Every finding on record at Homestead Hospice of Ohio, LLC

Observed in Record Review. In 2 of 19 patient records reviewed, it was noted by the nurse surveyor that the initial bereavement risk assessment was not completed as part of the comprehensive assessment. For RRNHV#5 (Main Office Akron), it was over a month late and for RRNHV#10 (Dover Branch), the initial bereavement risk assessment was not completed at all. Finding was confirmed by the Administrator and the Dover Branch Manager.

Observed in Record Review. In 14 of 19 patient records reviewed, the nurse surveyor noted that the goals were not consistently measurable. For example, “Caregiver will have improved knowledge and management of symptoms related to disease process and symptom management ongoing”, and “Pain will be managed at acceptable level by end of certification period”. There were minimal short-term goals at start of care to address issues of immediate needs such as understanding medication management, symptom management, pain management, or safety, most time frames for completion were at end of certification period or did not have a timeframe. Finding was confirmed by the Administrator, and the Regional Education and Clinical Specialist. Observed in Record Review. In 14 of 19 patient records reviewed, the nurse surveyor noted that the goals were not consistently measurable. For example, “Caregiver will have improved knowledge and management of symptoms related to disease process and symptom management ongoing”, and “Pain will be managed at acceptable level by end of certification period”. There were minimal short-term goals at start of care to address issues of immediate needs such as understanding medication management, symptom management, pain management, or safety, most time frames for completion were at end of certification period or did not have a timeframe. Finding was confirmed by the Administrator, and the Regional Education and Clinical Specialist.

Observed in Record Review. In 5 of 19 patient records reviewed, it was noted by the nurse surveyor that treatment orders were not clear or complete. For RRNHV#10 (DVP), the oxygen order was for Oxygen 2 – 4 liters by nasal canula as needed for comfort. The order did not include instructions for the titration of the oxygen. Findings were verified with the Administrator, and the Regional Education and Clinical Specialist. Observed in Record Review. In 5 of 19 patient records reviewed, it was noted by the nurse surveyor that medication/treatment orders were not clear or complete. For RRNHV#1 (ANP), there was an order for Norco 1/325 tablets 1-2 tablets every four hours prn. There were no instructions as to when to one tablet versus when to take two. RRNHV#2 (ANP), the patient was on a daily medication for her bowel status and there were three additional PRN orders for constipation: Polyethylene Glycol 3350 17 gm/dose oral powder. Take 17gm mixed in liquid by mouth daily as needed for constipation, Sena Plus 8.5mg-50mg tabs 1-2 tabs 2x’s daily as needed for constipation, and Docusate Sodium 100mg capsule 1/1 capsule by mouth 2x’s daily as needed for constipation. All without instructions as to when to take which medication. RRNHV#3 (ANP), order for Latanoprost 0.005% eye drops Ophthalmic (eye) 1/1 drop daily, did not have further instructions as to which eye to give in. Also, there were three prn orders for constipation medication: Bisacodyl Suppository, Fleet enema, and Senna Plus 8.6mg-50mg tab, all without instruction as to when to take which medication. RRNHV#5, order for Docusate Sodium 100mg capsule daily prn constipation was ordered plus there was an order for MiraLAX 17gm dose oral powder daily prn constipation. There were no instructions as to when to take which medication. Additionally, the MiraLAX order did not give any instructions regarding mixing the medication in a liquid. Findings were verified with the Administrator, and the Regional Education and Clinical Specialist.

Observed in Patient Home. In 3 of 4 home visits conducted, it was noted by the nurse surveyor that during the medication review by the nurse that the medication profile did not accurately reflect what the patients were taking. for RRHV#3(DVP), the patient was using Dorzolamide HCL Timolol Maleate Ophthalmic Solution Eye drops, 1/1 gtt each eye 2x’s daily for more than a year per the patient’s caregiver daughter. The eyedrops were not on the medication profile in the electronic medical record. Additionally, the patient was taking Tylenol 650mg tablets 1/1 every 8 hours prn pain, this was also not on the medication profile in the EMR. RRHV#4(DVP) the patient was ordered an Antibiotic for a probable UTI, a week ago and had one more day left per the patient’s daughter. The antibiotic had not been added to the medication profile in the EMR. Finding was validated by the Dover Branch Manager who was present during the visit. Observed in Patient Home. In 3 of 4 home visits conducted, it was noted by the surveyor during the medication review by the nurse that the medication profile did not accurately reflect what the patients were taking. For RRHV#1(ANP), the patient was taking Tylenol 500mg 1/1 tablet as needed for pain every 4 to 6 hours, however it had not been added to the medication profile. Additionally, the patient’s Celebrex had been decreased to one time daily several weeks ago but not change in the medication profile and the patient’s bottle for Folic Acid read 1mg, 1 tablet daily and the medication profile stated he was to take Folic Acid 400 Mcg oral 1 tablet daily. Finding was validated by the Administrator who was present during the visit.

Observed in Patient Home. In 2 of 4 home visits conducted, it was noted by the nurse surveyor that for RRHV#3 the backup E-tank was secured in a stand in the entryway of the home, however, it was covered up with a piece of material. The oxygen concentrator was under a table in the same hallway, and it too was covered up with a piece of material. For RRHV#4, the backup oxygen concentrator was secured in a stand, however in addition to the necessary supplies to use the backup tank in an emergency, it had another bag hanging on it that was overflowing with various supplies. Findings were verified by the Branch Manager of the Dover office. Observed in Patient Home. In 2 of 4 home visits conducted, it was noted by the nurse surveyor that for RRHV#1, the individualized disaster plan in his binder was blank. Additionally, when asked about it, the caregiver could not remember it ever being discussed. For RRHV#2, there was an individualized emergency plan in the patient’s Facility (Assisted Living Facility Binder) that referred to the patient’s plan, however, the individualized disaster plan in the patient’s home binder was not filled out. Finding was verified by the Administrator who was present during the home visit.

Observed in Infection Control System Tracer. On review of the written infection control plan and on interview with the Administrator/DON it was found that the organization had not identified infection risk based on its geographic location, community and population served. This was a repeat finding.