Every finding on record at Hospice Services of Sc, LLC

Based on review of the hospice's Emergency Preparedness Program and interview, the hospice failed to ensure an annual community and facility-based risk assessment was completed. --- The findings are: Review of the hospice's Emergency Preparedness plan on 10/26/23 revealed the last community and facility-based risk Assessment was dated 9/7/20. In an interview with the Hospice Administrator on 10/26/23 at 2:00 PM, the Hospice Administrator confirmed the finding.

Based on review of the Hospice's Emergency Preparedness Program and interview, the Hospice failed to ensure contract arrangements with other hospices/hospitals to receive patients in the event of limitations or cessation of operations during emergency situations. --- The findings are: Review of the Hospice's Emergency Preparedness Program on 10/26/23 revealed the Hospice had no evidence of contract/arrangements with other hospices/hospitals to receive patients to ensure continuity of services in the event of limitations/cessation of the hospice operations during a emergency. In an interview with the Hospice Administrator on 10/26/23 at 2:00 PM, he/she confirmed the finding.

Based on review of the Hospice Emergency preparedness Program and interview, the Hospice failed to ensure entities with arrangements/contracts with the Hospice had their contact information in the Hospice's Emergency Preparedness Program plan. --- The findings are: Review of the Hospice's Emergency Preparedness Program on 10/26/23 revealed the Hospice had no contact information for entities the hospice contracts with such as supplies, transportation, or medications. In an interview with the Hospice Administrator on 10/26/23 at 2:00 PM, he/she confirmed the finding.

Based on review of the Hospice's Emergency Preparedness Program and interview, the hospice failed to ensure the State Ombudsman contact was included in the Hospice's Emergency Preparedness plan. --- The findings are: Review of the Hospice's Emergency Preparedness Program plan on 10/26/23 revealed the Hospice had no contact information for the State Ombudsman listed. In an interview with the Hospice Administrator on 10/26/23 at 2:00 PM, he/she confirmed the finding.

Based on observations, record reviews, and interview, the hospice failed to ensure the patient's comprehensive assessment included an accurate drug profile reflecting a review of all of the patient's medications for two of two patients observed during home visits observed. (Patient #1 and #3) --- 1. During a home (Memory Unit) visit for Patient #3 on 10/25/23 at 11:00 AM with Licensed Practical Nurse (LPN#1), the medications were not reconciled with the patients medication list. When asked, the LPN#1 responded ";The facility does the meds". No personnel could be found on the memory unit to address the issue. This concern is brought to the attention of the Facility Administrator. On 10/24/23 at 2:30 PM, during a home facility visit to Patient #1 with Registered Nurse (RN) #1, RN #1 did not reconcile the patient's medications and confirmed she/he was finished with the visit. Upon request to reconcile the medications, the facility physician's orders for the month of October were compared to the hospice list of medications as of 10/23/23 and the following discrepancies were discovered: Lorazepam (for anxiety) 1 mg (milligram) tablet every eight hours as needed with a start date of 10/14/23 was on the facility physician's orders but not on the hospice list of medications; Fluticasone inhalation every 12 hours with a start date of 9/21/23 was on the facility physician's orders but not on the hospice list of medications; Levothyroxine (for thyroid) 75 mcg (micrograms) one tablet daily with a start date of 3/25/23 was on the facility's physician's orders but not on the hospice list of medications; Mirtazapine (for hypertension) 7.5 mg one tablet daily with a start date of 3/17/23 was on the facility's physician's orders but not on the hospice list of medications; Donepezil (for dementia) 10 mg tablet at bedtime with a start date of 3/14/23 was on the facility's physician's orders but not on the hospice list of medications; Albuterol 90 mcg inhaler (for cough/wheezing) two puffs every 4 hours as needed with a start date of 3/6/23 was on the facility's physician's orders but not on the hospice list of medications; and Senna (stool softener) 8.6 mg tablet daily as needed with a start date of 10/3/23 was on the hospice list of medications but not on the facility's physician's orders. During a concurrent interview with RN #1, she/he confirmed she/he did not reconcile Patient #1's medications since admission to hospice services on 10/3/23. RN #3 confirmed the discrepancies. The hospice's policy titled, "Medication Reconciliation" was reviewed and read, "...Hospice will reconcile patient's medications at time of admission and on an ongoing basis...Medications ordered while the patient is receiving care will be compared to the medication list/profile. The medication list/profile will be updated with each new changed medication..." And review of the hospice policy titled, "Care to Residents of a SNF/NF or ICF/MR" read, "...Hospice will provide to the SNF/NF or ICF/MR the following information...The most recent plan of care specific to each patient...Hospice medication information specific to each patient..."

Based on observations, record reviews, interviews, and review of the hospices policies, the hospice failed to develop an individualized written plan of care reflecting interventions based on the problems identified in the initial nursing assessment, initial comprehensive assessment, and updated comprehensive assessments for three of 10 active patient records reviewed. (Patient #1, #3, and #10) --- On 10/24/23 at 11:15 AM, review of Patient #1's record revealed Patient #1 was admitted to hospice services on 10/3/23 with a diagnosis of COPD (Chronic Obstructive Pulmonary Disease, a lung disease). The nursing visit note on admission dated 10/3/23 ,read, "...lung sounds diminished throughout with right base crackles, and posterior bilateral wheezing noted. Patient noted to have SOB (Shortness Of Breath) during conversing with nurse and rolling in bed...". The nursing visit note dated 10/17/23, read, "...Lung sounds diminished throughout, and bilateral wheezing noted. Patient dependent on oxygen via NC (nasal canula) at 2L (liters), staff nurse stated she had to increase O2 this morning to 4LPM (liters per minute) due to sat (oxygen saturation) 89% (percent) and stated she has been coughing up yellow phlegm. Instructed to give ordered nebulizer treatment as needed...". There was no documented evidence that the patient's plan of care was based on the initial assessment or the updated comprehensive assessments for Patient #1's respiratory diagnosis, status, or symptoms. During an interview with the Administrator (ADM) on 10/26/23 at 10:40 AM, he/she reviewed Patient #1's record and confirmed the findings stating the patient's care plan was "not specific to the patient." On 10/25/23 at 1:06 PM, review of Patient #3's record revealed Patient #3 was admitted to hospice services on 8/25/23 with a diagnosis of Heart Failure. The admission nursing visit note dated 8/25/23 indicated, "...NYHA (New York Heart Association) 4 (IV)..." (NYHA IV definition according to the American Heart Association is "Symptoms of heart failure at rest. Any physical activity causes further discomfort.") The nursing visit note further indicated Patient #3 had "...edema (swelling due to fluid) bilateral lower feet...irregular pulse...Pulse is noted to be bounding...". The nursing visit note dated 10/11/23 indicated Patient #3 had symptoms of fatigue and was "...in recliner at all times...". Review of the patient's plan of care revealed there was no documented evidence the patient's plan of care was based on the patient's initial assessment or updated comprehensive assessments of Patient #3's cardiac (heart) diagnosis, status, or symptoms. During an interview with the Administrator on 10/26/23 at 11:54 AM, he/she reviewed Patient #3's record and confirmed the findings. On 10/25/23 at 10:45 AM, review of Patient #10's record revealed Patient #10 was admitted to hospice services on 4/10/23 with a diagnosis of Heart Failure. The admission nursing visit note dated 4/10/23, read, "...NYHA Class IV..." The nursing visit note further indicated Patient #10 had edema to her/his "bilateral lower feet", an irregular pulse, and ...dyspnea (difficulty breathing) with minimal exertion (a symptom of heart failure) ...". The nursing visit notes dated 10/4/23 and 10/11/23 indicated Patient #10 had "...+1 pitting edema..." (an approximately 2-millimeter indentation caused by pressing into the swelling of fluid accumulated in the tissues) to her/his bilateral feet which is a symptom of Heart Failure. Review of the patient's plan of care revealed there was no documented evidence the patient's plan of care was based on the initial nursing assessment or updated comprehensive assessments for Patient #3's cardiac diagnosis, status, or symptoms. During an interview with the Administrator on 10/26/23 at 11:44 AM, he/she reviewed Patient #10's record and confirmed the findings. Review of the hospice policy, titled, "IDG (Interdisciplinary Group) Care Planning Process", on 10/26/23, revealed, "...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...interventions to manage...symptoms..."

Based on observations, interview, and review of the hospice policies, the hospice failed to ensure accepted principles for infection control were followed by the Registered Nurse (RN #1) while providing wound care to one of one patient observed for wound care. (Patient #1) --- On 10/24/23 at 2:14 PM, a home visit in a facility for Patient #1 revealed RN #1 was observed performing wound care for Patient #1's sacral (tail bone area) wound. RN #1 applied gloves, assessed the sacral wound by touching the wound edges and surrounding skin, picked up a bottle of wound cleanser spray, sprayed and wiped the wound with gauze, and picked up a tube of ointment and applied ointment to the wound. RN #1 did not remove the gloves or perform hand hygiene after touching the wound area and before picking up the wound cleanser spray or after cleansing the wound and before picking up the tube of ointment and applying it to Patient #1's wound. During an interview with RN #1 on 10/25/23 at 3:30 PM, he/she confirmed the breaches of infection control practices during wound care. Review of the hospice policy, titled, "Hand Hygiene Policy and Compliance Program", on 10/26/23, revealed, "...Hand hygiene will be done by all employees, volunteers and contract staff to reduce the transfer of microbes to patients...To prevent transfer of germs and transmission of infections to patients and caregivers...Indications for hand hygiene are...Before and after direct patient care...After any contact with contaminated materials...Hospice will follow the Centers for Disease Control and Prevention (CDD) guidelines for hand hygiene...CDC Hand Hygiene Guidelines...Indications for handwashing and hand antisepsis...After contact with blood, body fluids, mucous membranes, non-intact skin and wound dressings...Moving from contaminated patient body site to clean site during patient care...".

Based on record reviews, interview, and review of the hospice employee files and policies, the hospice failed to have an organized program for the provision of bereavement services furnished under the supervision of a qualified professional with experience or education in grief or loss counseling. --- On 10/25/23 at 2:06 PM, during an interview with the Bereavement Coordinator (BC), the BC stated he/she started the position a few months ago. When asked what background, experience, or training in bereavement he/she had, the BC stated, "I actually don't have any." Review of the BC's personnel file on 10/26/23 at 9:22 AM revealed he/she had no background, experience, or training in grief or loss counseling. During an interview with the Administrator on 10/26/23 at 12:24 PM, he/she confirmed the findings. Review of the hospice policy, titled, "Bereavement Services", on 10/26/23, revealed, "...Hospice provides an organized Bereavement Program supervised by a qualified bereavement counselor who has documented evidence of education or experience in dealing with grief or loss counseling."

Based record reviews and interview, the hospice failed to ensure a registered nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group met the patient's needs for three of 10 active patient records reviewed. (Patient #1, #3, and #10) --- On 10/24/23 at 11:15 AM, review of Patient #1's record revealed Patient #1 was admitted to hospice services on 10/3/23 with a hospice diagnosis of COPD (Chronic Obstructive Pulmonary Disease, a lung disease). HA (Hospice Aide) visits were ordered for 3x (times)/week beginning 10/3/23 to current. There was no documented evidence a HA supervisory visit by an RN was completed from 10/3/23 to current. During an interview with the Administrator (ADM) on 10/26/23 at 10:44 AM, he/she reviewed Patient #1's record and confirmed the findings. On 10/25/23 at 1:06 PM, review of Patient #3's record revealed Patient #3 was admitted to hospice services on 8/25/23 with a diagnosis of Heart Failure. HA visits were ordered for 2x/week beginning 8/29/23 and 3x/week beginning 10/2/23 to current. There was no documented evidence a HA supervisory visits was completed from 9/13/23 to 10/4/23 (21 days). During an interview with the Administrator on 10/26/23 at 11:59 AM, he/she reviewed Patient #3's record and confirmed the findings. On 10/25/23 at 10:45 AM, review of Patient #10's record revealed Patient #10 was admitted to hospice services on 4/10/23 with a diagnosis of Heart Failure. HA visits were ordered for 3x/week beginning 9/21/23 to current. There was no documented evidence a HA supervisory visit was completed from 10/4/23 to current (21 days). During an interview with the Administrator on 10/26/23 at 11:33 AM, he/she reviewed Patient #10's record and confirmed the findings.

Based on record reviews, interview, and review of the hospice policies, the hospice failed to send a discharge summary to the attending physician for two of two patient records reviewed discharged due to revocation. (Patient #12 and #13) --- On 10/25/23 at 10:19 AM, review of Patient #12's record revealed Patient #12 was admitted to hospice services on 6/13/22 and revoked hospice on 11/28/22. There was no documented evidence a Discharge Summary was forwarded to the attending physician. During an interview with the Administrator (ADM) on 10/26/23 at 11:18 AM, he/she reviewed Patient #12's record and confirmed the findings. On 10/25/23 at 10:42 AM, review of Patient #13's record revealed Patient #13 was admitted to hospice services on 9/8/23 and revoked hospice on 10/16/23. There was no documented evidence a Discharge Summary was forwarded to the attending physician. During an interview with the Administrator on 10/26/23 at 11:09 AM, he/she reviewed Patient #13's record and confirmed the findings. Review of the hospice policy, titled, "Discharge Summary", on 10/26/23, revealed, "...If a patient revokes the election of Hospice care, or is discharged from Hospice, Hospice will forward to the patient's attending physician, a copy of...the Hospice discharge summary...".

Based on record reviews, interview, and review of the hospice policies, the hospice failed to ensure the discharge summaries included a summary of the patient's stay including treatments, symptoms and pain management, the patient's current plan of care, and the patient's latest physician orders for two of two patient records reviewed for patients discharged due to revocation. (Patient #12 and #13) --- On 10/25/23 at 10:19 AM, review of Patient #12's record revealed Patient #12 was admitted to hospice services on 6/13/22 and revoked hospice on 11/28/22. The Discharge Summary did not include a summary of the patient's stay including treatments, symptoms and pain management, the patient's current plan of care, or the patient's latest physician orders. During an interview with the Administrator on 10/26/23 at 11:18 AM, he/she reviewed Patient #12's record and confirmed the findings. On 10/25/23 at 10:42 AM, review of Patient #13's record revealed Patient #13 was admitted to hospice services on 9/8/23 and revoked hospice on 10/16/23. The Discharge Summary did not include a summary of the patient's stay including treatments, symptoms and pain management, the patient's current plan of care, or the patient's latest physician orders. During an interview with the Administrator on 10/26/23 at 11:09 AM, he/she reviewed Patient #13's record and confirmed the findings. Review of the hospice policy, titled, "Discharge Summary", on 10/26/23, revealed, "The Hospice discharge summary will include...A summary of the patient's stay including treatments, symptoms and pain management...The patient's current plan of care...The patient's latest physician orders...".