Every finding on record at Hopehealth Hospice & Palliative Care

Observed in Record Review. In 1 of 5 patient records reviewed, the organization failed to provide the scope and frequency of services necessary to meet the patient's and family's needs as were assessed during the admission process by the hospice team.. In review of RRNHV #4 the Psychosocial Assessment completed at the start of care stated that the wife was interested in home health aide (HHA) services for the patient however the organization failed to provide home health services and instead provided the patient and wife with information on an agency where they could get HHA services. This was validated with the Senior Director of Quality & Compliance.

Observed in Individual Tracer. In 9 of 20 patient records reviewed, The surveyor noted that (RRHV#1) the psycho-social assessment was not completed until day ten and there was no evidence that the patient had deferred the visit. Also, there was no bereavement risk assessment completed until day ten. In (RRHV#3), the psycho-social assessment was not completed until day six. Also, in (RRNHV#7) there was no psycho-social assessment completed until two months after the patient was admitted. A bereavement risk assessment was never completed for (RRNHV#7, or (RRNHV#11). In (RRNHV#14) the social worker was refused by the patient, and a psycho-social and bereavement assessment was not completed by other members of the interdisciplinary team. In (RRNHV#17), the psycho-social assessment and bereavement risk assessment was not completed until day seven. In (RRNHV#18) the spiritual and bereavement risk assessments were not completed until day ten and there was no evidence that a psycho-social assessment was completed by either social services or nursing. In (RRNHV#19) there was no evidence that a psycho-social assessment or bereavement risk assessment was completed in five days, or since. This was confirmed with the quality director.

Observed in Individual Tracer. In 6 of 20 patient records reviewed, The surveyor (RRHV#2) noted that the patient had recently experienced recent seizures. The certification and nursing assessments acknowledged seizures; however, there was no description of the severity of the seizures documented in the patient record, The surveyor noted that the nurse discussed the use of lorazepam for seizures with the caregiver. In (RRNHV#8), the surveyor noted that the assessment indicated that the patient had a stage 3 wound; however, a wound assessment had not been completed and there was no evidence in the record that the nurse had observed the wound. Also, the patient was prescribed an anticonvulsant and had a recent history of seizure; however, there was no assessment of the severity of seizures. In (RRNHV#10-Pedi), the surveyor noted that the patient had several medications ordered for seizure management and the parent acknowledged that the child was at risk for future seizures; however, there was no evidence in the record that a seizure assessment had been completed, that described the severity of the symptoms. In (RRNHV#11), there was no assessment of the patients diabetes and blood glucose monitoring even though the physician had ordered that blood glucose monitoring occur daily as the patient's insulin was discontinued. In (RRNHV#13) there was no assessment of the severity of anxiety, in (RRNHV#15) there was no assessment of the patient G-tube insertion site or the patient's safe use of oxygen in the home when it was initiated in February or since. In (RRNHV#19) there was no assessment of the severity of ascites, itching or nausea and vomiting as noted in the visit notes. This was confirmed with the director.

Observed in Record Review. In 2 of 20 patient records reviewed, The surveyor noted (RRNHV#9) that the plan of care orders were not updated and a verbal order was not put into writing as required by organizational policy. The physician order indicated that the PT INR was to be completed every 2 weeks. A nurse visit note indicated that the order was changed and that the INR was to be obtained in three weeks; however, the verbal order was not written and the dosing for the Warfarin change, was not documented in the plan of care or physician order. Also, in (RRNHV#11) the physician summary indicated that the patient's blood glucose was to be monitored daily; however, there was no plan of care or order for blood glucose monitoring. This was confirmed with the director.

Observed in Document Review. During a review of the Hospice QAPI program, the quality director confirmed that the program had not involved all services provided by the organization, specifically, bereavement and contracted services.

Observed in Record Review. In 2 of 20 patient records reviewed, The surveyor noted that (RRNHV#15) the plan of care included orders to assess the G-tube site every visit; however, there was no evidence that the assessment was completed on the initial assessment or on the next three nursing visits. It was not assessed until week four. In (RRNHV#17), the surveyor noted that the plan of care included orders for MSW/social services 1 x a month; however, there was no evidence in the record that an assessment was completed until month two and no further visits were provided for the next three benefit periods. There was no evidence that the patient had refused.

Observed in Individual Tracer. In 1 of 2 records with home health aide, The surveyor noted (RRHV#3) that there was no evidence in the record that the hospice aide had been supervised for a period of 30 days in February to March. This was confirmed with the quality director.

Observed in Record Review. In 20 of 20 patient records reviewed, The surveyor noted that there was no evidence that the governing body and leadership had established requirements to support patient care treatment and services as evidenced by a condition level finding at 418.54, 418.56 and 418.100 as significant issues with care planning, physician orders and there were instances of not following physician orders as per policy.

Observed in Tracer Activities. During a review of contracts, the administrator confirmed that their contracts did not include how the organization would evaluate their contracted services, specifically pharmacy, DME, nursing homes and GIP/respite.

Observed in Individual Tracer. In 2 of 6 home visits conducted, The surveyor noted (RRHV#1) that an E-tank was stored in a standing position without support and there was no evidence that the patient/caregiver had been educated about how to store the tanks. Also, in (RRHV#3) the surveyor observed six E-tanks stored upright without support. There was no evidence in the record that the patient or the ALF staff were educated about the safe storage of the tanks. This was confirmed with the quality director.

Observed in Document Review. Upon interview, the quality director and administrator confirmed that the organization had not developed a process to evaluate their contracted services.

Observed in Individual Tracer. In 1 of 3 patient records for SNF, The surveyor noted (RRHV#6) that the patient resided in a skilled nursing facility. There was no information in the plan of care about which providers were responsible for performing the respective functions including medication administration, one-to-one feeding, Hoyer lift transfers and other care needs. This was required in the contract and confirmed with the quality director.

Observed in HR File Review. In 1 of 2 volunteer records reviewed, the Volunteer Coordinator confirmed that the required Massachusetts' home health aide registry check (as part of the background check) was not found in the record.

Observed in Record Review. In 1 of 4 patient records reviewed, the organization did not plan the patient's care. The hospice plan of care did not include all services, interventions, and goals needed for the management of the terminal illness and related conditions. In RR #7, the Nurse Surveyor noted the patient had a secondary diagnosis of diabetes mellitus type 2 and the nurse documented in her clinical narrative note that the patient is checking the blood sugar levels 3 times a day; however, the plan of care did not address the diagnosis of Diabetes Mellitus to include blood sugar monitoring and education. This was confirmed with the Director of Compliance.

Observed in Patient Home. In 1 of 3 home visits conducted, The organization failed to implements its infection prevention and control activities. During HOSV#1 the hospice surveyor noted that the Nurse failed to remove gloves to clean hand during wound care. This was confirmed with Director of Compliance.

Observed in Record Review. In 3 of 7 patient records reviewed, The surveyor noted that the social work services were not based on the patient's psychological assessment and the patient's and family's needs and acceptance of these services. In RR#1, RR#7,and RR#9 based on the assessment and visit notes the hospice surveyor noted that the social worker documented what interventions/services she is providing such as encouragement to express feelings, emotional support, community resources but there was no psychosocial plan of care developed to include measurable outcomes, goals and interventions to meet the patient's/family's needs. This was confirmed with the Director of Quality.

Observed in Record Review. In 9 of 10 patient records reviewed, the agency failed to document a spiritual assessment that included concerns or needs identified by the patient or family, such as despair, suffering, guilt, and forgiveness. for example in RR #7 records reviewed the spiritual care assessment documented the patient/family connection to faith and church but the assessment section of the spiritual needs evaluation was left blank. Spiritual Needs were not assessed or documented in RR # 1-9. This was confirmed with Director of Quality.

Observed in Patient Home. In 1 of 3 home visits conducted, during the medication reconciliation with the nurse on HOSV#1, they nurse surveyor noted that 1 of the medication that was in the patient home was missing on the organization medication profile. For example the patient prefilled medication packet had Methotrexate as part of the patient daily medication regimen, but the medication was no listed on the organization medication profile. This was confirmed by the Director of Compliance. .

Observed in Record Review. In 2 of 3 patient records reviewed, the hospice plan of care did not identify how the facility care plan was integrated with hospice. During review of RR#8 and RR# 9 the care plan did not specify the interventions of the facility staff. For example RR#9 , patient wound to be performed daily , the intervention did not specify which provider was responsible for the management of the wound care. this was confirmed by the Director of Compliance.