Every finding on record at Hospice and Palliative Care of Cabarrus County

Based on clinical record review, agency policy, and staff interviews, the agency failed to follow the plan of care [POC] related to obtaining INRs [International Normalized Ratio-blood test to measure how long it takes for blood to clot] for 1 of 2 patients receiving Coumadin [blood thinner] [# 3]. The findings included: --- The policy, Hospice IDG [interdisciplinary group] Care Planning Process Policy [1/23/24], was provided by the accreditation specialist on 8/28/24 at approximately 12 noon. The policy stated, ";...In order to assure that care provided is appropriately planned to meet each patients specific needs and problems..." Patient # 3 had a Start of Care date of 8/6/24 with a terminal diagnosis of protein calorie malnutrition [inadequate intake of food as a source of protein, calories, and other essential nutrients]. Review of the Plan of Care [POC] for the certification period 8/6/24 to 11/3/24 included orders for SN [skilled nurse] 2 times a week for 8 weeks and 2 PRN [as needed] and ";obtain INR lab on 8/9/24 and call results to provider." Review of the clinical record revealed the following documentation: 8/9/24 RN # 7 documented, ";INR 2.1. Notified _______ [name] NP [nurse practitioner], new coumadin orders received. 2.5 mg daily, recheck INR 8/13..." Review of the clinical record revealed no SN visit was made on 8/13/24 to obtain the INR as indicated in the POC. The next SN visit with INR was obtained on 8/12/24. On 8/12/24 RN # 6 documented the following information, ";...INR obtained. Results 4.0. Orders received to hold coumadin until INR obtained at next SNV [skilled nurse visit] ..."The next SN visit was made on 8/15/24. 8/15/24 RN # 10 documented, ";INR obtained. Results 2.2. Orders received to start warfarin [coumadin] 2 mg daily and recheck INR in one week 8/22/24..." Review of the clinical record revealed no SN visit was made on 8/22/24 to obtain the INR. The next INR was obtained on 8/23/24. During an interview with the accreditation specialist on 8/28/24 at approximately 2:30 pm. During the interview the accreditation nurse confirmed the INRs were not obtained/monitored in accordance with the Plan of Care.

Based on agency policy, observation, and staff interviews the hospice aide failed to perform hand hygiene after contact with a contaminated body site for 1 of 2 observations of personal care. (patient #21) Findings included: --- A policy, Hand Hygiene Policy (Hospice), (revised 04/15/2024) received on 08/27/24 at 11:21 AM from the Quality Accreditation Nurse stated, ";Wearing gloves are not a substitute for hand hygiene... Alcohol-based hand rub hand hygiene indications are: ... After contact with a contaminated body site, before moving to a clean body site... or contact with body fluids..." Patient # 21 was admitted on 02/14/2024 with a diagnosis of chronic congestive heart failure (a condition in which the heart doesnt pump blood adequately) . The plan of care for 08/12/24-10/10/24 included orders for hospice aide 24/7 (continuous). Patient #21 was a long-term care patient in the agencys inpatient unit. An observation visit was conducted on 08/26/2024 at 12:50 PM with hospice aide (HHA) #7 with patient #21. HHA #7 failed to remove contaminated gloves and perform hand hygiene after cleaning stool during personal care. HHA #7 handled patient #21s urinary catheter tubing, sheets, and pillows with the contaminated gloves. During an interview conducted on 08/26/2024 at approximately 1:30 PM HHA #7 stated, ";I was nervous, I would normally change gloves and do the hands [perform hand hygiene] before touching the catheter tubing." During an interview on 08/26/2024 at approximately 1:40 PM the Clinical Operations Manager stated, ";My expectation for hand hygiene is, they [all staff] should change the gloves, perform hand hygiene, and put on new gloves after contacting any contaminated areas."

Based on policy review, client record review, and staff interview the agency failed to provide aide supervision for 2 of 8 hospice aide records reviewed (#5 and #9). Findings included: --- 2. Patient #9 was admitted on 07/20/24with a diagnosis of cerebrovascular disease (condition effecting blood vessels of the brain). The plan of care for 07/20/24-10/17/24 included orders for skilled nurse visits 1 time a week for 1 week, 3 times a week for 1 week, 2 times a week starting 07/28/24, and 3 PRN (as needed) and home hospice aide (HHA) visits 2 times a week. Review of the clinical record revealed aide visits were made on 07/23/24, 07/25/24, 07/30/24, 08/01/24, 08/13/24, 08/15/24, 08/22/24, and 08/27/24. There was no evidence in the clinical record of any HHA supervisory visits. During an interview on 08/27/24 at 4:00 PM the Clinical Operations Manager stated, ";They [HHA supervisory visits] should be done every 14 days, or more often if there is a problem." Review of policy ";Hospice Aide Supervision Policy" approved 3/18/2024 was received from Employee #1 on 8/28/24 at 12:01 PM. The policy stated," ...hospice aides are closely supervised to ensure their competence in providing care ...at least every 14 days..." 1.Patient #5 had a SOC (start of care) of 7/8/24 and included diagnoses of cerebrovascular disease (stroke), vascular dementia, anorexia, dysphagia (difficulty swallowing), and adult failure to thrive. Hospice aide orders were for 2 times a week. Review of the clinical record revealed hospice aide visits started on 7/16/24. The first supervisory visit was not made until 8/12/24. Interview with Employee #3 on 8/27/24 at 1:27 PM confirmed the first supervisory visit was missed.

Based on agency policy, observation, and staff interviews the agency failed to remove expired supplies from the clean supply storage room located at the in-patient unit. Findings included: --- A policy, Hospice Supply Maintenance Policy (Hospice), (revised 04/15/2024) received on 08/28/24 at approximately 9:36 AM from the Clinical Operations Manager stated, ";Supplies will be checked for expiration date... If outdated, the supplies will be immediately removed from stock and discarded." An observation of the clean supply room was conducted on 08/26/24 at approximately 12:15 PM. Two Sliver Touch foley catheter insertion kits with an expiration date of 04/30/24 and 1 Silver Touch foley catheter insertion kit with an expiration date of 03/31/23 were in supply. During an interview on 08/27/24 at approximately 9:40 AM the Clinical Operations Manager stated, ";Our teams assistant is responsible for.... Rotating and removing expired supplies."

Based on agency policy review, clinical record review and staff interviews the agency failed to follow the plan of care for wound care for 1 of 6 charts with a wound [#11]. The findings included: The policy, Hospice IDG Care Planning Process [10/21/21], was provided by the agency director on 11/3/21 at 9 am. The policy stated, " ...An individualized written plan of care is developed for each patient. The plan of care reflects patient and family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The Plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including ...drugs and treatments necessary to meet the needs of the patient ..." Patient # 11 had a Start of Care [SOC] date of 9/27/21 and a terminal diagnosis of Malignant Neoplasm of Unspecified Site of Right Female Breast. The patient also had diagnoses of Pressure Ulcer of Right Buttock [stage 4] and Pressure Ulcer of Left Buttock [stage 4]. A review of the Plan of Care for the certification period 9/27/21 to 12/25/21 revealed orders for nursing 2 times per week and 3 PRN [as needed] for symptom management and "hospice nurse to perform pressure ulcer care as follows to right lower buttock- cleanse with wound wash, apply AG Alginate and cover with foam dressing ...change drsg [dressing] every other day and PRN for dislodgement, excessive drainage or if it becomes soiled. Hospice nurse to perform pressure ulcer care as follows to left lower buttock - cleanse with wound wash, apply AG Alginate and cover with foam dressing ...change drsg every other day and PRN for dislodgement, excessive drainage or if it becomes soiled. Hospice nurse to perform care to right axilla and breast-- cleanse with wound wash, apply AG Alginate and cover with foam dressing ...change drsg every other day and PRN for dislodgement, excessive drainage or if it becomes soiled." A review of the clinical record revealed on 9/27/21 RN # 1 documented the following information, "Wound 1- Left low buttock: Wound care not provided-refused care. Wound 2- Right low buttock: Wound care not provided-refused wound care. Wound 3- Right axilla and breast: Wound care not provided. Caregiver completed care." On 10/14/21 and 10/28/21 RN # 2 made a routine visit and documented the following information, "Wound 1- care not provided-caregiver completed care. Wound # 2-wound care not provided-caregiver provided care. Wound 3- care not provided. Caregiver provided care." On 10/16/21 RN # 3 made a routine visit and documented the following," Wound 1- care not provided-caregiver completed care. Wound # 2-wound care not provided-caregiver provided care. Wound 3- care not provided. Caregiver provided care." On 10/21/21 RN # 2 made a routine visit and did not provide wound care to wound # 3. The RN documented, "Wound care not provided. Caregiver completed care." During an interview with the agency director on 11/3/21 at approximately 11 am, the agency director confirmed the plan of care was not followed related to wound care.