Every finding on record at Homestead Hospice of Cartersville, LLC

Observed in Record Review. In 1 of 1 patient records reviewed, where two bath options were available, the organization failed to maintain a complete and accurate patient record. During record review for RRHV#2, the Hospice Nurse Surveyor observed the aide care plan allowed for a bed bath or a shower. During at least 4 aide visits, documentation incorrectly stated that the patient received both a bed bath and a shower. This was discussed and reviewed with the Hospice Director and the leadership team.

Observed in Record Review. In 9 of 20 patient records reviewed, the organization failed to plan the patient's care. During record review for RRHV#1, RRHV#2, RRHV#3, RRHV#4, RRNHV#2, RRNHV#5, RRNHV#8, RRNHV#9, RRNHV#10, the Hospice Nurse Surveyor observed all required components of the plan of care were not present. For example in RRHV#3, the patient had a goal of pt/ CG verbalizes/ demonstrates understanding of proper safety measures related to fall prevention with no goal date. The patient had a goal of Pt/ CG verbalizes/ demonstrates understanding of medication schedule/ set up and how to dispense with no goal date. And the patient had a goal of facility knowledgeable and involved in hospice plan of care for patient by enter date which was not filled in. Also for RRHV#3, the patient's most recent recertification care included goals to establish SW and SC, which were both established at SOC and not updated or removed at recertification. In RRHV#2, the patient had a goal of changes in neurological status will be addressed appropriately which was not measurable. Pt had a goal of pt anxiety/ agitation is minimized/ controlled and caregiver verbalizes understanding of its effects/ origin/ treatment with no date to achieve the goal by. In RRHV#4, the patient had a goal of PT/CG will verbalize/ demonstrate understanding of applicable safety measures with no goal date and it had been put in place 1 1/2 years prior to survey. Patient also had a goal of PT stress/ anxiety is reduced to level of comfort which was not measurable. In RRNHV#2, the patient had a goal pain is currently managed at a level acceptable to the patient with no criteria as to what the acceptable level is. And the patient recently had an increase in pain per the nursing narrative notes. In RRNHV#5, the Social Worker documented at SOC that the pt/ family were working on funeral arrangement and continued to document progressing for the 6 months prior to survey but there was no goals or timeframes in assisting the family with preparations. In RRNHV#8, the patient has new onset difficulty swallowing and dysphagia which was mentioned in IDG but there are no interventions, goals or education to the primary caregiver related to these issues as the patient lives at home. In RRNHV#9, the patient had a goal of pt/ CG verbalizes understanding of psychological effects of incontinence and measures to improve/ maintain dignity with no goal date and was put intp place at SOC which was 1 1/2 yrs prior to survey. The patient also had a goal of Pt/CG understands the 24 hr/day availability of the on call hospice nurse with no goal date and was put in place 7 months prior to survey. In RRNHV#10, the chaplain had a goal of appropriate clergy/ faith groups have been contacted for spiritual support with no timeframe to achieve that goal and it had been in place for 9 months. This was discussed and reviewed with the Hospice Director and her leadership team.

Observed in Record Review. In 2 of 2 patient records reviewed, with wound care, the organization failed to plan the patient's care. During record review for RRNHV#3 and RRNHV#4, the Hospice Nurse Surveyor observed For example in RRNHV#3, the patient had two wound upon admission but once healed the wound care orders were not discontinued. There was also no mention of the wounds being healed on the updated plan of care. In RRNHV#4, the patient had two different wounds (skin tear and coccyx wound) with ordered wound care but there was no order to discontinue when the wounds were documented as healed and there was no mention of the healed wounds on the updated plan of care. This was discussed with the Hospice Director and the leadership team.

Observed in Record Review. In 1 of 1 patient records reviewed, on continuous oxygen, the organization failed to provide care, treatment, or services according to the plan of care. During record review for RRNHV#3, the Hospice Nurse Surveyor observed the patient order for oxygen was 8 liters continuous per nasal cannula since SOC six months prior to survey but consistent documentation had the patient using between four and five liters per nasal cannula. This was discussed and reviewed with the Hospice Director and leadership team.

Observed in Record Review. In 8 of 20 patient records reviewed, the organization failed to plan the patient's care. During record review for RRHV#1, RRHV#2, RRHV#3, RRNHV#1, RRNHV#5, RRNHV#7, RRNHV#8, RRNHV#9, the Hospice Nurse Surveyor observed the aide plan of care did not contain all needed elements. For example in RRHV#3, the aide care plan did not contain information about oxygen usage and the bath if the patient was using their intermittent oxygen. Also in RRHV#3, the most recent plan of care included aspiration precautions but it was not included on the aide plan of care. In RRHV#2, the patient did not have oxygen or bleeding precautions on the aide care plan. In RRNHV#1, the patient was on long term aspirin but bleeding precautions were not on the aide plan of care. In RRHV#1, NHV#5, and RRNHV#8, the patient did not have oxygen precautions on the aide care plan. In RRNHV#7, the patient is on a blood thinner and PRN oxygen but these are not addressed on the aide plan of care. In RRNHV#8, the patient has new onset dysphagia and difficulty swallowing but this is not included in precautions on the aide plan of care. In RRNHV#9, the patient recently had an addition to their plan of care to add aspiration precautions but it was not added to the aide plan of care. This was discussed and reviewed with the Hospice Director and her leadership team.

Observed in Tracer Activities. The organization failed to provide services that met the patient needs. During tracer activities for the Volunteer Program, the Hospice Nurse Surveyor observed the volunteers did not provide at least 5% of the total patient care hours of all paid hospice employees and contract staff. Upon review, the organization fell below 2% consistently for the last two years. This was discussed and reviewed with the Hospice Leadership Team.

Based on record review, staff interview, and review of policy titled ";Plan of Care Policy-PC30" (II), dated 4/2022, it was determined the hospice failed to develop a plan of care that included all services necessary for the palliation and management of the terminal illness and related conditions for one patient (P) (P#11) of 13 sampled patients (P#1, P#2, P#3, P#4, P#5, P#6, P#7, P#8, P#9, P#10, P#11, P#12, P#13). --- The findings include: Review of ";Plan of Care Policy-PC30", dated 4/2022 reveals the following: Policy II. ";The POC must reflect patient and family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The POC will include all services necessary for the palliation and management of the terminal illness and related conditions." Review of records reveal P#11 was re-admitted to hospice on 6/21/2023 with a diagnosis of lung cancer and a newly inserted abdominal drain (tube to drain the fluid) to be used for intermittent drainage of peritoneal (a space between the wall of the abdomen and the organs inside) fluids. Review of ";Visit Note Report, FACE TO FACE ENCOUNTER" by Nurse Practitioner dated 6/21/2023 reveals insertion of peritoneal drain just prior to re-admission. Review of clinical records reveal nursing visits by Registered Nurse (RN) dated 6/21/2023, 6/27/2023, 7/5/2023, 7/11/2023, and 7/18/2023 noting presence of peritoneal drain. Review of ";Hospice IDG Comprehensive Assessment and Plan of Care Update Report" dated 6/21/2023, 7/5/2023 and 7/19/2023 reveal no physician orders regarding ongoing use and care of the peritoneal drain. Drainage tube interventions or goals, and discussion regarding the peritoneal drain by the interdisciplinary team failed to be noted on the plan of care. Review of physician order for care of the drain is dated 7/25/2023. Interview with Administrator on 7/26/2023 at 11:00 a.m., revealed no physician orders for the ongoing management of the drain were obtained prior to 7/25/2023. Administrator acknowledged there was no documentation of any discussions by the hospice interdisciplinary group (IDG) regarding peritoneal drain. The patients peritoneal drain failed to be included in the plan of care (POC).