Every finding on record at Hospice of the Panhandle, Inc.

Based on record review and staff interview, it was determined the facility failed to ensure care and services are provided by hospice home health aides (HHAs) and skilled nursing (SN) services in accordance with the plan of care for four (4) of seventeen (17) active patients (patients #7, 10, 19, and 23). This failure has the potential to affect all patients provided care by the facility. --- A review of the medical record for Patient #7, start of care (SOC) date 01/14/23, revealed that HHA services were initiated on 01/24/23 at two (2) times a week. There were two (2) missed visits documented - on 01/25/23 for ";inclement weather" and on 02/07/23 for ";short staffed". There was no other documentation in the record that the family was notified or consulted for the change in the plan of care for any of the missed visits, and the visits were not made up on another day of the week. A review of the medical record for Patient #10, SOC date 12/14/22, revealed that HHA services were initiated on 12/20/22 at three (3) times a week, and increased to five (5) times a week the following day, on 12/21/22. On 01/31/23, the visits were decreased to two (2) times a week. There were documented missed visits on 12/22/22 and 01/25/23 for ";inclement weather" and on 12/23/22,12/24/22,12/30/22, and 01/02/23 for ";holiday scheduling". There was one (1) undocumented missed visit for the week starting on 12/25/22. There was no documented evidence that the family was notified or consulted for the change in the plan of care for any of the missed visits. A review of the medical record for Patient #19, SOC date 09/23/22, revealed that HHA services were ordered ten (10) times a week. There were documented missed visits on 12/22/22 times two (2) for ";inclement weather" and on 12/26/22 times two (2), 12/30/22, and 01/02/23 times two (2) for ";holiday scheduling". There was one (1) undocumented missed visit for 12/30/22. There was no documented evidence that the family was notified or consulted for the change in the plan of care for any of the missed visits. A review of the medical record for Patient #23, SOC date 01/23/23, revealed that SN services were ordered two (2) times a week. There was one (1) documented visit on the week starting on 01/29/23, and a telephone call regarding medical equipment. There was no corresponding missed visit documented for the same week. An interview was conducted on 02/15/23 at 2:40 p.m. with the Chief Clinical Officer (CCO) regarding Patients #7 and 19. The CCO confirmed that all missed visits were to be documented. For Patient #7, the CCO stated: ";The HHA documented a missed visit for short staffing and that is an unacceptable reason for missing a visit." The CCO also confirmed that there was an opportunity to make up the two (2) missed visits on another day of the week, as the visits were ordered two (2) times a week, but it was not done. Regarding Patient #19, the CCO confirmed that the HHA visits were ordered five (5) times a week, and harder to make up, but staff are available to work the weekends. The CCO then conceded there was no documentation of any contact with the family regarding the changes in the plan of care for the missed visits in any of the records for Patients #7 or 19. An interview was conducted on 02/15/23 at 9:50 a.m. with the Nurse Manager (NM) regarding Patient #10. The NM stated that there were missed visits documented for inclement weather and holiday scheduling. The NM stated there are no policies regarding missed visits, but the protocol is to make telephone calls to the patient and families for updates and rescheduling, especially during inclement weather and holiday staffing. The NM confirmed that there is no clearly defined meaning of ";holiday staffing"; it is generated in a drop down box that the HHA documents, and there is no other documentation from the HHA regarding missed visits. The NM then conceded that there were no documented telephone calls from any staff to Patient #10 or the family around the time of the missed visits. An interview was conducted on 02/15/23 at 2:20 p.m. with the Social Services Manager (SSM) regarding Patient #23. The SSM stated Patient #23 had skilled nursing orders for two (2) times a week; on the week starting 01/29/23, there was one (1) visit and a telephone call documented. The SSM then confirmed that a telephone call regarding medical equipment was not considered a visit. The SSM conceded there was no other documentation of a missed visit in the records.

Based on record review, document review, and staff interview it was determined the agency failed to ensure all needs of the patient were met, by not performing a complete updated comprehensive assessment upon admission for respite care to the agency's Inpatient Facility (IPF) for two (2) out of eight (8) respite patients receiving care (patients #1 and 4). This failure has the potential to negatively impact all patients presenting to the IPF for respite care. Findings include: A review of a policy titled "Wound Care," last revised 09/2020, states in part: "Policy: The palliative treatment of wounds will focus on comfort and quality of life consistent with patient and family goals ... Procedure: (Agency) Best Practice: 1. Wounds should be visualized, measured, and documented on the first visit of each week. Wounds must be added to the "wound man" diagram ... 2. Each wound should be in the care plan with specific dressing orders/instructions, including frequency and updated as appropriate ..." A review of a document titled "Hospice of the Panhandle Inpatient Facility Respite Standing Orders," states in part: " I. General Patient Care: * Admit to IPF Respite * Vital Signs on admit and PRN (as needed) ... *Wound/skin care - follow wound care guidelines recommendation sheet for treatment options with available wound care products on hand ... " A review of a document titled, "Covid Isolation Process for the IPF," last updated 09/30/21, revealed it states in part: "... Rounding/care tips ...*Vital signs are not necessary. Obtain any palpable/observatory vitals such as pulse and respirations ..." A medical record review was conducted for patient #1. The patient was admitted to Hospice care on 10/08/20 with a diagnosis of Congestive Heart Failure. The patient arrived to the agency's IPF for respite care in the evening on 11/08/21. On 11/08/21 at 9:01 p.m., Registered Nurse (RN) #1 completed the "Update to the Comprehensive Assessment". Under "Skin Breakdown," it states: "Stage 1 (one) to buttocks, unstageable to the right heel ... Notes: ... Wounds: right heel has black pressure area, see wound assessment ..." No wound assessment template was implemented, or any additional wound documentation noted during the inpatient respite stay. A medical record review was conducted for patient #4. The patient was admitted to Hospice care on 06/23/21 with a diagnosis of senile degeneration. On 1/23/22, the patient and the patient's spouse both tested positive for COVID-19. The patient's spouse was unable to care for the patient due to their illness, and the patient was accepted to the agency's IPF for respite care. On 01/23/22 at 4:30 p.m., the "Update to the Comprehensive assessment" was completed. The RN documented the values for "Blood pressure-systolic/diastolic, O2 Sat (Oxygen Saturation), Respiration, and Apical Pulse'' as "0 (zero)." Documentation further states: "Patient Measurements, Comments: VS (Vital signs) were deferred due to COVID+ (COVID-19 positive) status." No documented values for Blood pressure, oxygen saturation, pulse, respirations, or temperature was noted in the patient chart as of the date of this review, 01/25/22. An interview was conducted with Nurse Manager (NM) #1 on 01/24/22 at 1:34 p.m. Regarding patient #1's initial assessment to the IPF, NM #1 stated, "For respite care, we are to do an initial head-to-toe assessment. We do not take pictures of wounds, just select click boxes and add the wound assessment which includes a body outline to mark where the wounds are." An interview was conducted with NM #1 on 01/25/22 at 8:30 a.m. Regarding patient #1, NM #1 stated, "Nursing followed the policy for the respite admission, except for the wound assessment piece." An interview was conducted with the Clinical Director on 01/25/22 at 9:30 a.m. Regarding patient #4, the Clinical Director stated, "Vital signs are not taken in COVID-19 positive patients, due to they are at imminent risk of death, and this is not necessary. We cannot do blood pressure or listen to the pulse and lungs with a PAPR (Powered Air Purifying Respirator). We have no disposable equipment available. No temperatures are taken either." A telephone interview was conducted with the Medical Director on 01/25/22 at 10:50 a.m. Regarding patient #4, the Medical Director stated, "Up until most recently, all COVID positive patients were a general inpatient. This is our first respite patient with COVID. We are starting vitals today for this patient. We will do the vitals per standing order for respite care."