Every finding on record at Holistic Care Hospice and Palliative Services, Inc.

Observed in Emergency Management Session. The organization's Emergency Operations Plan (EOP) did not include a staffing plan for managing all staff and volunteers based on the settings and services provided to meet patient care needs during the duration of an emergency or disaster incident or during a patient surge. The plan did not include: methods for contacting off-duty staff; use of volunteer staffing, such as staffing agencies, and those deployed as part of the disaster medical assistance teams. This was discussed with the Alternate Administrator. Observed in Emergency Management Session. The organization's Emergency Operations Plan (EOP) did not address the management of staff and volunteers as follows: integrating staffing agencies, volunteer staffing, or deployed medical assistance teams into assigned roles and responsibilities; verifying the identity and licensures of volunteer practitioners (such as nurses, social workers, chaplains). This was discussed with the Alternate Administrator.

Observed in Record Review. In 2 of 10 patient records reviewed, the patient record did not include information about the patient's treatment that promoted continuity of care among providers. In the chart for RRHV#1, the IDT team meeting notes, the MSW updates to the IDT team meeting contained the exact same verbiage for the most recent six IDT meetings despite the patient being seen monthly. In the chart for RRHV#2, the MSW note in the IDT meetings contain the exact same verbiage in the most recent eight IDT's despite the patient being seen monthly. This was discussed with the Alternate DPCS.

Observed in Record Review. In 2 of 10 patient records reviewed, goals had not been individualized to the needs of the patient. In the charts for RRHV#1 and RRHV#2, at the admission visit, the patients were assessed to be at risk for falls. The fall goal was Pt/Family/PCG will verbalize understanding of safety intervention. with target date the last day of the initial certification period, 90 days after the need was assessed. Additionally, in the chart for RRHV#1, an initial goal identified upon admission on the plan of care related to oxygen use was Family/PCG will maintain understanding of safety measures re; oxygen use for the next month, rather than having been prioritized as a high risk educational need with a plan to meet this goal rapidly upon identification. This was discussed with the Alternate DPCS.

Observed in Record Review. In 5 of 10 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including the following: a statement of the scope and frequency of the services necessary to meet the patient’s and family’s needs. In the chart for RRNHV#4, there were prn visits ordered on the POC for RN, LVN, MSW and Spiritual care, though no indications were included as to what indication might precipitate a prn visit. In the charts for RRHV#1 and RRHV#2, there were prn visits included in the discipline frequencies for nursing, spiritual care and social work, however no indication for why prn visits would be made. In the charts for RRBR#8 and RRBR#9, the plans of care were not updated to reflect a change in level of care to continuous. This was discussed with the Alternate DPCS.

Observed in Record Review. In 1 of 10 patient records reviewed, the hospice plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including medications and treatment necessary to meet the patient’s needs. In the chart for RRNHV#5, the RN provided wound care to the patient during the admission visit. An order was found to refer the patient to a wound specialist for evaluation, however no physician orders were found for wound care provided between the admission visit and wound care orders received after the wound center evaluation visit. Wound care orders for the patient were in the chart as a scanned document after the wound care specialist evaluation, however they had not been incorporated into the hospice POC. This was discussed with the Alternate DPCS.

Observed in Record Review. In 1 of 10 patient records reviewed, the organization had not provided the patient with care according to the patient's individualized plan of care. In the chart for RRNHV#4, RN was ordered 1 per 2 week yet saw the patient twice the first week of service; weekly in weeks two and three. LVN was ordered weekly at admission. LVN did not see the patient until week four. This was discussed with the Alternate DPCS.

Observed in Record Review. In 3 of 10 patient records reviewed, the patient record was incorrect. In the chart for RRHV#2, Metoprolol was duplicated on the medication list on the hospice plan of care. In the chart for RRHV#1, the medication list in the plan of care still included Azithromycin and Prednisone which were ordered only for four and five days respectively more than seven weeks prior to the date of the survey. In the chart for RRNHV#5, on the first nursing visit after new wound care orders were received, the documentation of wound care was incomplete, reading Changed dressing on left heel as written on wound specialist treatment plan.. This was discussed with the Alternate DPCS.

Observed in Individual Tracer. During the review of the record for the home visit, the surveyor noted that the patient had stage 4 breast cancer. There was no documentation in the nurses notes or MD notes that addressed whether or not the patient had a single or bilateral mastectomy which would affect blood pressure cuff placement on her arms. This was validated in a discussion with and observation by the RN supervisor who performed the visit.