Every finding on record at Homestead Hospice of Blairsville LLC

Observed in Record Review. In 1 of 12 patient records reviewed, During RR# 4's patient record review it was noted the organization had not ensured it maintained complete and accurate patient records. For example: review of RR# 4's registered nurse (RN) start of care comprehensive assessment revealed RR# 4 was admitted at the General Inpatient (GIP) level of care with a diagnosis of Sepsis and was unresponsive. Further review of RR# 4's RN start of care comprehensive assessment revealed under pain a Patient self-identified acceptable pain level of 1 and documentation of the duration and character of the pain the patient was experiencing. Review of RR# 4’s plan of care revealed both GIP and Respite levels of care. Review of RR# 4’s physician certificate of terminal illness revealed RR# 4 was admitted on GIP.This was reviewed, discussed, and validated with the Administrator/Branch Director.

Observed in Record Review. In 8 of 12 patient records reviewed, During RRHV# 1, RRHV# 2, RRHV# 3, RR# 1, RR# 2, RR# 3, RR# 4, and RR# 7 it was noted the organization had not ensured the plan of care was based on the patient's goals and the time frames, settings, and services required to meet those goals. For example: review of the eight patients’ plans of care and recertification plans of care revealed Chaplain services with the goal that the Chaplain would develop a care plan and all recertification had the same goal that the Chaplain would develop a care plan. All patients with MSW had the goal “Patient/Caregiver will have decreased fear/anxiety regarding the death and dying process with no indication how to measure “decreased” and/or “Patient will experience an increased sense of closure and peacefulness at end of life” with no indication of how to measure “increased”. In addition, review of RRHV# 2’s plan of care revealed the pain goal, Pain will be managed at a level acceptable to the patient. However, there was no indication what an acceptable level for RRHV# 2 was. Review of RR# 4’s plan of care revealed the pain goal Pain will be managed at a level acceptable to the patient. This was reviewed, discussed, and validated with the Administrator/Branch Director.

Observed in Record Review. In 6 of 6 patient records reviewed with oxygen, During RRHV# 1, RRHV# 2, RRHV# 3, RR# 3, RR# 5, and RR# 6's patient records review it was noted the organization had not ensured the plan of care included treatments necessary to meet the patient's needs. For example: review of RRHV# 1, RRHV# 2, RRHV# 3, RR# 5, and RR# 6's plans of care revealed oxygen orders with no documentation on the delivery method of oxygen, such as nasal canula. Review of RR# 3's patient record revealed documentation that RR# 3 was on continuous oxygen at 3 lpm. However, review of the plan of care and recertification plan of care revealed no order for oxygen. Further review of RR# 3's patient record revealed an order dated one day prior to the survey for continuous oxygen at 3-4 lpm with no indication of the deliver method. This was reviewed, discussed and validated with the Administrator/Branch Director.

Observed in Patient Home. In 2 of 2 home visits conducted with a nurse bag, During RRHV# 1 and RRHV# 3 home observation it was noted the organization had not ensured staff followed the organization policy Bag Technique that included using a barrier for the nurse bag if a safe and clean surface is not available and to close the bag before performing patient care. For example: During RRHV# 1 and RRHV# 3's home observations the nurse bag was left open for the duration of the visit. During RRHV# 1's home observation the registered nurse was observed picking up the nurse bag at the end of the visit to remove the barrier and then placed the nurse bag back on the bare mattress at the Skilled Nursing Facility. This was observed, discussed, and validated with the Administrator/Branch Director.

Observed in Patient Home. In 4 of 8 patient records reviewed with hospice aide services, During RRHV# 1, RRHV# 2, RRHV# 3, and RR# 3's patient records review it was noted the registered nurse (RN) had not ensured the hospice aide written patient care instructions were complete. For example: review of RRHV# 1's patient record revealed RRHV# 1 as on continuous oxygen at 4L. Review of RRHV# 1's hospice aide written patient care instructions revealed the task of bed bath. However, review of the hospice aide written patient care instructions revealed no documentation of oxygen, directions regarding if oxygen could be removed during care, or oxygen precautions. Review of RRHV# 3's patient record revealed RRHV# 3 was on continuous oxygen at 2L. Review of RRHV# 3's hospice aide written patient care instructions revealed the task of a shower. However, further review of RRHV# 3's hospice aide written patient care instructions revealed no documentation of oxygen, directions regarding if oxygen could be removed during care, or oxygen precautions. Review of RR# 3's patient record revealed RR# 3 was on continuous oxygen at 3L. Review of RR# 3's hospice aide written patient care instructions revealed the task of bathing with no documentation regarding if oxygen could be removed during care, or oxygen precautions. Review of RRHV# 2's patient record revealed RRHV# 2 was on continuous oxygen at 2l. Review of RRHV# 2's hospice aide written patient care instructions revealed no documentation of oxygen precautions. This was reviewed, discussed, and validated with the Administrator/Branch Director.

Observed in Patient Home. In 2 of 2 home visits conducted at a Skilled Nursing Facility, During RRHV# 1 and RRHV# 2's home observation the organization had not ensured it treated the patient in a dignified and respectful manner that supports the patient's dignity. For example: during RRHV# 1's home observation at the Skilled Nursing Facility (SNF) the registered nurse was observed assessing the patient with the privacy curtain open and the room door open. During RRHV# 2's home observation at the SNF the Chaplain was observed providing spiritual support with the privacy curtain open with the roommate present. In addition, the room door was left open. This was observed, discussed, and validated with the Administrator/Branch Director.

Observed in HR File Review. In 1 of 1 HR files reviewed, During HR# 10's HR file reviewed it was noted the organization had not ensured contracted staff education and training complied with law and regulation, and the organization's policy Agency In-Services, HR.65 that included annual Bloodborne Pathogen education. Review of HR# 10's HR files revealed no annual Bloodborne Pathogen education for approximately 20 months. This was reviewed, discussed, and validated with the Administrator/Branch Director.

Observed in Patient Home. In 2 of 2 home visits conducted with medication reconciliation, During RRHV# 1 and RRHV# 3's home observation it was noted the organization had not ensured it maintained a current medication list, including prescribed and over-the-counter medications. For example: during RRHV# 1's home observation the medication reconciliation revealed the organization's medication list had a multivitamin daily, nasal spray as needed, and Refresh eyedrops. However, review of the Skilled Nursing Facility's (SNF) medication list revealed no documentation of a multivitamin, nasal spray, or eyedrops. Further review of the SNF's medication list revealed Culture Digestive 200mg daily. However, review of the organization's medication list revealed no documentation of Culture Digestive. During RRHV# 3's medication reconciliation it was noted RRHV# 3 was taking Quinine 500 mg 1 tablets every day at 2:00 p.m. and had stopped taking Calcium with vitamin D approximately 2-3 week prior to the surveyor's home observation. However, review of the organization's medication list revealed Calcium with vitamin D and no documentation of Quinine. This was observed, discussed, and validated with the Administrator/Branch Director.

Observed in Patient Home. In 2 of 2 home visits conducted at a Skilled Nursing Facility, During RRHV# 1 and RRHV# 2's patient record review it was noted the organization had not ensured it provided the Skilled Nursing Facility (SNF) with the physician recertification of the patient's terminal illness. For example: review of RRHV# 1's SNF Hospice binder revealed no documentation of the current physician recertification of RRHV# 1's terminal illness. Review of RRHV# 2's SNF Hospice binder revealed no documentation of the physician recertification of RRHV# 2's terminal illness. This was reviewed, discussed, and validated with the Administrator/Branch Director.