Every finding on record at Hospicecare in the Berkshires, Inc.

It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 2 of 23 (9%) clinical records reviewed, it was revealed that the agency did not ensure the patient’s individualized written plan of care identified planned interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 1: The patient elected the hospice benefit on 02/23/2024, with a terminal diagnosis of chronic obstructive pulmonary disease. The Registered Nurse (RN) assessment on 08/29/2024 documented anxiety, constipation, and dyspnea. The plan of care was reviewed for the time period between 08/05/2024 and 10/18/2024. The plan of care identified a problem on 08/05/2024, deficit related to patient care management related to anxiety, constipation, and dyspnea. The plan of care did not include interventions for anxiety, constipation, and dyspnea. Clinical Record 2: The patient elected the hospice benefit on 07/11/2024, with a terminal diagnosis of Organ Limited Amyloidosis. The Registered Nurse (RN) assessment on 10/09/2024 documented notable abdominal distention due to fluid retention. The plan of care was reviewed for the time period between 08/05/2024 and 10/18/2024. The plan of care identified a problem on 08/05/2024, deficit related to patient care management of cardiovascular, ascites, med management. The plan of care did not include interventions for ascites. During a joint record review and interview with the Director of Clinical Services on 10/18/2024, the Director of Clinical Services reviewed the findings and stated more staff education is needed.

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as hand hygiene. This standard was not met as evidenced by document review, interview and observation. In 1 of 6 (17%) home visit observations it was revealed that the agency did not ensure the staff followed the agency hand hygiene policy. Document 1: Agency policy, Hand Hygiene, Policy No. C:2-048.1, stated in part, “Hand decontamination using an alcohol-based hand rub should be performed after contact with non-intact skin and wound dressings." Home Visit 1/Clinical Record 1: During the home visit on 10/15/2024 to observe the Registered Nurse (Personnel Record 6), the Registered Nurse donned gloves, removed a soiled coccyx wound dressing, put dermaseptin around the wound, then applied a new wound dressing. The Registered Nurse did not wash her hands between removing the soiled wound dressing and applying the dermaseptin and clean wound dressing. During an interview with the Director of Clinical Services on 10/18/2024, the Director of Clinical Services agreed the agency policy is to wash the hands between a dirty and clean dressing change.