Every finding on record at Homestead Hospice of Central Georgia, LLC

Observed in Record Review. In 14 of 14 patient records reviewed, the organization failed to plan the patient's care. During record review for RRNHV#1, RRHV#1, RRHV#2, RRHV#3, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5, RRNHV#6, RRNHV#7, RRDC#1, RRDC#2, RRBR#1 and RRBR#2, the Hospice Nurse Surveyor observed the Plan of Care did not contain target dates for goal completion. For example in RRNHV#1, the patient had a goal of PT/ CG will verablize/ demonstrate understanding of how to correct safety hazards in the home:. The goal was started over 1 year prior to survey with no target date. In RRHV#1, the patient had a goal of PT/ CG verbalizes understanding of medication schedule/ set up and how to dispense. This goal was started 10 months prior to survey with no goal date. In RRHV#2, the patient had a goal of PT/ CG verbalize understanding of when to use PRN medications with no goal date. The goal was added 8 months prior to survey. In RRHV#3, the patient had a goal of facility staff is knowledgeable and involved in hospice plan of care for patient by enter date. The goal date was not entered. In RRNHV#2, the patient had a goal of PT/ CG verbalize understanding of oxygen safety. This was placed at SOC 7 months prior to survey with no goal date. In RRNHV#3, the patient had a goal of PT/ CG will verbalize/ demonstrate understanding of pain management measures with no goal date. Also in RRNHV#3, the patient had visits from the Chaplain with narrative commenting that the patient is open to monthly chaplain visits but the Chaplain was not adding to the Plan of Care. In RRNHV#4, the patient had a goal of PT/ CG verbalize/ demonstrate understanding of oxygen safety that was put into place 4 months prior to survey with no goal date. In RRNHV#5, the patient had a goal of PT/ CG verbalize and demonstrate understanding of skin breakdown which was placed 1 1/2 years prior to survey with no goal date. In RRNHV#6, the patient had a goal of PT/ CG verbalize understanding of when to use PRN meds with no goal date. In RRNHV#7, the patient had a goal of PT/CG verbalize understanding of when to utilize PRN medications and to document each usage which was put into place over a year prior to survey with no goal date. In RRDC#1, the patient had a goal of PT/ CG understands the 24/hr day availability of on-call hospice nurse with no goal date. In RRDC#2, the patient had a goal of PT/FAMILY verbalize understanding of stages of grief with no goal date and the goal was put into place 7 months prior to discharge. In RRBR#1, the patient had a goal of verbalizes/ understands applicable safety measures with no goal date and it was put into place 6 months prior to death. In RRBR#2, the patient had a goal of PT/CG verbalizes/ understands oxygen safety with no goal date. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 7 of 14 patient records reviewed, the organization failed to plan the patient's care. During record review for RRNHV#1, RRHV#1, RRHV#2, RRNHV#2, RRNHV#3, RRNHV#6, and RRNHV#7, the plan of care did not include all needed elements. For example in RRHV#1, the patient had a recent episode of passing out which was not added to the POC and the patient had oxygen in the home ( for at least 6 months) and it was not addressed on the POC with DME or with medication orders. In RRNHV#1, the plan of care did not contain orders related to the current medications the patient was taking. For example the patient was taking PRN medications: Acetaminophen supp 4x daily PRN, Biscodyl, and Dulcolax PRN with no instructions or reason for use. Oxygen was also ordered at 2 Liters PRN with no route, reason for use or instructions. In RRHV#2, the patient had orders for oxygen with no route. She also had Hydrocodone and Morphine PRN ordered for pain with no orders for indication for use ( when to take which PRN medication). For RRNHV#2, the patient had orders for oxygen but those orders did not include route. In RRNHV#3, the patient had a recent UTI with confusion and hallucinations but this was not addressed on the plan of care. In RRNHV#6, the patient had orders for oxygen but those orders did not include the route. In RRNHV#7, the patient had orders for oxygen but those orders did not include the route. Also in RRNHV#7, the patient was taking Morphine and Hydrocodone PRN for pain but there were no indications when the patient should take which medication. This was corrected while the surveyor was on-site. The patient also had an URI 6 months prior to survey but this was not addressed on the plan of care at the time. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 2 of 14 patient records reviewed, the organization failed to plan the patient's care. During record review for RRHV#2 and RRNHV#3, the Hospice Nurse Surveyor observed the Chaplain had entered orders for each visit rather than a frequency order. For example in RRNHV#3, the Chaplains goals/interventions/ outcomes were not documented for collaboration with the IDG. The goals were only listed in the Chaplain's narrative. And the visit frequency was not included in IDG or on the POC. For RRHV#2, the orders were for individual visits, no visit frequency and the IDG notes did not include information on recent updates related to goals/interventions/ outcomes. This was discussed with the Hospice Team. Observed in Record Review. In 2 of 14 patient records reviewed, the organization failed to plan the patient's care. During record review for RRNHV#1 and RRHV#2, the plan of care did not get updated when the patient's needs changed. For example in RRNHV#1, the patient had recent coccyx redness and chest itching but the goal and interventions related to integument on the plan of care was not opened up from previous resolution. RRHV#2, the patient had a recent worsening of constipation with the need for a PRN visit but the goal for constipation to be controlled which was resolved 5 months prior to survey was not reopened. This was discussed and reviewed with the Hospice Team.

Observed in Patient Home. In 1 of 2 home visits conducted, private home visits, the organization failed to provide the written patient education based on needs and abilities. During home visit for RRHV#1, the Hospice Nurse Surveyor observed the patient did not have a written individualized emergency disaster plan in the home. This was verified with the DON who was in attendance at the visit. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 2 of 8 patient records reviewed, where aide services were ordered, the organization failed to plan the patient's care. During record review for RRHV#1 and RRNHV#1, all items needed on the aide care plan were not included. For example in RRHV#1, the patient had oxygen in the home for PRN use but there were no instructions for care on the aide care plan if patient was wearing the oxygen. For RRNHV#1, the patient was taking aspirin but bleeding precautions were not included on the aide POC and aspiration precautions were put into place by the nurse at the last recertification but this was not added to the aide plan of care. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 1 of 1 patient records reviewed, discharge to home, the organization failed to document that they provided a written discharge summary to the patient's physician. During record review for RRDC#1, the Hospice Nurse Surveyor observed the nurse had documented the steps taken for discharge but there was no documentation that the discharge summary was sent. This was confirmed and discussed with the Hospice Team.