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

Upon patient record review, 1 of 35. (Patient #24) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #24, Admitted to IPU GIP 1/12/24. Order for VO IPU volunteer to provide support to patient and /or family per patient/caregiver request as directed by RN, SW, or VOL Coordinator. PRN frequency not acceptable as base visit frequency.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. In 2 of 6 patient visits, staff failed to follow acceptable standards of practice. Patient #2: RN placed equipment (stethoscope, BP cuff, thermometer) on patient OBT without wiping the surface before or after use and placing it there again. RN returned to kitchen and placed used equipment on kitchen island with no barrier and did not clean surface before or after. RN changed incontinent brief and cleaned stool off patient with disposable wipes as family assisted. RN failed to remove dirty gloves before shifting covers and placing patient on bed pan. Patient #6: Nurse applied gloves without washing hands or sanitizing first. After working around the room and gathering supplies and touching patient linens, SN typed short entry on tablet without changing gloves or sanitizing first x2. She did sanitize hands 3rd time, but keyboard was not cleaned. RN leaned in as performing wound care and patient toes pressed up against her uniform for several seconds.

Upon personnel record review, 1 of 16 (Personnel # 7) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·(C) Shampoo, sink, tub, and bed Personnel #7: HA Competency for shampoo was not specified to include competency for sink, tub and bed type shampoos.

Condition of Participation: Hospices that Provide Inpatient Care Directly.

Upon observation, there was no evidence the hospice inpatient facility tests their power systems in accordance with NFPA 99 and NFPA 110 including the maintenance and testing of alternate power sources and transfer inspection and testing and maintenance and testing of circuitry. Upon review of inspection records dated 7/2023, it was stated "battery tested poorly." A recommendation was added to replace the battery, there is no evidence in the maintenance records that the battery has been replaced. Upon monthly inspection December 20, 2023 it was reported that the generator radiator has a leak, the facility reports that parts have not been received at this time, and repairs have not been completed.

Upon observation, there was no evidence the hazardous areas of a facility are provided consistent with the 2012 editions of the LSC of the National Fire Protection Association and NFPA 99. The provisions of the adopted edition of the Life Safety Code do not apply in a State if CMS finds that a fire and safety code imposed by State law adequately protects patients in hospices. Existing Construction It is noted during the inspection at the Hospice Home at High Point that portable, non-secure alcohol based hand-rub devices are placed on counter tops in room 202, 206, and 207. The devices are adjacent to potential sources of ignition, a light switch on the right and an electrical outlet on the left. They also present a hazard of being knocked off of the counter creating a potential spill of flammable/combustible liquids. In addition, (Reference inpatient kitchen) Existing Construction During inspection of the facility, it was noted that bulk alcohol-based hand-rub dispensers are on portable mini stands and not mounted to a wall, they are placed on a counter that contains a light switch that is frequently used and impeding easy access to the light switch, creating greater risk of spill of a flammable liquid and in violation of NFPA30 requirements of the 8.7.3.1 code. Flammable liquids should be stored in approved containers and cabinets that are designed to prevent leaks and spills.

Upon observation, there was no evidence the inpatient facility has adequate supply of hot water at all times and include plumbing fixtures with control valves that automatically regulate the temperature of hot water used by patients. During the inspection at Hospice House of High Point, room 206 was noted that the water temperature at the patient hand sink registered 130 degrees and is out of the range of safe use of 110 degrees. In addition, during the inspection at facility #1 room #202 the water temperature in the room was noted to be 130 degrees.

Upon observation, there was no evidence the hospice inpatient facility furnishes meals to each patient that are consistent with the patient's plan of care, nutritional needs and therapeutic diet, palatable, attractive and served at the proper temperature, obtained, stored, prepared, distributed and served under sanitary conditions. It was noted during the inpatient inspection of Hospice Home at High Point and The Randolph Hospice House, dry food storage does not meet acceptable guidelines of the US Food & Drug Administration: • Date all foods when they arrive. • Keep older food at the front of shelving to be used first. • Store all food at least 18 inches away from the outer walls. • Storage area need to be dry, cool, well-lit, ventilated and vermin proof. • Storage areas must be protected from moisture and direct sunlight. • Keep food protected during storage. It was noted that canned goods located on storage shelves at both locations included items that were not dated and past the expiration date for consumption. Food storage at the Hospice Home of Piedmont are stored on a wire shelf against an outer wall within the main kitchen area and are subject to temperature changes from the cooking area, less than 10 feet away and the dishwashing area within 5 feet away. Packages of dry goods including pasta, oatmeal, crackers, gravy mix and cereal were not sealed or stored in sealable containers.

Based on policy review, clinical record review and staff interview, the agencys aides failed to provide baths daily as indicated on the aide care plan for 1 of 3 patients receiving services at the inpatient hospice facility (Patient #3). Findings included: --- Policy titled ";NURSING DOCUMENTATION" and last approved 05/02/23, was received from the agencys vice president of quality on 09/25/23 at 4:48 PM. This policy revealed, ";Nursing aide orders will be completed and updated by the RN [registered nurse] as patient condition and needs change...The NA [nurse aide] is to complete their documentation in the EMR [electronic medical record] format...The completed visit notes are monitored by licensed nurses for accuracy and completion..." Patient #3 was admitted to the agency on 05/15/23 with diagnoses including malignant neoplasm of the brain (brain cancer), hemiplegia affecting left side (paralysis of the left side), and dysphagia (difficulty swallowing). Plan of care from 05/15/23 to 08/12/23 revealed orders for skilled nursing two to three times per week for 13 weeks. Patient #3 was transferred from home to the agencys inpatient hospice facility for respite level of care 07/27/23 to 08/01/23. Patient #3s aide plan of care interventions included orders for a complete or partial bed bath daily. Aide documentation from 07/27/23 to 07/31/23 revealed that Patient #3 received a partial bed bath on 07/28/23 and 07/29/23, and a complete bed bath on 07/29/23. There was no evidence that Patient #3 received any type of bath and there was no documentation in the clinical record addressing the absence of bathing on 07/27/23 or 07/30/23. An interview was conducted on 09/25/23 at approximately 4:30 PM that included the agencys vice president of compliance (Employee #3) and two of the staff nurses who provided care for Patient #3 07/27/23 an 07/30/23 (Employees #1 and #2 respectively). During the interview, Employee #1, staff nurse who provided care for Patient #3 on 07/28/23, stated that during her shift Patient #3 had been constipated and the aides were waiting for the patient to have a bowel movement prior to giving her a bath. Employee #2, staff nurse who provided care for Patient #3 on 07/30/23, stated that patients (in general) would typically receive a bath every other day while in the inpatient unit and Patient #3 had received a bath the day prior. Employee#2 added that Patient #3s hair was shampooed during her shift on 07/30/23. Neither Employee #1 nor #2 were able to recall discussing changes to Patient #3s bathing plan or schedule with the patient or her family during their shifts. Employee #3, vice president of quality, stated that the interventions documented on the aide care plan are to be completed daily and if the aide is not able to complete an intervention, the aide is to notify the nurse and the nurse is to document in the clinical record. The hospice aides were not available for interview at the time of survey.