Every finding on record at Human Touch Palliative and Hospice Care, Inc.

Observed in Record Review. In 3 of 3 patient records reviewed, During review of RR#1, it was noted on three of four problems identified on the POC the established goals lacked measurable outcomes on the POC. For example: Patient will demonstrate proper use of assistive device (Walker), Patient will report a reduction in itching and pain to a tolerable level. During RR#2 it was noted lack of goals for the SC and the MSW on the POC. During RR#3 it was noted lack of goals for the MSW and the SC on the POC. In addition it was noted 2 out of 5 goals on the POC lacked measurable, individualized outcomes. For example: Patient will maintain orientation to person and place, with verbal cueing as needed, Patient will experience a sense of security and comfort in her environment and under Impaired Activity there was lack of goals identified. This was discussed with the organization leadership.

Observed in Record Review. In 1 of 3 patient records reviewed, During RR#2 it was noted during an IDG meeting in May 2025, the addition of new bowel regimen orders and changes to wound care orders. There was lack of an update to the POC for additional interventions related to the GI and skin problems. This was discussed with the organization leadership.

Observed in Record Review. In 1 of 3 patient records reviewed, During RR#2 it was noted wound care was provided on SN visits however the wound care procedure was not documented by the SNs. This was noted during SN visits reviewed from the middle of May 2025 to date. This was discussed with the leadership team.

Observed in Record Review. In 1 of 3 patient records reviewed, During RR#2 it was noted lack of RN supervision of the hospice aide at least once every 14 days. The time frame reviewed was 28 days without documentation of an RN assessment of the aide care and services. This was discussed with the leadership team.

Observed in Document Review. In 1 of 1 contracts reviewed, During review of the therapy contract it was noted lack of the stipulation that the outside agency will complete criminal background checks on contracted employees who provide direct patient care or have access to patient records. This was discussed with the organization leadership.

Observed in Emergency Management Session. During review of the emergency plan, it was noted a disaster drill in 2025 was identified as an earthquake drill, participating in the national shakeout earthquake drill initiated by the shake out org. The drill lacked the following documentation: the disaster scenario and documentation that the planned drill stressed the limits of its emergency response procedures in order to assess how prepared the organization may be if a real event or disaster were to occur. The outcome and after action evaluation of the organization documented everyone participated and took cover, everyone exited in appropriate exits and met at the designated areas. This was discussed with the organization leadership.

Observed in Record Review. During review of the organization admission packet information on patient's rights to make decisions about their care, treatment or services it was noted lack of the Patient Notification of Hospice Non-Covered Items, Services and Drugs form for the patients to review. This was discussed with the organization leadership.  Observed in Record Review. In 1 of 2 patient records reviewed, who were discharged alive. During LiveD/C record review #1 it was noted the Notice of Non Medicare Coverage (NOMNC) was signed by the patient on the date of discharge. This was discussed with the DPCS.

Observed in Record Review. In 12 of 14 patient records reviewed, During HV#1-3, RR#1, RR#2, RR#3, RR#5, RR#6 BRRR#1, LiveD/C #1 and #2, BRRR#1 and #2. it was noted the initial bereavement risk assessment completed by the MSW for the survivor lacked documentation of the nature of the relationship with the patient, availability of coping mechanisms, and potential for pathological grief reactions. The documentation stated the risk factor without any other identifying information about the bereaved. This was discussed with the organization leadership.

Observed in Record Review. In 2 of 14 patient records reviewed, During LiveD/C#1 record review it was noted the RN summary during the IDG meeting the end of March 2025 lacked documentation that the physician ordered a new bowel regimen for the patient. In addition the patient was placed on contact precautions due to the results of a wound culture the middle of March 2025 that was not documented on the RN summary at the IDG meeting. During HV#1 record review it was the IDG RN summary the end of February 2024 lacked the documentation that medications were ordered for a UTI. This was discussed with the organization leadership.

Observed in Record Review. In 1 of 14 patient records reviewed, During LiveD/C RR#2 it was noted lack of the documentation of accurate clinical findings. The RN initial assessment stated the patient has a #20 Foley catheter (F/C) for long term urinary incontinence. The subsequent SN notes within the GU status documented the presence of a F/C as none. This was discussed with leadership.

Observed in Record Review. In 12 of 14 patient records reviewed, During review of 14 patient medical records, HV#1-3, RR #1,2,3,5,and 7, Live D/C RR#1 and BRRR#1-2, it was noted lack of goals with measurable outcomes on the POC. The goals were not based on the individual patient assessments. The goals from patient to patient with the same for the deficits identified during comprehensive assessments. For example, the goals for alteration in bowel elimination was Verbalizing understanding of etiology and factors affecting bowel disturbance, and appropriate interventions, demonstrating the safe use of bowel regimen, establishing or regaining normal pattern of bowel function was the same for all the patients. .This was discussed with the organization leadership.

Observed in Record Review. In 2 of 14 patient records reviewed, During HV#3 it was noted the following medications ordered for constipation without clear direction in what order to take which medication: senna 8.6mg 2 tabs 3x per day, senna 8.6 mg 2 tabs daily as needed for no BM x 2 days, MiraLAX 17 grams 3x/day however in the treatment column it is written as 17 grams for constipation daily, lactulose 30 ml 3x/day as needed for constipation, Colace 100mg 3x/day for constipation and Dulcolax supp every 3 days as needed for constipation. During HV#2 record review it was noted orders on the POC for Senna, MiraLAX in addition to Dulcolax and Colace in the comfort kit without direction on which medication to take first. This was discussed with the organization leadership. Observed in Record Review. In 14 of 14 patient records reviewed, During HV#1 record review it was noted during an IDG meeting in October 2024 the patient has a UTI and was started on Cipro 500 mg twice a day for 3 days. The POC lacked an update that included interventions related to the GU system and UTI. During review of the IDG POC it was noted lack of interventions on the POC for the MSW and the SC. During HV#3 it was noted lack of interventions on the POC for the MSW and SC. During the 7th certification for HV#3 the POC was not updated to include wound care and interventions for a coccyx pressure ulcer and a pressure ulcer on the left malleolus was not added to the POC. In addition the POC was not updated to include assessment and interventions of the respiratory system when antibiotics were ordered for a respiratory infection. During the 8th certification the patient developed an infection in the suprapubic region with an order for wound care and antibiotics. There was lack of an update to the POC to include interventions related to the suprapubic wound. During HV#2 record rview it was noted dysphagia was checked on the nutritional assessment portion of the RN initial assessment however instruction on aspiration precautions were not added to the POC. The POC lacked MSW and SC interventions. During RR#2 it was noted a new right leg wound documented on the RN summary in March 2025 however the POC was not updated to include interventions related to the wound. In addition the POC lacked interventions for the MSW and SC with a discipline frequency for both of 1x/month. During RR#3 it was noted lack of interventions related to aspiration precautions added to the POC. In addition the POC lacked MSW and SC interventions with frequencies of 1x/month for both disciplines. There was an order for Fentanyl 25 mcg patches for pain the end of December 2024 however the POC was not updated to add interventions related to the new medication effectiveness. During LiveD/C#1 it was noted a physician order for medications for a new bowel regimen however bowel assessments and interventions were not added to the POC in March 2025. The patient was prescribed antibiotics and placed on contact precautions due to wound culture results, however infection control measures and interventions were not added to the POC. The POC lacked MSW and SC interventions. During BRRR#1 it was noted lack of MSW and SC interventions on the POC. During RR#6 it was noted lack of MSW and SC interventions on the POC with MSW and SC frequencies of once a month. During RR#6 it was noted the patient had a G-tube with feedings ordered. The POC lacked assessment and interventions related to the nutritional deficit documented on the RN initial assessment. The patient had oxygen therapy at 4L/min per the initial RN assessment. The POC lacked interventions on the use and safety of oxygen use. During HV#1-3, RR#1,2,3,4,5,7, BRRR#1, BRRR#2, LiveD/C#1 and #3, it was noted patients had oxygen ordered for PRN use. The POCs lacked interventions on 02 safety and use. During RR#7 it was noted during an IDG meeting the patient had a foley catheter inserted for urinary issues. The POC was not updated with GU deficit interventions. This was discussed with the organization leadership.

Observed in Record Review. In 5 of 14 patient records reviewed, During HV#1, HV#2, HV#3 and RR#5 it was noted lack of documentation of progress toward goals. The patients had multiple certification periods with SOCs 9-12 months prior to the current survey. The same goals were documented as completed with each certification. During each subsequent certification, the goals remained the same, however the goal date would be changed to the new certification period. For example, RR#5 SOC was February 2024 with goals and interventions documented as accomplished for that certification period in February. The next certification in May 2024 had the same goals with the dates advanced to the new certification period and continued on the same way through 5 additional 60 day certifications. During RR#6 it was noted the goals on the certification in January 2025 lacked documentation of progress to date in May 2025. This was discussed with the organization leadership.

Observed in Record Review. In 1 of 14 patient records reviewed, During LiveD/C#2 record review it was noted care, treatment, or services according to the patient's individualized plan of care were not followed. An order for 0xygen therapy at 2L/min PRN was written on the initial POC and the RN initial assessment documented 02 at 2L/min PRN. The subsequent SN notes documented O2 at 4-5 L/min without documentation of a physician order changing the liter flow. This was discussed with leadership.

Observed in Patient Home. In 1 of 3 home visits conducted, During HV#2 it was noted the hospice aide changed her gloves multiple times without hand disinfection after removing and donning a clean pair including after providing peri-care to remove stool due to incontinence. This was discussed with the DPCS.

Observed in Record Review. In 4 of 4 patient records reviewed, During BRRR#1, BRRR#2, RR#4 and RR#7, it was noted lack of a bereavement POC that specified the type of bereavement services to be offered and the frequency of service delivery. This was discussed with the DPCS.

Observed in Record Review. In 1 of 14 patient records reviewed, During RR#6 it was noted the patient had a oxygen order for 4L/min continuous. The aide assignment form did not include direction on leaving the oxygen on during personal care or direction to remove for personal care. This was discussed with the organization leadership.

Observed in Document Review. There was lack of evidence that the governing body and leadership had established processes to support patient care treatment and services through sustained compliance as evidenced by CLD findings at 418.54, 418.56 and 418.100. This was discussed with the organization leadership. Observed in Document Review. There was lack of evidence that the governing body and leadership had established processes to support patient care treatment and services through sustained compliance as evidenced by repeat findings from the previous survey in the areas of establishing individualized goals, updating the POCs, and demonstrating progress toward goals. This was discussed with the organization leadership.

Observed in Document Review. In 1 of 4 contracts reviewed, During review of the therapy contract for PT,OT, and ST it was noted the organization did not describe, in writing, the nature and scope of services provided through contractual agreements. The therapy contract reviewed did not reference hospice services or describe the nature and scope of therapy in a hospice setting. This was discussed with the organization leadership.

Observed in HR File Review. In 2 of 10 HR files reviewed, During HR#5 file review it was noted lack of orientation for the RN to the duties of the DPCS designee. During HR#2 it was noted lack of orientation for the RN to the duties of the Administrator. This was discussed with the DPCS.

Observed in Record Review. In 1 of 14 patient records reviewed, During RR#3 it was noted an RN summary during an IDG meeting the end of December 2024 that the patient was started on Fentanyl 25 mcg patch however the medication was not added to the medication profile. This was discussed with the organization leadership.

Observed in Document Review. In 1 of 3 contracts reviewed, During review of the SNF contract it was noted lack of a delineation of the responsibilities of the hospice and the SNF, NF, or ICF/IID to provide bereavement services to SNF, NF, or ICF/IID staff. This was discussed with the organization leadership.

Observed in Document Review. In 2 of 4 contracts reviewed, During review of a contract for MSW and therapy contract, it was noted lack of a stipulation that the outside agency will complete criminal background checks on contracted employees who provide direct patient care or have access to patient records. This was discussed with the organization leadership.

Observed in Record Review. In 5 of 5 patient records reviewed, Hospice surveyor noted the patient records reviewed had the same time frame for each goal identified. For example, for record #1, all goals were dated within certification period 7/22-9/29/22. For record #2, all the goals were dated for completion 8/16/22 to 11/13/22. This was confirmed by the Director of Nursing.

Observed in Record Review. In 5 of 11 patient records reviewed, the surveyor found that the plan of care was not specific for needs identified in the comprehensive assessment. For example, in review of the medical record for RR1, the plan of care included goals and interventions related to NG/G tube. In review of the medical record for HV1, the plan of care included a goal to demonstrate competency in performing NG/G tube care. These patients did not have either type of tube. In review of the medical record for RR6, the initial assessment indicated the patient was a high risk for falls but this was not addressed in the POC. In review of the medical record for RR5, the initial assessment indicated the patient was a high risk for falls and skin break down but these findings were not addressed in the POC. In review of the medical record for RR4, the initial assessment indicated the patient was at severe risk for skin break down and had a G-tube in place but these findings were not addressed in the POC. This was discussed with the DPCS.

Observed in Record Review. In 10 of 11 patient records reviewed, the surveyor noted that the identified outcomes did not have time frames established for completion. This was found for HV1, HV2, HV3, RR1, RR3, RR4, RR5, RR6, RR7, and RR8 and discussed with the DPCS and QAPI manager

Observed in Record Review. In 9 of 11 patient records reviewed, the surveyor found that the organization had not individualized the patient's plan of care related to medications and/or treatments necessary to meet the patient's needs. For example, in review of the medical record for HV3, the plan of care had Haloperidol and lorazepam both ordered as needed for agitation without further defining when each one should be taken. In review of the medical record for RR1, the surveyor found that the patient had initial orders for Senna, Milk of Magnesia and Dulcolax ordered as needed constipation without further defining when to give each medication. This same record had Lorazepam and Haldol both ordered as needed for agitation without further defining when to give each medication. The plan of care also contained an order for a foley catheter but did not include the balloon size or frequency of change. Similar findings were found for RR2, RR3, RR4, RR5, RR6, RR7 and RR8. This observation was discussed with the DPCS and office manager.

Observed in Record Review. In 1 of 11 patient records reviewed, the surveyor found that the organization had not provided the patient with wound care as required by the plan of care. For example, in review of the medical record for RR5, the patient had wound care orders on admission. One order was for daily care to necrotic toes and a second order was for wound care every 2-3 days for a sacral ulcer. The second nurse visit was approximately three days from the previous visit. There was no documentation that the required wound care was completed during this visit. This was discussed with the DPCS and QAPI program manager.

Observed in Data Session. In review of the documentation provided and discussion with the DPCS and QAPI program manager, the surveyor found that the organization's QAPI program was not reflective of the complexity and scope of services that were provided. For example, the program did not include quality indicators for the bereavement or volunteer program, or social work services. In addition, the organization provided complex wound care through a contracted entity and had not included indicators to validate improved outcomes.

Observed in Patient Home. In 1 of 3 home visits conducted, the surveyor observed that the staff member did not follow organization policy 9-014, Bag Technique. The staff member was observed cleaning her equipment with gloves on and then placing it immediately into a plastic bag which also contained unused gloves. Policy required the staff member to remove gloves and perform hand hygiene prior to returning the cleaned, reusable equipment to her bag. This was discussed with the DPCS.

Observed in Record Review. In 8 of 8 patient records reviewed, where the patient had hospice aide services ordered, the surveyor found that the registered nurse had not provided the aide with specific patient care instructions, information on safety precautions to implement, and/or when to notify the nurse. For example, during the home visit for HV1 the surveyor observed that the patient had a wound dressing to her left foot that the caregiver stated had been there for over a month. The plan of care for the hospice aide did not specify the unique safety precautions or notification requirements related to the wound dressing. The aide plan of care also required the aide to complete vital signs as needed but did not identify situations when vital signs should be obtained. In review of the medical record for HV2, HV3, RR1, RR3, RR4, RR5, and RR8, the aide plan of care required the aide to complete vital signs as needed but did not identify situations when vital signs should be obtained. In RR1, the aide plan of care did not list safety precautions and the patient had been assessed to be at risk for falls and skin breakdown. This was discussed with the DPCS and QAPI program manager.

Observed in Record Review. In 4 of 8 patient records reviewed, where the patient had hospice aide services ordered the surveyor found that the aide had not provided care that was listed on the aide plan of care. For example, in review of the medical record for RR1, the aide plan of care included soaking the feet. This was not completed on three of four visits in the first 14 days of care and there was no documentation that the patient had refused. In review of RR3, the aide plan of care included passive range of motion but on multiple occasions, active range of motion was completed. In review of HV1, the aide was to provide passive range of motion according to the aide plan of care but active range of motion was provided on multiple visits. In review of RR5, the aide was to provide passive range of motion according to the aide plan of care but this was not completed on any visit. This was discussed with the DPCS.

Observed in Tracer Activities. The governing body/leadership did not ensure that the following Conditions of Participation were met as determined through observations, documentation, and staff interviews:  - §418.100, 418.104, 418.56, and 418.58.

Observed in Document Review. In 2 of 4 contracts reviewed, the surveyor noted that the contract did not contain the following elements:: 1) The manner in which contracted services would be coordinated, supervised and evaluated by the hospice 2) The delineation of the role of the hospice and contractor in the admission process, patient/family assessment, and the interdisciplinary group conferences 3) Requirements for documenting that services are furnished in accordance with the agreement. These elements were not found for the pharmacy contract or the Wound Pro contract. In addition, the Wound Pro contract did not include the qualifications of the individuals providing the service. This was discussed with the DPCS.

Observed in Record Review. In 3 of 11 patient records reviewed, the surveyor found that the record contained inaccurate information. For example, in review of the medical record for HV1, the aide plan of care listed shampoo as needed. In review of the aide's documentation, shampoo was documented as needed for approximately three months. It was not clear if the aide had provided this service during those three months. In review of the medical record for HV3 and RR1, multiple aide notes had that a bed bath and tub/shower was completed. It was not clear if the aide had provided a bedbath, a tub bath, or a shower during these visits. In RR1, the assessment had that wound/decubitus care was provided but patient did not have a wound. This was discussed with the DPCS and QAPI nurse.

Observed in Record Review. In 1 of 11 patient records reviewed, the surveyor found that the medical record did not contain all information to reflect the patient's care, treatment, and or services. For example, during the home visit for HV3, it was found that the facility medication list included Diphenoxylate atropine which had been ordered prior to admission to hospice. This medication was not part of the hospice medication profile. This was discussed with the DPCS.

Observed in Record Review. In 7 of 11 patient records reviewed, the surveyor found that the clinical record was not readily accessible and systematically organized to facilitate retrieval. During the course of the survey, patient records that were requested for review were provided in parts and in no particular order. The organization migrated its medical records to a new EMR in March 2022. Though the organization stated they had an electronic medical record for each patient, they chose to print the record for review. The printed parts were not provided as a complete medical record for each patient. For example, by the end of survey day 2, only consents and admission documents for RR4, RR5, RR6, RR7, and RR8, had been provided. These documents were original signed documents. No documents from the new EMR system had been provided and were still in the process of being printed. In HV1 and HV2, the chart provided contained mostly documents from prior to the migration to the new EMR in March 2022 and the most current documentation was still in the process of being printed. This was discussed with the DPCS. Observed in Record Review. In 2 of 4 patient records reviewed, for bereavement services, the surveyor found that documentation that was captured in the previous EMR platform was not readily accessible. In discussion with the Bereavement Coordinator, he stated that documentation of ongoing contact calls as required by the plan of care had been documented in the previous EMR platform for BR3 and BR4. When attempting to access this documentation, he was only able to retrieve the call made at or about the time of death. He was not able to access the subsequent call documentation at the time of the review and was unsure if it could be retrieved. This was discussed with the DPCS.

Observed in Document Review. In 1 of 4 contracts reviewed, the surveyor noted that the contract had no stipulation that the contracted agency would complete criminal background checks on contracted employees who provide direct patient care or have access to patient records. This stipulation was not found for the Wound Pro contract. This was discussed with the DPCS.