Every finding on record at Hoffmann Hospice of the Valley, Inc

It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments; Includes all services necessary for the palliation and management of the terminal illness, including the following a detailed statement of the scope and frequency of services necessary to meet specific patient and family needs; Measurable outcomes anticipated from implementing and coordinating the plan of care; This standard was not met as evidenced by clinical record review and interview. In 3 of 7 (43%) clinical records reviewed of patients with wounds revealed that the agency did not ensure that there were documented measurable goals, frequency or delegation of responsibility in the plan of care. Clinical Record 5: The patient elected the hospice benefit on 09/07/2024. The initial RN assessment dated 09/07/2024 identified "stage 2 wound on buttocks". On the initial plan of care there was an order written for a stage 2 wound on the patient's buttocks that read "cleanse L & R buttock bilaterally with soap and water, pat dry and apply calmoseptine topically three times a day and as needed prophylactically to prevent skin breakdown. There was no documentation of who was to perform the wound care three times a day and who was responsible for the as needed applications. In a joint review of the clinical record with key compliance and QA NP, it was agreed that the plan of care did not identify individuals responsible for wound care. Clinical Record 10: The patient elected the hospice benefit on 08/24/2023. During the initial RN comprehensive assessment on 08/24/2024, the RN identified a wound on the external labial fold and another wound on the patient’s coccyx. The care plan dated 08/24/2024, and the updated plan of care dated 09/10/2024, included a problem entry for impairment of skin integrity. The goal listed was to maintain adequate cardiac function, as evidenced by pulse, blood pressure, and respiration within the constraints of the disease. However, there were no measurable goals documented for the identified wounds. In joint review of the clinical record with key compliance and QA NP she agreed that there were no measurable goals listed on the plan of care. Clinical Record 11: The patient elected the hospice benefit on 08/20/204. In the initial RN assessment, a fungating lesion with light serosanguineous drainage was identified on the patient's right chest. An order was written "cleanse wound with cleanser, pat dry, apply Silvadene, cover with small island dressing and hypoallergenic tape." There was no documentation of how often to perform wound care noted in the plan of care, on the physician order or in the nursing notes. In an interview with and joint record review with key compliance and QA NP it was confirmed that there was no frequency identified for wound care.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 8 of 30 (53%) clinical records reviewed of patients that accepted Hospice Aide (HA) services, revealed that the agency did not provide the HA with specific written patient care instructions. Clinical Record 5: The patient elected to receive hospice benefits on 09/07/2024 and accepted aide services starting on 09/09/2024, scheduled for twice a week. The patient had a wound on her buttocks covered with a dressing and a Foley catheter in place. The aide plan of care included the following instructions: “informational: wound” and “Foley: empty and drain.” There were no specific instructions for the aide regarding the care and cleaning of the Foley catheter and perineal area. Additionally, there were no instructions provided for handling a dislodged or soiled dressing on the wound Clinical Record 7: The patient elected the hospice benefit on 08/27/2027 and accepted aide services. The aide plan of care included an order that read "nail care prn" There were no specific instructions on when nail care should be provided for this patient Clinical Record 28: The patient elected the hospice benefit on 09/24/2024 and was admitted to the IPU. The aide plan of care read "apply barrier cream" there were no specific documented instructions regarding where to apply the barrier cream or when to apply the barrier cream. Clinical Record 30: The patient elected the hospice benefit on 09/09/2024 and was admitted to the IPU. The care plan for the aide included an order to “apply OTC barrier cream.” However, there were no specific documented instructions on where or when to apply the barrier cream. Clinical Record 8: The patient elected the hospice benefit on 03/06/2024 and accepted aide services. The care plan for the aide included an order to “apply OTC barrier cream.” However, there were no specific documented instructions on where or when to apply the barrier cream. Clinical Record 11: The patient elected the hospice benefit on 08/20/2024 and accepted aide services. The care plan for the aide included an order to “apply OTC barrier cream.” However, there were no specific documented instructions on where or when to apply the barrier cream. Clinical Record 12: The patient elected the hospice benefit on 08/13/2024 and accepted aide services. The patient lived in a private resident and had a private caregiver. The RN documented the patient had a tracheostomy and PEG tube in place. The aide plan of care did not include specific instructions on caring for or what issues to report regarding these devices. It only read "Informational: Tracheostomy and PEG tube". Clinical Record 27: The patient elected the hospice benefit on 04/11/2024 and accepted aide services. The care plan written by the RN included a note: “Informational: NG tube and Foley.” However, there were no specific instructions on the care of these devices or issues to report to the RN. During joint review of clinical records and interview the Key Compliance NP she agreed and confirmed that the aide plans of care were not completed or written correctly per the training the staff receives.

It is required that the hospice inpatient facility provides meals to each patient that are obtained, stored, prepared, distributed, and served under sanitary conditions. This standard was not met as evidenced by interview and observation. A tour of the IPU on 09/25/2024 revealed that the agency did not ensure that all food which was made available for the patient was not expired. Observation 1: During a tour of the IPU on 09/25/2024, which was observed by the Director of the IPU (PR5), the following items were found in the Nourishment Room: Island Snacks Chili Mango dried fruit, 9 oz bag approximately half full, expired on 08/21/2024; Ocean Spray Cran-Grape juice, 10 fl. Oz. bottles, 5 present in pack of 6, expired on 04/08/2024; I Love Chamoy Chamoy Pickle sauce, 10 fl. oz. bottle approximately 30% full, expired on 07/24/2024; Amor Chamoy Sauce mild sauce, 1 liter bottle approximately 90% full, expired on 09/22/2024; Golden Flake Barbecue Fried Pork Skins, 9.5 oz. container approximately 60% full, expired on 11/20/2023. In an interview with the Director of the IPU (PR5) on 09/25/2024, she confirmed that the above-mentioned food items were expired. She did confirm that the food items were in a space, the Nourishment Room, from which food is made available to patients as needed as snacks and between meals. A tour of the IPU on 09/25/2024 revealed that the agency did not ensure that all food which was made available for the patient was not expired.

Based on interview and record review, the agency failed to follow its policy and procedure for one of three sampled patients (Patient 1), when Hospice Aide (HA) 1 did not report to her supervisor when she cut Patient 1's lip while shaving him. This failure had the potential for the lip to become infected. Findings: During an interview on 9/7/22, at 3:56 PM, with HA 1, HA 1 stated, she would go bathe and shave Patient 1 two times a week at the skilled nursing facility. When HA 1 was asked if she recalled cutting the patient while shaving him. HA 1 stated, she did recall cutting the patient while shaving him. HA 1 was asked if she had reported the cut to her supervisor, and HA 1 stated, she had not reported the incident to her supervisor because she did not feel the cut was a significant to report it. During an interview on 9/7/22, at 4:10 PM, with Director of Outpatient (DOOP), DOOP stated she was not aware of Patient 1 obtaining a cut while being shaved by HA 1. During a review of the agency's policy and procedure (P&P) titled, "Shaving Patient Care," dated 1994, the P&P indicated, " Procedure: 1. Wash hands DON gloves. . . if you nick the patient's skin, report this to your supervisor."

It is required that hospice care and services provided to patients and families follow the individualized plan of care established by the hospice IDG in collaboration with the attending physician (if any). This standard was not met as evidenced by interview and review of clinical records. 1 of 20 (5%) clinical records revealed the hospice agency did not ensure that skilled nursing followed the visit frequencies on the individualized plan of care. Record #46543 - The skilled nursing visit frequency was two times a week and one PRN visit every 14 days. During the 14 day time frame of 7/4/21 to 7/17/21, there was one extra PRN visit on 7/17/21. During interview, the Nurse Practitioner/Compliance Manager stated that she could not locate an update to the nursing visit frequency and/or a physician's order for the extra PRN nursing visit made on 7/17/21.

It is required that the hospice inpatient facility provides meals to each patient that are obtained, stored, prepared, distributed, and served under sanitary conditions. This standard was not met as evidenced by document review, observation and interview. The hospice inpatient unit (IPU) did not ensure that meals were obtained, stored, prepared and distributed under sanitary conditions. A tour of the kitchen at the IPU was conducted. A stack of serving plates was noted in the middle of the food preparation countertop. There were three plates with dried food residue. This stack of plates was covered with an inverted bowl which did not cover all areas and edges of the plates. There was evidence that the plates being used for serving food were not clean and sanitary and non-food items were not stored away from food items. During interview, the kitchen supervisor stated that clean plates were removed from the dishwashing machine then stored in the middle of the food preparation countertop, and that food might have splattered onto the plates. During a final tour of the kitchen at the hospice inpatient unit, the serving plates were no longer stored on the food preparation countertop and the clean plates were stored on the clean storage rack at the end of the kitchen countertop. Policy "Safe Food, Handling and Preparation", Policy Number 17.01, "Date reviewed: annually", included, in part, "Non-food items shall be stored away from food items", and "Regular ware servers (i.e., standard plates, glassware, cups and utensils) shall be used with all patients".