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

Upon personnel record review, 1 of 13 (Personnel #5) 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.) Personnel#5: No evidence of all required tasks of the competency evaluation with a patient or pseudo-patient. ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(B) Sponge bath ·(C) Shampoo, sink, tub, bed The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient.

Upon personnel record review, 1 of 13 (Personnel #6) did not have evidence the hospice employees and contract employees have received orientation on the hospice philosophy. Personnel #6: did not show evidence of orientation to hospice philosophy and has provided care to one patient.

Upon patient record review, 4 of 14 (Patient #6,7,13,14) did not have evidence that the discharge summary includes all required information. Patient #6,7,13,14: The discharge summaries were brief stating the reason and assessment on admission, and the reason for discharge. They did not include plan of care or physician orders.

Observed in Record Review. In 1 of 5 patient records reviewed, the agency failed to conduct an interdisciplinary comprehensive assessment within the first 5 days of care. In RR#1 for a patient who was on service for approximately one month there was no documented social work assessment and no documented reason for missing this assessment. This was validated with the nurse assisting with chart navigation.

Observed in Record Review. In 2 of 5 patient records reviewed, the plan of care did not reflect time frames for achieving patient and family goals. In HV#1 and HV#2 all goals had initial target dates of the next IDG meeting after admission. Throughout care the target date was updated to the next IDG meeting with no prioritization that would indicate which goals should be achieved in the short term to insure patient safety. This was validated with the nurse assisting with chart navigation.

Observed in Record Review. In 1 of 5 patient records reviewed, the plan of care did not address all needs identified in the patient assessment. In HV#1 the initial assessment identified a moderate skin risk on the Braden Scale. Maintaining skin integrity was not included in the plan of care. Additionally, Seroquel for anxiety and Miralax for constipation were identified in the intial assessment and an IDG note. Neither medication was included in the medication list on the plan of care. This was validated with the nurse assisting with chart navigation.

Observed in Patient Home. In 1 of 3 home visits conducted, the agency clinician failed to follow CDC guidelines and agency policy for hand hygiene. In HV#1 the nurse turned off the faucet with her bare wet hands rather than using a paper towel and she re-entered her nursing bag after patient contact without doing hand hygiene first.