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

Observed in Regulatory Review. In 3 of 5 patient records reviewed, with wounds , the surveyor observed that wounds had not been measured weekly as required by HCO policy. In one record the surveyor observed that the wound had been identified on 7/1/24 and to date of visit 8/27/24 only one other wound measurement had been documented on 8/15/24. On a second record the surveyor observed that the wound had been identified on 7/30/24 and only date of wound identification had been measured. Further on record 3 the surveyor observed 6/18/24 wound identified and measured and not measured again until 7/10/24 when weekly measures started until wound healed. This issue was discussed and confirmed with organization leadership.

Observed in Record Review. In 8 of 10 patient records reviewed, the surveyor observed that patient records had not contained a care plan with measurable or updated goals. For example record review #1 the care plan did not have any measurable goals and goals had not had any updated change in over a year. The surveyor also found that 6/10 records review with identified pain goals that the pain goals had only stated to acceptable level and on record # 6 that the patient had fell 3 times during certification period, but no update or changes had been made to fall goals. Another example was on record review # 5 the surveyor observed that the patient experienced increased edema and anxiety, the nurse added medications to treat these problems, but had not updated the POC to include goals for edema and anxiety. All POC issues stated above where reviewed with and confirmed by organization leadership, who informed surveyor a new EMR system had been ordered to address these issue and organization planned to have EMR implemented in October 2024 .

Observed in Patient Home. In 2 of 3 home visits conducted, the surveyor observed during home visit #1 the hospice nurse had not followed organization policy and infection control guideline as evidenced by observation of nurse cleaning dirty wound and continuing with wound care without required hand hygiene and the observation of the nurse not changing gloves for entire process of wound care. This issue was both observed by leadership on visit with surveyor and confirmed. During home visit #3 with CHHA the surveyor observed the home health aide clean bowel movement from patient perineal area /buttocks and continue with bath to back and neck without removing gloves or doing hand hygiene. Further the CHHA changed gloves 5 times without completing hand hygiene. These two visits issue were observed and confirmed with organization leader.

Based on clinical record review, it was determined that the hospice failed to ensure that the plan of care included correct physician's order for six of 14 patients (P) (P#1, P#5, P#6, P#11, P#13 and P#14) sampled. The finding include: 1. Patient #1 was admitted to hospice on 9/28/21, with the hospice diagnosis of senile degeneration of the brain. P#1's clinical record was reviewed for the certification period 9/28/21 to 12/26/21. The initial hospice Social Worker visit dated 9/30/21, contained a narrative stating the hospice Social Worker would visit the patient once per month. P#1's record also contained a care plan containing goals and interventions for the hospice Social Worker. However, there was no physician's order present in the clinical record allowing for social work services to continue after the initial assessment visit on 9/30/21. 2. Patient #5 was admitted to hospice on 5/13/2,1 with the hospice diagnosis of atherosclerotic heart disease of native coronary artery without angina. P#5's clinical record was reviewed for the certification period 8/11/21 to 11/8/21. On 8/31/21, the following physician's order was entered into the clinical record: "Wound care to be performed by Homestead Hospice staff twice weekly and PRN (as needed): Cleanse with wound cleanser, pat dry, apply band aid. Report s/s (signs and symptoms) of infection to HH (Homestead Hospice) RNCM (Registered Nurse Case Manager)". The order lacked the location of the wound to be treated. On 9/14/21, the following physician's order was entered into the clinical record: "May leave wounds open to air if no drainage noted". The order lacked the location of the wound that was to be treated. 3. Patient #6 was admitted to hospice on 5/6/21,with the hospice diagnosis of senile degeneration of the brain. P#6's clinical record was reviewed for the certification period 8/4/21 to 11/1/21. On 9/14/21, the following physician's order was entered into the clinical record: "Facility staff to perform wound care/ dressing change daily as needed: Clean with wound cleanser, pat dry with gauze, cover with band aid". The order lacked the location of the wound that was to be treated. On 10/21/21, the following physician's order was entered into the clinical record: "CG (care giver) to perform wound care/ dressing change daily and as needed: cleanse with wound cleaner, pat dry with clean gauze and cover with band aid". The order lacked the location of the wound that was to be treated. 4. Patient #11 was admitted to hospice on 11/12/19, with the hospice diagnosis of unspecified sequelae of cerebral infarction. P#11's clinical was reviewed for the certification period 8/3/21 to 10/1/21. A review of the skilled nurse visit in the clinical record dated 9/23/21, revealed P#11 had a 16 french Foley catheter with a 10 cc (cubic centimeter) bulb for urinary retention. However, the clinical record lacked a physician's order for placement or maintenance of the Foley catheter during the duration of the care received by the hospice agency. 5. Patient #13 was admitted to hospice on 3/19/21, with the hospice diagnosis of senile degeneration of the brain. P#13's clinical record was reviewed for the certification period 3/19/21 to 6/16/21. A review of the skilled nurse visit in the clinical record dated 4/25/21, revealed that the skilled nurse removed a Foley catheter from P#13 during post-mortem care. However, the clinical record lacked a physician's order for placement or maintenance of the Foley catheter during the duration of the care received by the hospice agency. 6. Patient #14 was admitted to hospice on 8/21/20, with the hospice diagnosis of senile degeneration of the brain. P#14 's clinical record was reviewed for the certification period 4/18/21 to 6/16/21. The plan of care for this certification period revealed the following physician's order dated 3/2/21: "Wound care to right inner ankle lesion: cleanse with wound cleanser, pat dry with gauze, apply Neosporin ointment, elevate BLE (bilateral lower extremities) and leave open to air". The order lacked a frequency for the wound that was to be treated. During interview on 10/27/21, at 10:30 a.m. at the agency, the Administrator and the Director of Nursing were made aware of the presence of incorrect physician's order for six of 14 patients.

Based on clinical record review and review of agency policy "500 Bereavement Services", it was determined that the hospice failed to ensure that bereavement services were provided after the patient's death in two of two patients (P#) (P#13 and P#14) bereavement records reviewed. The findings include: 1. Documentation in clinical record for patient #13 reflected that the patient's death was 4/25/21. Review of the bereavement record revealed that the record lacked documentation of bereavement follow up as outlined in the agency's bereavement services policy and as outlined in the post death bereavement plan of care for P#13. 2. Documentation in clinical record for patient #14 reflected that the patient's death was 4/19/21. Review of the bereavement record revealed that the record lacked documentation of bereavement follow up as outlined in the agency's bereavement services policy and as outlined in the post death bereavement plan of care for P#14 During interview on 10/27/21, at 10:30 a.m. at the agency, the Administrator and Director of Nursing were made aware that no documentation of bereavement follow up care was present in the clinical record for two of two (P#13 and P#14) bereavement records reviewed.

Based on review of clinical documents, it was determined that the hospice failed to ensure that the plan of care contained specific individualized frequencies of tasks to be performed by the hospice aide for five of 14 patients (P) (P#2, P#3, P#4, P#5 and P#6). The findings include: 1. The clinical record for patient #2 was reviewed for certification period 9/11/21 to 11/9/21. P#2 was admitted to hospice with a diagnosis of senile degeneration of the brain. Upon review of the clinical record, it was revealed that P#2 had an order for a hospice aide to visit five times per week. However, the plan of care did not contain frequencies for the tasks listed on the plan of care to be completed by the hospice aide for P#2. 2. The clinical record for patient #3 was reviewed for certification period 9/3/21 to 12/1/21. P#3 was admitted to hospice with a diagnosis of senile degeneration of the brain. Upon review of the clinical record, it was revealed that P#3 had an order for a hospice aide to visit three times per week. However, the plan of care did not contain frequencies for the tasks on the plan of care to be completed by the hospice aide for P#3. 3. The clinical record for patient #4 was reviewed for certification period 10/4/21 to 12/2/21. P#4 was admitted to hospice with a diagnosis of Alzheimer's disease. Upon review of the clinical record, it was revealed that P#4 had an order for a hospice aide to visit five times per week. However, the plan of care did not contain frequencies for the tasks listed on the plan of care to be completed by the hospice aide for P#4. 4. The clinical record for patient #5 was reviewed for certification period 8/11/21 to 11/8/21. P#5 was admitted to hospice with a diagnosis of atherosclerotic heart disease of native coronary artery without angina. Upon review of the clinical record, it was revealed that P#5 had an order for a hospice aide to visit three times per week. However, the plan of care did not contain frequencies for the tasks listed on the plan of care to be completed by the hospice aide for P#5. 5. The clinical record for patient #6 was reviewed for certification period 8/4/21 to 11/1/21. P#6 was admitted to hospice with a diagnosis of senile degeneration of the brain. Upon review of the clinical record, it was revealed that P#6 had an order for a hospice aide to visit three times per week. However, the plan of care did not contain frequencies for the tasks listed on the plan of care to be completed by the hospice aide for P#6. In an interview at 10:30 a.m. on 10/27/21, at the agency, the Administrator and the Director of Nursing were informed that plan of care for five of 14 hospice patients (P#2, P#3, P#4, P#5 and P#6 ) reviewed did not reflect the specific individualized frequencies of the tasks to be performed by the hospice aide.