Every finding on record at Hope Hospice & Healthcare, Inc

Based on observation, interview, and record review, the agency failed to ensure the medication listed in the patient's current Plan of Care (POC) and medication profile were updated, accurate, and with the right dosage and frequency, for one of three patients reviewed for medication reconciliation (Patient 8), when the prescription bottle of medication Seroquel (an antipsychotic medication used to treat mental health conditions) in Patient 8's home had a different prescription administration instruction to use, which was not listed in Patient 8's current medication profile.This failure increased the potential for patient's primary care giver (PCG) to administer the wrong dosage of Seroquel to Patient 8. --- Findings:On April 21, 2025, Patient 8's record was reviewed. Patient 8 was admitted to the agency with the start of care (SOC) date of August 11, 2023, with diagnoses which included senile degeneration of the brain (outdated term for dementia - significant and progressive decline in cognitive abilities), end stage renal disease (ESRD - kidney failure) requiring hemodialysis (a life saving treatment that filters a patient's blood when their kidneys are no longer functioning properly), and dependence on renal dialysis three times a week, with arteriovenous fistula left arm (AV fistula - a surgical connection between an artery and a vein used for hemodialysis access).A review of Patient 8's current medications listed in the agency's form "CURRENT TREATMENT / MEDICATION / DME LIST (Durable Medical Equipment)," indicated, the medication Seroquel as: - "Seroquel 25 milligram (mg - a unit of measurement) tablet, 1 tablet oral at bedtime for agitation; and - Seroquel 50 mg tablet, 1 tablet oral at bedtime for agitation..."On April 22, 2025, at 8:43 a.m., a home visit was conducted for Patient 8 with the Registered Nurse (RN). Patient 8's primary caregiver (PCG) was present during the visit. The PCG signed the consent for home visit with permission from Patient 8's Power of Attorney (POA - a person with authority to make medical, legal, or financial decisions for another person).Patient 8 was observed lying in bed, awake, alert, and able to verbalize his needs in Spanish. Patient 8 was observed with dressing on his left lower arm. The PCG stated Patient 8 had a hemodialysis treatment yesterday.During the medication reconciliation at 9:50 a.m., and a concurrent interview conducted with the RN, the RN stated a pill box was set up for Patient 8's daily medications.The current medication profile reviewed with the RN listed the medication Seroquel as "Seroquel 25 mg, 1 tablet oral at bedtime, and Seroquel 50 mg, 1 tablet oral at bedtime". The prescription bottle containing the medication Seroquel indicated, "Quetiapine Fumarate 25 mg tablet. Take 3 tabs (75 mg) po (by mouth) at bedtime for agitation".The RN stated he was not aware Patient 8 had a new prescription bottle of Seroquel. The RN stated the medication profile should have been updated when the pharmacy delivered a new prescription bottle of Seroquel. On April 22, 2025, at 10:08 a.m., a concurrent interview and record review was conducted with the Director of Patient Care Services (DPCS). The DPCS stated the Skilled Nurse (SN) who visited Patient 8 should have known the new prescription bottle of Seroquel instruction. The DPCS stated the medication reconciliation should be done on every visit by the SN. She stated the current medication list should have been updated with the new dosage and frequency of Seroquel.A review of the delivery receipt provided by the agency indicated the medication Seroquel (Quetiapine Fumarate) 25 mg was delivered in Patient 8's home on April 10, 2025. A review of the agency's policy and procedure titled, "Medication Profile," dated October 2014, indicated, "...Patients receiving medications administered by hospice will have current, accurate medication profile in the clinical record. Medication profiles will be updated for each change to reflect current medications..."A review of the agency's policy and procedure titled, "Identification Of Medication For Administration," dated October 2014, indicated, "...To provide general guidelines for the safe administration of medications in the home...The nurse will review the medication label for name, additional patient identifier, drug, dosage, and prescription..."

Based on observation, interview, and record review, the agency failed to include in the patient's plan of care, the hemodialysis (a life saving treatment that filters a patient's blood when the kidneys are no longer functioning) information, the care of patient's Arteriovenous fistula (AV fistula - a surgical connection between an artery and a vein used for hemodialysis), the education and instruction when there are complications of the dialysis site for one of three patients reviewed (Patient 8).This failure increased the potential for Patient 8, and Patient 8's primary caregiver (PCG) not to be educated of the signs and symptoms of fistula emergency, that can lead to serious complications and potentially life-threatening condition. --- Findings:On April 21, 2025, Patient 8's record was reviewed. Patient 8 was admitted to the agency with the start of care (SOC) date of August 11, 2023, with diagnoses which included senile degeneration of the brain (an outdated term for dementia- a significant and progressive decline in cognitive abilities), and end stage renal disease (ESRD - a kidney failure) dependence on hemodialysis three times a week. The re-certification assessment dated March 20, 2024, indicated, "... PT's (patient) left arm fistula has a moderately strengthened bruit...ESRD...dependence on renal dialysis (Left Arm AV Fistula).The physician's Certification for Terminal Illness (CTI) dated February 1, 2025, indicated, "...PT BP (blood pressure) decreasing during dialysis treatment, leading to him not receiving full treatment and BP meds (medication) have been titrated...)The Plan of Care (POC) dated April 21, 2025, indicated Patient 8's diagnoses which included, "...ESRD, dependence on renal dialysis..."The POC did not include the Patient 8's hemodialysis treatment, goals and objectives to meet his needs. There was no documented evidence in the plan of care that addressed the proper care of his AV fistula after hemodialysis treatment and instruction to follow when the dialysis site had signs and symptoms of complications.On April 22, 2025, at 9:10 a.m., a home visit was conducted for Patient 8, with the Registered Nurse (RN). The Primary care giver was present during the visit. Patient 8 was observed awake, alert and able to verbalize his needs in Spanish. Patient 8 was observed with dressing on his left lower arm.During a concurrent interview and POC review with the RN, the RN stated Patient 8's hemodialysis treatment and care of AV fistula should be included in the POC. The RN stated he had not provided specific education to the PCG related to Patient 8's hemodialysis access site.During an interview with Patient 8's PCG, the PCG stated Patient 8 had received heparin (blood thinner) during dialysis on March 21, 2025. The PCG stated the dialysis staff instructed her to leave the dressing on Patient 8's left arm and remove the dressing today. The PCG stated she did not receive any education from the agency's staff on the care of Patient 8's hemodialysis site.On April 23, 2025, at 9:20 a.m., a concurrent interview and review of Patient 8's POC was conducted with the Director of Patient Care Services (DPCS). The DPCS stated the patient and PCG's education related to their current health condition should be included in the POC from the initial comprehensive assessment and during very home visit. The DPCS stated Patient 8's hemodialysis treatment, care and services of his dialysis site should have been included in the POC.A review of the agency's policy and procedure titled, "The Plan of Care," dated October 14, 2025, indicated, "...The plan of care will be based on the initial, comprehensive  and ongoing comprehensive assessments performed by members of the interdisciplinary group and will be reviewed on a regular basis...The Plan of care will identify the patient's needs and services to meet those needs...As needed, the patient and family/caregiver will receive written instructions regarding treatments or aspects of care that will be the responsibility of the patient and family/caregiver to provide or follow through...The written plan off care will contain...patient and family /caregiver educational needs and assessment of their ability to learn and understand teaching..."

Based on observation, interview, and record review, the agency failed to ensure the patient's primary care giver (PCG) followed the standard of infection control precautions in handling and care of the patient's oxygen nasal cannula (a device that delivers oxygen to the patient through the nose) tubing, for one of three patients reviewed with oxygen (Patient 8).This failure increased the potential for Patient 8 to be at risk for exposure to respiratory infection. --- Findings:On April 21, 2025, Patient 8's record was reviewed. Patient 8 was admitted to the agency with the start of care (SOC) date of August 11, 2023, with diagnoses which included senile degeneration of the brain (an outdated term for dementia - a significant and progressive decline in cognitive abilities), and end stage renal disease (ESRD - kidney failure) requiring hemodialysis (a life saving treatment that filters a patient's blood when their kidneys are no longer functioning properly), dependence on hemodialysis three times a week.A review of Patient 8's current treatment and medication list, indicated a physician's order, dated August 11, 2023, for "...Oxygen via NC (through nasal cannula) @ (at) 2LPM (two liters per minute) PRN (as needed) for mild SOB (shortness of breath), 3 LPM for moderate SOB, 4 LPM for severe SOB..."On April 22, 2025, at 9:10 a.m., a home visit was conducted with the Registered Nurse (RN) for Patient 8. The primary caregiver (PCG) was present during the visit. Patient 8 was observed lying in bed, awake, alert, and able to verbalize his needs. One oxygen concentrator was observed at the bedside, with the nasal cannula tubing coiled in front of the concentrator and was left exposed. During a concurrent observation and interview with Registered Nurse (RN), at 9:30 a.m., the RN stated he was not aware that Patient 8 had been using his oxygen. The RN acknowledged the nasal cannula tubing was undated and exposed. On April 22, 2025, at 9:35 a.m., during an interview with the PCG, the PCG stated she had been administering oxygen to Patient 8 at two and a half liters (a unit of measurement) by nasal cannula when Patient 8 arrived home from the dialysis treatment. The PCG stated she had not change the oxygen tubing for a while.On April 23, 2025, at 10:15 a.m., a concurrent interview and record review was conducted with the Director of Patient Care Services (DPCS). The DPCS stated the oxygen tubing should be kept in a Ziploc storage bag provided by the agency when not in use. The DPCS stated there would be an infection control issue when oxygen tubing was left exposed and not stored properly. A review of the agency's policy and procedure titled, "Infection Control Precaution," dated October 2014, indicated, "...The patient and family/caregiver will receive...information and instruction regarding infection control precautions...Ongoing assessments will continually address the use of standard precautions..."A review of the agency's policy and procedure titled, "Safe And Appropriate Use Of Medical Equipment And Supplies," dated October 2014, indicated, "...It is the responsibility of the clinicians, as appropriate, to instruct patients and their family/caregiver the safe and appropriate use of oxygen..."

Based on observation, interview, and record review, the agency failed to ensure the medications listed in patient's current medication profile were updated, accurate, and medications were not expired for two of 15 sampled patients (Patients 2 and 5) when: 1. For Patient 2, two medications in the comfort kit (a hospice emergency kit containing small supply of medications kept in the home to rapidly treat symptoms of terminal illness) were expired and readily available for use. This failure increased the potential for Patient 2 not to be able to receive the comfort medications immediately to meet Patient 2's needs. In addition, Patient 2's primary care giver (PCG) would not be able to identify the effectiveness of the comfort medications as ordered. 2. For Patient 5, one medication, Flagyl powder (an antibiotic), was not available for use at home but still listed in Patient 5's current medication list. This failure had the potential for Patient 5 and Patient 5's PCG not to be able to use the antibiotic powder for wound treatment as ordered by the physician. Findings: 1. On April 11, 2022, Patient 2's record was reviewed. Patient 2 was admitted to the agency with a Start of Care (SOC) date of January 22, 2021, with diagnoses which included cerebral infarction (a condition as a result of disrupted blood flow to the brain), heart failure and chronic obstructive pulmonary disease (COPD - lung disease). Patient 2 resides in a board and care facility. On April 12, 2022, at 9:30 a.m., a home visit was conducted with Registered Nurse (RN) 1 for Patient 2. Patient 2 was observed lying in a hospital bed awake, alert, and able to respond verbally. On April 12, 2022, at 10:15 a.m., a concurrent interview and medication review was conducted with RN 1. During the medication review of the contents of the comfort kit the following were observed: - The medication Roxanol (Morphine Sulfate - used for pain) 20 mg/ml (milligram/milliliter - a unit of measurement) 0.25 ml SL (sublingual - under the tongue) every two hours as needed had an expiration date of January 22, 2022; and - The medication Levsin (used for excessive secretions) 0.125 mg, one tablet oral (SL) every six hours as needed for excessive secretions had an expiration date of January 17, 2022. RN 1 stated she had not checked the medications in the comfort kit stored in Patient 2's refrigerator for a while. RN 1 stated she should have included the comfort kit medications when she reconciled Patient 2's current medications during every home visit. On April 13, 2022, at 11:20 a.m., a concurrent interview and review of Patient 2's current medication profile was conducted with the Director of Patient Care Services (DPCS). The DPCS stated the contents of comfort kit which included the Roxanol and the Levsin medications stored in Patient 2's refrigerator should have been inspected by RN 1, during every home visit. 2. On April 12, 2022, Patient 5's record was reviewed. Patient 5 was admitted to the agency on February 10, 2021, with diagnoses which included heart failure and pressure ulcer (damage to the skin and underlying tissue). On April 12, 2022, at 11:35 a.m., a home visit to Patient 5 was conducted with Licensed Vocational Nurse (LVN) 1. The home medication profile was reviewed with LVN 1 and Patient 5. Patient 5's medication profile indicated, "...Medication...Flagyl powder...topical affected area..." On April 12, 2022, at 12:15 p.m., an interview with LVN 1 was conducted. LVN 1 stated the Flagyl powder was not available. LVN 1 stated Flagyl powder should be available, as ordered by the physician. In a concurrent interview, Patient 5 stated he had not been using the Flagyl powder for his affected area (pressure ulcer). On April 13, 2022, at 11:30 a.m., the Director of Patient Care Services (DPCS) was interviewed. The DPCS stated the Flagyl powder should not have been on Patient 5's medication profile. The DPCS stated the physician was not called in order to discontinue the Flagyl powder for Patient 5. The DPCS stated the nurse should have verified if the medication Flagyl powder was still being used for Patient 5. On April 14, 2022, the agency's policy and procedure titled, "Ongoing Comprehensive Assessments," revised October 2019, was reviewed. The policy and procedure indicated, "...The nurse will assess the patient on each visit, for...Compliance with treatments and medication regimen..." The agency's policy and procedure titled, "MEDICATION PROFILE," dated September 2020, was reviewed. The policy indicated, "...Patients receiving medications...will have a current, accurate medication profile in the clinical record. Medication profiles will be updated for each change to reflect current medications and new...or discontinued medications..."

Based on observation, interview, and record review, the agency failed to ensure the wound care treatment, frequency, medications and supplies were included in the patient's Plan Of Care (POC) for one of 15 sampled patients (Patient 2). This failure increased the potential for Patient 2's primary caregiver (PCG) not to follow the frequency of dressing changes and the proper steps in performing wound care treatment to avoid the development of infection. Findings: On April 11, 2022, Patient 2's record was reviewed. Patient 2 was admitted to the agency with a Start of Care (SOC) date of January 22, 2021, with diagnoses which included cerebral infarction (a condition as a result of disrupted blood flow to the brain), heart failure and chronic obstructive pulmonary disease (COPD - lung disease). Patient 2 resides in a board and care facility. The nurse's notes dated March 29, 2022, and April 5, 2022, were reviewed. The notes indicated Patient 2 had a small skin tear in the left lower leg, with dressing intact. The agency's form titled, "CURRENT TREATMENT / MEDICATIONS / DURABLE MEDICAL EQUIPMENT (DME)," for Patient 2 was reviewed. The current form did not indicate the skin tear treatment, frequency of treatment, and supplies for wound treatment. The Plan Of Care (POC) summary dated March 30, 2022, was reviewed. The POC did not include the wound care treatment, medication, supplies and frequency of dressing changes for Patient 2's skin tear in her left lower leg. On April 12, 2022, at 9:30 a.m., a home visit was conducted with Registered Nurse (RN) 1 for Patient 2. Patient 2 was observed lying in a hospital bed, awake, alert, and able to respond verbally. On April 12, 2022, at 9:45 a.m., Patient 2 was observed with a dressing on her left lower leg. On April 12, 2022, at 10:25 a.m., a concurrent interview and POC review was conducted with RN 1. RN 1 stated Patient 2 had skin tear on her left lower leg. RN 1 stated she would do the following: - Cleanse the wound with normal saline or wound cleanser; - Pat and dry the wound area; and - Apply the Hydrocellular dressing over the wound area. RN 1 was not able to find documented evidence of the skin tear treatment, frequency and supplies needed for dressing changes in Patient 2's current POC. RN 1 stated the skin tear treatment, frequency and supplies should be included in the current POC. On April 13, 2022, at 11:14 a.m., a concurrent interview and POC review was conducted with the Director of Patient Care Services (DPCS). The DPCS was not able to locate documented evidence of skin tear treatment, frequency and supplies needed for the wound care treatment in Patient 2's current POC. The DPCS stated the skin tear treatment, frequency and supplies for wound care treatment should be included in Patient 2's current POC. The agency's policy and procedure titled, "PLAN OF CARE," dated October 2019, was reviewed. The policy indicated, "...The care provided to the patient must be in accordance with the plan of care...The written plan of care will contain...Drugs and treatments..."

Based on observation, interview, and record review, the agency failed to ensure the Durable Medical Equipment (DME) being used at home to meet the patient's needs were included in the current Plan of Care (POC) for one of 15 sampled patients (Patient 2). This failure had the potential for Patient 2's primary caregiver not to be educated with the care and use of the DME necessary for the management of Patient 2's terminal illness. Findings: On April 11, 2022, Patient 2's record was reviewed. Patient 2 was admitted to the agency with the Start of Care (SOC) date of January 22, 2021, with diagnoses which included cerebral infarction (a condition as a result of disrupted blood flow to the brain), heart failure and chronic obstructive pulmonary disease (COPD - lung disease). Patient 2 resides in a board and care facility. The Plan of Care (POC) dated March 30, 2022, was reviewed. The POC indicated Patient 2 had an order for oxygen via (by) NC (nasal cannula - a device used to deliver oxygen through the nose) dated January 22, 2021. The POC did not include the DME and supplies. On April 12, 2022, at 9:30 a.m., a home visit was conducted with Registered Nurse (RN) 1 for Patient 2. Patient 2 was observed lying in a hospital bed awake, alert, and able to respond verbally. On April 12, 2022, at 9:38 a.m., the following were observed by Patient 2's bedside: - A portable oxygen concentrator (a medical device used to deliver the higher amounts of oxygen); - A humidifier (a plastic container used to add moisture to the air) approximately half full of water; and - A nasal cannula oxygen tubing attached to the humidifier. On April 12, 2022, at 9:54 a.m., a concurrent interview and review of Patient 2's POC was conducted with RN 1. RN 1 was not able to locate documented evidence the DME and supplies were listed in the current POC. RN 1 stated the DME and the oxygen supplies ordered at the Start of Care (SOC) on January 22, 2021, should have been listed in Patient 2's current POC. On April 13, 2022, at 11:27 a.m., a concurrent interview and POC review was conducted with the Director of Patient Care Services (DPCS). The DPCS acknowledged the DME and oxygen supplies were not written in Patient 2's current POC. The DPCS stated the DME and oxygen supplies should be included in the POC. The agency's policy and procedure titled, "PLAN OF CARE," dated October 2019, was reviewed. The policy indicated, "...The written plan of care will contain...DME and medical supplies necessary to meet patient needs..."

Based on observation, interview, and record review, the agency failed to ensure the patient's primary caregiver (PCG) followed the standard infection control precautions in handling and care of the patient's oxygen nasal cannula tubing and oxygen humidifier for one of 15 sampled patients (Patient 2). This failure increased the potential for Patient 2 to be at risk for exposure to respiratory infection. Findings: On April 11, 2022, Patient 2's record was reviewed. Patient 2 was admitted to the agency with a Start of Care (SOC) date of January 22, 2021, with diagnoses which included cerebral infarction (a condition as a result of disrupted blood flow to the brain), heart failure and chronic obstructive pulmonary disease (COPD - lung disease). Patient 2 resides in a board and care facility. The Plan of Care (POC) dated March 30, 2022, was reviewed. The POC indicated Patient 2 had an order for oxygen via (by) NC (nasal cannula - a device used to deliver oxygen through the nose) dated January 22, 2021. On April 12, 2022, at 9:30 a.m., a home visit was conducted with the Registered Nurse (RN) 1 for Patient 2. Patient 2 was observed lying in a hospital bed awake, alert, and able to respond verbally. On April 12, 2022, at 9:38 a.m., the following were observed in Patient 2's bedside: - A portable oxygen concentrator (a medical device used to deliver the higher amounts of oxygen); - A humidifier (a plastic container used to add moisture to the air) approximately half full of water; and - A nasal cannula oxygen tubing attached to the humidifier. The oxygen nasal cannula tubing was observed hanging over the decorative floral arrangement at Patient 2's bedside. The oxygen cannula tubing was left exposed. On April 12, 2022, at 10:30 a.m., RN 1 was interviewed. RN 1 stated she had seen the oxygen nasal cannula tubing hanging at the bedside when she visited Patient 2 on April 5, 2022. RN 1 stated she did not know when Patient 2 had last used her oxygen. RN 1 stated she should have disposed the nasal cannula tubing and the humidifier. On April 13, 2022, at 11:30 a.m., a concurrent interview and review of Patient 2's current POC was conducted with the Director of Patient Care Services (DPCS). The DPCS stated RN 1 should have asked Patient 2's primary caregiver when Patient 2 had used her oxygen. The DPCS stated RN 1 should have identified in her last visit on April 5, 2022, the nasal cannula tubing had been left exposed at the bedside. The DPCS stated RN 1 should have disposed the used oxygen nasal cannula tubing, and the humidifier container. The agency was not able to provide specific policy and procedure related to the care of oxygen cannula tubing and humidifier when not in use by the patient at home.