Every finding on record at Homestead Hospice of Augusta, LLC

Observed in Record Review. In 11 of 12 patient records reviewed, The surveyor observed that the plan of care had not contained measurable goals or time frames for achieving said goals. For example in HV#2 the goals for indwelling foley catheter was the caregiver demonstrates appropriate care for indwelling urinary catheter. Further examples during record review and repeated 11/12 records had been goal for pain had been acceptable level, goal for coping had been documented as improved coping skills goal for falls on 7/11 had been applicable safety measures. The issue was discussed and confirmed with organization leaders that stated this was a identified issue they had begun quality work on.

Observed in Individual Tracer. The surveyor observed during HV #2 with organization RN that the patient had a foley catheter, which had been listed on Plan of care, but no initial order had been observed or updated order. The patient had the foley since 6/2022, but no care orders or specifics related to foley had been noted on plan of care. Further the surveyor observed in patient home that the patient had oxygen in home since admission 6/2022 to include concentrator and cylinders, but the Plan of care had not included oxygen. The issue was discussed and confirmed with organization leaders.

Observed in Record Review. In 12 of 12 patient records reviewed, the surveyor observed no evidence that the organization had documented any information toward the patients progress toward the identified goals. The survey found no documentation of progress towards goals and had discussion with organization leaders, who stated this was an issue they also had identified and had begun to work on.

Observed in Patient Home. The surveyor observed that the Hospice aide, caring for elderly patient with multiple open wounds, had not followed organization policy for use of hand gel as evidenced by not following organization policy or manufactures guidelines which stated to rub hands together until dry and instead the hospice aide was waving hands around to dry and still placed gloves on wet hands. Further the surveyor observed that the hospice aide had long artificial nails. This was discussed and confirmed with hospice aide and organization leaders. The surveyor observed that Staff fingernails were not in compliance with standard precautions, regulation or organizational policy as evidenced by: Staff had artificial fingernails, which were prohibited by HCO policy.

Observed in Individual Tracer. The surveyor found no evidence that the organization had reached the required volunteer 5 percent of total patient care hours. The surveyor observed that in 2024 and to date of survey that the organization volunteers had not provided the required minimum 5 percent of day to day administrative and/or direct patient care services hours. The organization had , within last two months hired new experienced volunteer coordinator and she had oriented one volunteer. The issue of volunteers had been identified and was being followed with a PIP in QAPI, but to date of this survey the 5% had not been obtained. The issue was discussed and confirmed with organization leadership.

Observed in Record Review. In the record of a discharged alive patient, the surveyor observed that the organization had not sent a copy of discharge summary to the patients next provider which was a skilled nursing unit. This issue was discussed and confirmed with organization leadership.

Based on record review and staff interview, it was determined the agency failed to provide information about hotline phone number to call if needed, for one (1) of fourteen (14) sampled patients (P#1). The Finding include: On 8/23/22 at 11:00 a.m., during the home visit, (P#1) ' s family stated that the hospice agency did not inform or explain to them about the hotline phone number to call, if needed. On 8/23/22 at 10:40 a.m., an interview was conducted with Registered Nurse (RN) AA, who confirmed that she was not aware that P#1 ' s family did not have the hotline phone number in the hospice agency home folder.

Based on observation, clinical record review, and staff interviews, it was determined the agency failed to ensure that patients' medication profiles were updated to reflect current medications at the time of the comprehensive assessment for one (1) of fourteen (14) sampled patients (P#1). The Findings include: During a home visit observation conducted on 8/23/22 at approximately 10:40 a.m., with Registered Nurse (RN) AA, for (P#1), it was revealed that (P#1) was admitted on 5/11/20, with a diagnosis of hypertension, cardiac pacemaker, and congestive heart failure. The surveyor compared P#1's current medication list at home to the hospice agency's medication profile. Discrepancies were found. Patient #1 was taking Senna 8.6 milligrams (mg) one tablet oral daily for constipation. The above medication was missing from P#1's hospice medication profile and plan of care. On 8/23/22 at 10:40 a.m., an interview was conducted with Registered Nurse (RN) AA, who confirmed that she was not aware that P#1 was taking Senna 8.6mg for constipation.

Based on home visit observation and staff interviews, it was determined that the hospice agency staff failed to follow standard precautions to prevent the transmission of infection by contaminating clean bag for one (1) of fourteen (14) patients sampled (P#1). The Findings include: During a home visit to P#1 on 8/23/22 at 11:40 a.m., this surveyor observed Registered Nurse (RN) AA, wore dirty gloves, and used it to count P#1's medication (Ativan tablets). She also contaminated clean bag technique by putting the dirty gloves used for blood pressure cuff in the clean bag. On 8/23/22 at 11:40 a.m., an interview was conducted with (RN) AA, who stated she was nervous, and by the time she realized the error, it was too late. During an interview on 8/23/22 at 12:15 p.m., the Administrator and the Director of Nursing (DON) both acknowledged that (RN) AA, did not follow acceptable standards for infection control to prevent transmission of infectious and communicable diseases.

Based on observation, clinical record review, and staff interviews, it was determined that the agency failed to order patients' medications (Morphine and Ondansetron); and also that these drugs must be made routinely available on 24 hours basis, 7 days a week, for all patients. The hospice agency failed to comply with this regulation for one (1) of fourteen (14) sampled patients (P#1). The Finding include: During a home visit observation conducted on 8/23/22 at approximately 10:40 a.m., with Registered Nurse (RN) AA, for (P#1), it was revealed that the patient was admitted on 5/11/20, with a diagnosis of hypertension, cardiac pacemaker, and congestive heart failure. The surveyor compared P#1's current medication list at home, to the hospice agency's medication profile. Discrepancies were found. Patient's medications were Morphine Concentrate 100 milligrams (MG), /5milliliters (ML), (20mg/ml) oral solution: give 0.5ml every two hours as needed for pain or shortness of breath; and ondansetron 4mg: give one tablet oral every six hours as needed, for nausea and vomiting. Both medications were missing because the listed medications were not ordered by (RN) AA. On 8/23/22 at 10:40 a.m., an interview was conducted with (RN) AA, who stated that "they must get it from the pharmacy when they need it. They don't need it now."

Based on record review and staff interviews, it was determined that the agency failed to provide the needed medications related to the co morbidities in one (1) of fourteen (14) sampled patients (P#1). The Findings include: Clinical records for P#1 were reviewed for certification date 6/30/22 to 8/28/22. Per the patient's plan of care: the patient was admitted to hospice services on 5/11/20, with a diagnosis of hypertension, cardiac pacemaker, and congestive heart failure. The record showed that the agency was not providing coverage for payment of Bumetanide 2 milligrams (mg) one tablet oral daily, the medication used to manage the co morbidities. On 8/23/22 at 10:40 a.m., an interview was conducted with Registered Nurse (RN) AA, who confirmed that she was not aware that P#1 was paying for the above medication. In an interview at the agency's office on 8/23/22, at 12:10 p.m., the Administrator and the Director of Nursing (DON), both stated they were unaware that the patient was paying for medication related to listed co morbidities on the patient's plan of care.