Every finding on record at Hospice of Huntington, Inc.

Observed in Record Review. In 1 of 4 patient records reviewed, the surveyor noted for RRHV#4, the nurse inaccurately documented the wound as closed however the would had eschar in wound bed which rendered the wound unstageable. The inaccurate documentation was discussed with the VP of clinical services and the managers.

Observed in Record Review. In 1 of 3 patient records reviewed, the organization failed to provide discharge planning. In RRLiveDC#1 and RRLiveDC#2, there was no documentation in the records of discharge planning having been provided. This was discussed with the VP of Clinical Services and managers.

Observed in Patient Home. In 1 of 4 home visits conducted, the surveyor observed the organization had not ensured the clinical followed standard precautions that including cleaning equipment after use. For example in RRHV#4, the nurse utilized a non-disposable retractable tape measure to measure the wound to the left leg lower extremity. She touched the wound with the tape measure, retracted the tape measure without cleaning the tape measure prior to retracting and placed in her lab jacket. The nurse then utilized the same retractable tape measure from her pocket to measure an open area to the patient's buttock, with the same retractor. This was discussed with the nurse conducting the visit, the manager onsite observing the visit and the VP of clinical services. Observed in Patient Home. In 1 of 3 home visits conducted, the surveyor noted during RRHV#1, the organization had not ensured that the clinician followed the organization's bag technique that included cleaning the vital sign equipment prior to placing the equipment back in the nursing bag. This was discussed with the nurse conducting the visit and the clinical manager observing the visit.

Observed in Patient Home. In 2 of 4 home visits conducted, the surveyor noted the clinician failed to conduct an effective medication evaluation on the follow up nursing visits. For example in RRHV#1, the patient is taking nitroglycerin 0.4mg SL one under tongue repeat dose after 5min for a max of 3 doses, RRHV#4, Glycerin suppository 2GM times 4 days if no bowel movements, however these medications were not on the medication list. This was discussed with the nurse conducting the visit, the manager onsite during the visit and the VP of Clinical services.

Observed in Record Review. In 1 of 4 patient records reviewed, the surveyor noted in RRHV#4, the nurse documented wound care daily and prn, but did not document where the wound was located. This was discussed with the VP of Clinical services and the managers.

Observed in Record Review. In 2 of 3 patient records reviewed, the agency did not ensure the patient record contained accurate information as required by policy. In record review of RRLiveDC#1, the patient revoked the hospice benefit for treatment, however, there was not a discharge summary completed or sent to the physician. For RRLiveDC#2, the patient was discharged to home/community, however a discharge summary was not completed. This was discussed with the VP of clinical services and clinical manager.

Observed in Emergency Management Session. The Emergency Management Plan did not discuss how the agency would obtain and replenish medical supplies. This was discussed with the safety officer and the VP of Clinical Services. Observed in Emergency Management Session. The Emergency Management Plan did not discuss how the agency would obtain and replenish non-medical supplies such as food, water and other provisions.. This was discussed with the safety officer and the VP of Clinical Services. Observed in Emergency Management Session. The Emergency Management Plan did not discuss how the agency would obtain and replenish medications and related supplies. This was discussed with the safety officer and the VP of Clinical Services.

Observed in Emergency Management Session. The Emergency Management Plan did not discuss how the agency would notify state and local officials of on-duty staff that they are unable to reach during an emergency This was discussed with the safety officer and the VP of Clinical Services.

Observed in Emergency Management Session. The Emergency Management Plan did not identify how the agency would notify physicians, volunteers, entities providing services under arrangement or relevant federal, state and tribal staff when they activate their EOPS plan. This was discussed with the safety officer and the VP of Clinical Services.

Observed in Record Review. In 3 of 3 patient records reviewed, for active patients, there was no initial spiritual assessment or initial psychosocial assessment completed within the first 5 days as required by regulation and agency policy. For example in record HV#1 there was no initial spiritual assessment completed within 5 days of admission and no documentation by the Chaplin during the first benefit period as to why there was no contact with the patient or family. There also was no psychosocial initial assessment conducted within the first 5 days for this patient and no documentation explaining why the visit was not made. In clinical record HV#2 there was no initial spiritual assessment conducted within the first 5 days after admission and the first documentation explaining the lapse occurred 10 days after admission. In clinical record HV#3. there was no spiritual assessment conducted in the first 5 days after admission.. There was a communication note written on day 8 after admission but no follow up for 1 month. This was discussed with the PCM (patient care manager), the Lead MSW and the VP.

Observed in Record Review. In 2 of 3 patient records reviewed, for social worker documentation, there were no measurable outcomes or target time frames included for the estsblished goals as required by regulation andagency policy. This was discussed with the PCM and the VP of Clinical Services. (HV#1, HV#2)

Observed in Patient Home. At the end of home visit #2 with the LPN, she packed up her bag and pick up her basket of used equipment - she had placed a plastic basket on the floor in the patient's room without a barrier and used it to put her used vital sign equipment in - and walked into a public restroom to clean her equipment. She placed her clinical bag on the floor of the restroom without a barrier as required by agency policy and proceeded to clean her equipment with a non disinfecting wipe which the packaging said was for hand hygiene. This was also observed by the PCM. Observed in Patient Home. During home visit #2 with the LPN (licensed practical nurse), she failed to follow agency policy by not cleansing her hands on multiple occasions after being in contact with the patient and her equipment / tablet. As an example, she took the patient's blood pressure, then documented it in her tablet, th went into her clinical bag for the pulse ox then returned to finish taking the patient's vital signs all without cleansing her hands. This was also observed by the PCM.

Observed in Patient Home. In 2 of 3 home visits conducted, During medication review with the patient care manager (PCM) at home visit #1, the medications on the agency's MAR (medication administration record) and the facility's MAR did not match. For example the agency's MAR listed Prednisone a 10mg prn, the facility's MAR said daily; Ativan 0.5mg on the agency's MAR was recorded as TID on the facility's MAR; The nebulizer treatment was ordered as Q4H PRN but the facility was giving it twice a day per their MAR; Anora and Breo eppiltas were present on the agency's MAR but not on the facility's MAR. In discussion with the facility's nurse, she stated the their pharmacy had merged with another pharmacy and they hadn't been able to synchronize their systems. In reviewing the previous month's medications administered by the facility, this surveyor observed that no nebulizer treatments had been given for the last 3 weeks of the previous month. The facility nurse said that sometimes their given but not signed off. The PCM was present for these discussions. At home visit HV#2, similarly the agency and facility MARs did not match. The medications Calmoseptine, Ativan, Miralax, and hydrocortisone 0.5% topical cream were not listed on the facility MAR. The facility MAR also demonstrated that in the previous week the patient had not receive any scheduled Tramadol for one week. There was no explanation or documentation anywhere in the record and the facility nurse said that she knew nothing. This was also observed by the PCM.

Observed in Document Review. The pharmacy contract did not include expectations for performance within the contract to support agency review of services. This was discussed with the Administrator.