Every finding on record at High Care Hospice, Inc.

Observed in Tracer Activities. During the review of the Volunteer Training Program, it was noted that education on their role during an emergency was not included in the initial training for volunteers. Finding was verified by the DPCS/Volunteer Coordinator.

Observed in Record Review. In 1 of 2 patient records reviewed, for discharged patients, the nurse surveyor noted that the organization did not follow their revocation process. For RRDC#1, the patient revoked hospice to seek aggressive treatment however, the signed revocation statement was not in the EMR and could not be found. Finding was verified by the Director of Patient Care Services.

Observed in Record Review. In 1 of 10 patient records reviewed, for active patients, it was noted by the nurse surveyor that the initial bereavement risk assessment had not been completed as required. For RRNHV#2, it is agency practice for the medical social worker to complete the initial bereavement risk assessment. The social worker documented the difficulty she was having in setting up a time to visit the patient and her daughter and the date for the visit kept getting pushed out further and further. When the medical social worker did make the visit, she did not document an initial bereavement risk assessment. Finding was verified by the Director of Patient Care Services.

Observed in Record Review. In 3 of 10 patient records reviewed, for active hospice patients the nurse surveyor noted that the goals were not measurable for RRHV#1, RRHV#2, and RRNHV#1. For example, “Patient will have a lower Blood Pressure,” and “Pain will remain in comfortable level during care.” Additionally, there were no short-term goals at start of care to address issues of immediate needs such as understanding medication management, symptom management, pain management, mobility, or safety, all goals were to be achieved by the end of the hospice benefit period. Findings were verified by the Director of Patient Care Services.

Observed in Record Review. In 1 of 10 patient records reviewed, for active patients, it was noted by the surveyor that care was not provided according to the individualized plan of care. For RRHV#1, the hospice aide frequency was increased to four times a week, however the hospice aide did not see the patient at the increased frequency until a week after the plan of care was changed. Finding was validated by the Director of Patient Care Services.

Observed in Patient Home. In 1 of 3 home visits conducted, it was observed by the Nurse Surveyor that the organization did not implement the infection prevention and control activities it had planned per their “Hand Hygiene Policy No. 7-009.1”. For example, during RRHV#1 the hospice aide performed hand hygiene upon entering the home, then donned gloves. The hospice aide then touched items in the patient’s room, assisted her to the bathroom, assisted her to undress and get in the shower and washed her back all with the same pair of gloves on and not performing hand hygiene at designated time frames defined per policy. Finding was verified by the Director of Patient Care Services who was present during the visit.

Observed in Record Review. In 3 of 10 patient records reviewed, for active patients, it was noted by the nurse surveyor that for RRHV#1, the hospice aide care plan had numerous sections blank. It did not address skin care or hair care, or whether the patient’s oxygen could be removed for the patient’s bath/shower if it was on at the time of the hospice aide’s visit. For RRHV#2, the hospice aide care plan had not been updated to reflect requested changes to the plan to have the hospice aide assist with light housekeeping rather than assist with his ADL's. For RRNHV#1, there were no instruction as to what the hospice aide's responsibility was regarding the patient's dressing (i.e. notifying the nurse if it was soiled) or whether the patient's oxygen could be removed for the patient's bath if it was on at the time of the visit. Findings were verified by the Director of Patient Care Services.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the nurse surveyor that for RRHV#1 the hospice aide did not provide care according to the hospice aide plan of care. During the home visit, the patient, and the hospice aide both stated that the hospice aide applied lotion to the patient’s skin after her shower. There was not any instruction for skin care on the hospice aide plan of care. Additionally, the hospice aide assisted the patient with washing her hair and back and that was not noted on the care plan. Findings were verified by the Director of Patient Care Services who was present on the home visit.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the surveyor that the medication profile was inaccurate. During RRHV#1, the patient showed off her organized medication drawer in her bedroom. At that time, it was noted that she had a bottle of MiraLAX that was not on the medication profile. The patient stated that she takes it for constipation when needed. Finding was validated by the Director of Patient Care Services who was present during the visit.

Observed in Patient Home. In 3 of 3 home visits conducted, it was noted by the nurse surveyor that the patient’s admission packet did not include an individualized emergency plan or information regarding the development of one. Finding was further validated during RRHV#1, RRHV#2, and RRHV#3 upon review of the packet in the home. Finding was validated by the Director of Patient Care Services who was present during the home visits and in discussion with the Compliance Director.