confirmed by the Regional Director of Survey Readiness.

Observed in Record Review. In 3 of 3 patient records reviewed, During review and discussion of bereavement services, the Surveyor noted that the organization had not developed bereavement plans of care that specified individualized types and frequencies of bereavement services to be provided, based on assessed risks of family members following patient’s deaths. For example in BRR#1 the family score low on the post death risk assessment and BRR#2, 3 were sored at moderated risk. The bereavement care plans interventions were the same exactly for all levels of bereavement risk. This was confirmed by the Regional Director of Survey Readiness.

Observed in Record Review. In 1 of 3 patient records reviewed, it was noted lack of a supervisory hospice aide visit every 14 days. During HOSV#3, it was noted the RN performed a hospice aide supervisory visit the beginning of the certification period. The second supervisory visit was documented more than 4 weeks later. This was confirmed by the Regional Director of Survey Readiness.

Observed in Record Review. In 6 of 10 patient records reviewed, the surveyor noted that the Medical Director reviewed clinical information and signed the initial certificate of terminal illness (CTI) on a timely manner but The CTI did not consider all of the required elements. For example: During record review of HV#3, the nurse surveyor noted that the clinical information necessary for certification was not present in the record. This was confirmed by the Regional Director of Survey Readiness.