Every finding on record at Hospice Compassionate Care Services, LLC

Observed in Record Review. In 1 of 2 Live discharge records, it was noted the organization failed to ensure that the patient was informed in advance about the expected outcomes of care and services. For example, in RRDC#1 the patient was discharged from hospice services due to patient no longer terminally ill. The Notification of Medicare Non-Coverage (NOMNC) was provided however, it was issued on the same day the patient was discharged. This finding was discussed and validated by the Hospice management team.

Observed in Record Review. In 1 of 14 patient records reviewed, it was noted that the organization failed to ensure that the plan of care includes all services needed for the palliation and management of the terminal illness and related conditions, including the treatment necessary to meet the patient's needs. For example, during the home visit conducted for record RRHV#1, it was observed that the patient was using oxygen continuously at 2 LPM via nasal cannula. However, a review of the clinical record revealed no documented physician order for the oxygen use. This finding was discussed and validated by the Director of Nursing.

Observed in Record Review. In 2 of 14 patient records reviewed, it was noted that the organization failed to ensure that the plan of care includes all services needed for the palliation and management of the terminal illness and related conditions, including the medical appliances necessary to meet the patient's needs. For example, a review of records of RRHV#1 and RRBR#2, it was noted the plan of care did not include oxygen concentrator as medical appliances necessary to meet the patient's needs. This finding was discussed and validated by the Director of Nursing.

Observed in Record Review. In 7 of 14 patient records reviewed, it was noted that the organization failed to ensure that all documentation entries were appropriately authenticated as per required by policy. (Policy no. C15 Clinical Records). During the review of RRHV#3,RRNHV#3,RRNHV#4,RRNHV#5,RRNHV#6,RRDC#1, some paper clinical documents, such as the Home Oxygen Safety Risk Assessment form, were found to be missing the required title of the individual signing the form. Additionally, in record RRBR#2, the signature was not present. This finding was discussed and validated by the Director of Nursing.

Observed in Patient Home. In 1 of the 2 home visits conducted with home oxygen, (RRHV#3), it was observed that the oxygen cylinder was stored in a closet filled with clothes and boxes. Throughout the entire episode of the home visit, there was no follow up action or re-education provided to the family regarding proper storage of oxygen when not in use. This finding was discussed and validated by the Administrator who was present during the home visit.

Observed in Record Review. In 3 of 7 active patient records reviewed, During HV# 1, HV# 2, and RR# 3's patient record review it was noted the organization had not ensured the plan of care included all services needed for the palliation and management of the terminal illness and related conditions. For example: review of HV# 1's registered nurse (RN) comprehensive assessment revealed HV# 1 had a skin tear on the left forearm and a second skin tear located on the left shin and the family was completing the wound care. Review of the plan of care revealed no documentation of specific wound or wound care being completed by the family. Further review of the RN comprehensive assessment revealed documentation HV# 1 was NPO [nothing by mouth] and was receiving Ensure four times a day via a PEG tube by the family. However, review of the plan of care revealed no documentation on the volume of Ensure provided or if the family was including water for hydration. In addition, the plan of care did not include aspiration precautions. Review of HV# 2's RN comprehensive assessment revealed HV# 2 had a left chest wall port-a-cath that was last accessed approximately two months prior to start of care. However, there was no documentation on the plan of care regarding the left chest wall port-a-cath. In addition, review of HV# 2's patient record revealed HV# 2 was started on oxygen seven days after the start of care. However, review of the update to the plan of care/IDT revealed documentation that HV# 2 was receiving oxygen as needed with no indication how it would be delivered or the Liter flow. Review of RR# 3's RN comprehensive assessment dated approximately 60 days from the surveyor review of the record, revealed documentation RR# 3 had a Stage II right heel pressure ulcer. However, review of the update to plan of care/IDT dated approximately 37 days and two subsequent updates to the plan of care/IDT revealed no documentation of the location of the wound or wound care being provided. This reviewed, discussed, and validated by the Director of Nursing.

Observed in Patient Home. In 2 of 3 home visits conducted, During HV# 2 and HV# 3's home observation the surveyor noted the organization had not implemented the infection prevention and control activities it had planned. For example: during HV #2 and HV# 3 the clinician placed the BP equipment, stethoscope, thermometer, and pulse oximetry into the clinical bag and had not cleansed per the organization Infection Control - Bag Technique PC-110 policy. This was observed, reviewed, and discussed with the Registered Nurse Case Manager present during the visits and confirmed

Observed in Regulatory Review. In 1 of 11 patient records reviewed, During RR# 5's patient record review it was noted the organization had not ensured the patient record contained information that reflected the patient's care, treatment, or services. For example: review of RR# 5' patient record revealed no documentation of an Election of Benefit or an indication regarding a primary physician. This was reviewed, discussed, and validated by the Director of Nursing.

Observed in Record Review. In 1 of 11 patient records reviewed, During RR# 3's patient record review it was noted the organization had not ensured it protected health information against loss, damage, unauthorized alteration, and unintentional change. For example: review of the Initial Plan of Care/Certification of Terminal Illness revealed the Medical Director signed 22 days after the start of care. Review of the patients record revealed the Registered Nurse modified the Initial Plan of Care/Certification of Terminal Illness approximately four months after the Medical Director signed. This was reviewed, discussed, and validated by the Director of Nursing.

Observed in Patient Home. In 1 of 2 home visits conducted with oxygen, During HV# 2's home observation the nurse did not take action when multiple freestanding oxygen cylinders were observed in the home. This was observed and confirmed by the nurse and the Registered Nurse Case Manager during the home observation.