Every finding on record at Incare Home Health, Inc

Based on review of the hospice's Emergency Preparedness Program (EPP) and interview, the hospice failed to ensure the emergency preparedness plan contained a policy and procedure to address volunteers. --- The findings include: On 03/06/23 at 9:00 AM, review of the hospice's emergency preparedness program revealed no documentation of a policy and procedure to address the use of volunteers in an emergency and/or designated health care professionals during surge needs during an emergency. During an interview on 03/06/23 at 9:02 AM, the Director of Patient Operations (DOPS) verified the findings.

Based on record review and interview, the hospice failed to ensure the emergency preparedness plan contained documentation of contact information for federal, state, local emergency preparedness agencies, state licensing and certification agencies and the office of the State Long-Term Care Ombudsman. --- The findings include: On 03/06/23 at 9:00 AM, review of the emergency preparedness book revealed no documentation of contact information for federal, state, local emergency preparedness agencies, state licensing and certification agencies, and the office of the State Long-Term Care Ombudsman. During an interview on 03/06/23 at 9:02 AM, the Director of Patient Operations (DOPS) verified the findings.

Based on review of the hospice's Emergency Preparedness Program (EPP), interview, and review of the hospice's policy and procedure, the hospice failed to ensure the emergency preparedness plan contained documentation for primary and alternate means of communication. --- The findings include: On 03/06/23 at 9:00 AM, review of the hospice's emergency preparedness program revealed there was no documentation for communicating with hospice staff and/or federal, state and local emergency management agencies. During an interview on 03/06/23 at 9:02 AM, the Director of Patient Operations (DOPS) verified the findings. Facility policy, entitled, ";Emergency and Disaster Management" revealed, ";Hospice develops and maintains an emergency preparedness communication plan which complies with Federal, State and local laws. The communication plan is reviewed at lease biennially and includes the following: names and contact information for hospice employees, volunteers, entities providing services under arrangement, patients, physicians and other hospices; a. a. Primary and alternate means for communication with Hospice employees, and local emergency management agencies...".

Based on review of the hospice's Emergency Preparedness Program, interview, and review of the hospice's policy and procedure, the hospice failed to ensure the emergency preparedness plan contained a method for sharing information. --- The findings include: On 03/06/23 at 9:00 AM, review of the emergency preparedness book revealed no method for sharing information and medical documentation with other health providers to maintain continuity of care during an emergency. During an interview on 03/06/23 at 9:02 AM, the Director of Patient Operations (DOPS) verified the findings. Facility policy, entitled, ";Emergency and Disaster Management" revealed, ";";Hospice develops and maintains an emergency preparedness communication plan which complies with Federal, State and local laws... b. method for sharing information and medical documentation for patients under Hospice care, as necessary, and with other health care providers to ensure continuity of care...".

Based on record review and interview, the hospice failed to ensure emergency preparedness training for all new and existing employees for 13 of 13 employees. --- The findings include: On 03/09/23 at 2:43 PM, review of the hospice staff training file revealed no documentation of emergency preparedness training for 13 of 13 staff members. Review of emergency preparedness documentation from the hospice corporate office revealed no documentation of the training date(s) of the emergency preparedness training. During an interview on 03/09/23 at 2:44 PM, the Administrator verified the findings.

Based on record review and interview, the hospice failed to provide a comprehensive assessment, including risk factors affecting care planning, for one of 14 patient records reviewed, Patient #14 --- Findings: On 3/8/23 at 10:00 AM, review of Patient #14s record revealed a document, titled, ";RN Initial Assessment," dated 7/21/22 that had no documentation regarding insects in the home. Review of the document, titled, "MSW Assessment," dated 7/22/22 revealed the assessment was conducted by telephone. There was no documentation regarding insects in the home. Review of the document, titled, "IDG (Interdisciplinary Group) Meeting," dated 7/21/22 revealed there was no documentation regarding insects in the home. Review of the document, titled, ";RN Comprehensive Assessment," dated 8/31/22 showed, ";...Roach infestation is present in the home since admission...". Review of the document, titled, ";Discharge – Live," dated 8/31/22 by the Registered Nurse (RN) revealed ";Patient discharged for cause today as family has made multiple promises to move patient to a clean and safe environment...Roach infestation in the home since admission...Unsafe environment for staff...". On 3/9/23 at 1:35 PM, the Administrator stated there were many issues in the patient's home that affected care planning and were not documented in the comprehensive assessment and not included in the plan of care.

Based on record reviews, interviews, and review of the hospice's policy and procedure, the hospice failed to ensure reconciliation of the patient's hospice medication profile with the skilled nursing facility (SNF) medication administration record (MAR) for 1 of 1 patient in a nursing care facility (Patient 1) and 2 of 3 home patients (Patient 2 and 3). --- The findings are: On 3/7/23 at 12:00 PM, review of Patient #1s record revealed the patient was admitted on 7/16/21 with a primary diagnosis of Alzheimer (a disease affecting memory). Review of the document, titled, ";Patient Communication," dated 2/26/23, showed, ";Patients daughter called to report that patient has not had a bowel movement in 3 days. She also states that pt (patient) is complaining of nausea. Senna 8.6-50 milligrams (mg) take 2 tabs PO (orally) daily PRN (as needed) for constipation ordered per standing orders. Compazine 10 mg take 1 tab PO every 6 hours PRN ordered per standing orders for nausea..." When Patient #1s medication list was reviewed, neither Senna nor Compazine were on the patient's medication list. During a review of Patient #1s record with the Administrator on 3/9/23, the Administrator confirmed the nurse did not add the medication Senna and Compazine to Patient #1s medication list. On 3/7/23 at 8:15 AM, a home visit was made to Patient #3. Patient #3s medications were reconciled with the hospice medication profile and reviewed with the patients primary caregiver (PCG). There were discrepancies between the medications in the home and the hospice medication list. The discrepancies were: Medications Patient #3 takes in the home but were not on the hospice medication profile included Docusate 100 mg (milligrams) daily (stool softener), Miralax (laxative), and Vitamin D 1000 iu (international units). Medications with dosage discrepancies or frequencies included Eliquis (blood thinner) being given twice daily, but the hospice profile showed once daily. The PCG stated the physician changed the dose sometime last year. Omeprazole 20 mg daily given in the home, but the hospice medication profile showed 40 mg. On 3/9/23 at 1:00 PM, during an interview with the Administrator, the Administrator confirmed the findings. During a home visit on 03/07/23 at 2:01 PM to 2:45 PM, review of Patient 2s home medications when compared with the hospice medication profile revealed Acetaminophen 650 mg, 2 tablets every AM while the hospice medication profile revealed Acetaminophen 500 mg, take 2 capsules every 6 hours as needed for pain. The following hospice medication profile had the following medications that were listed but the patient is not taking: Prochlorperazine maleate 10 mg tab, take 1 tab every 6 hours as needed for nausea and Hycodan oral solution 5-1.5 mg/5 ml, take 5 ml every 6 hours for 5 days and the following medications the patient is taking but is not listed on the hospice medication profile: Lexapro 10 mg, take 1 tab every AM and Pantoprazole sodium 40 mg, take 1 take every AM. The findings were verified by the Administrator on 03/09/23 at 12:26 PM.

Based on record review and interview, the hospice failed to provide a complete nursing assessment as indicated in the physician's standing orders before initiating standing orders for one of 14 patient records reviewed. (Patient #1) --- Findings: On 3/7/23 at 12:15 PM, review of Patient #1s record revealed a document, titled, ";Patient Communication," dated 2/26/23 that showed, ";Patients daughter called to report that the patient has not had a bowel movement in 3 days. She also states that pt (patient) is complaining of nausea. Senna (laxative) 8.6-50 mg (milligrams) take 2 tabs PO (orally) daily PRN (as needed) for constipation ordered per standing orders. Compazine 10 mg take 1 tab PO every 6 hours PRN ordered per standing orders for nausea..." On 3/9/23, at 9:30 a.m., Patient #1s standing orders were reviewed. The physician orders revealed, ";...The nurse initiating any standing order is expected to use the orders in conjunction with a complete nurse assessment...". There was no documented evidence the nurse performed a complete assessment of Patient #1 before initiating the standing orders. During an interview with the Administrator on 3/9/23 at 1:15 PM, the Administrator confirmed the findings and stated the nurse should have done a complete nursing assessment of Patient #1 per the physician orders before initiating the new medications.

Based on observation, interview, and record review, the hospice failed to include all assessment findings and interventions in the patient's plan of care for one of 14 patient records reviewed (Patient #7) and for one of three patient home visits. (Patient #3) --- The findings are: On 3/8/23 at 12:50 PM, review of Patient #7s record revealed a document, titled, ";Patient Communication," dated 1/31/23, that reads the patient had a fever and tested positive for Covid-19. There was no documented evidence the patient's plan of care was updated to include Patient #7s change in condition. During an interview with the Administrator on 3/9/23 at 12:30 PM, the Administrator confirmed the findings and stated Patient #7s plan of care should have been updated after the new diagnosis of Covid-19. On 3/7/23 at 8:15 AM, a home visit conducted to Patient #3's home revealed Patient #3 was observed to have a low air loss mattress (prevents pressure wounds). On 3/7/23 at 10:30 AM, review of Patient #3s record revealed no documented evidence of the low air loss mattress in Patient #3s plan of care. During an interview with the Administrator on 3/9/23 at 1:00 PM, the Administrator confirmed the low air loss mattress should have been included in Patient #3s plan of care.

Based on record reviews and interview, the hospice failed to ensure the Skilled Nurses (SN) and Hospice Aide (HA) completed home visits per the ordered frequency on the patient's plan of care for 4 of 14 patient charts reviewed. (Patient #2, #8, #9, and #14). --- On 3/8/23, at 10:00 a.m., Patient 14s record was reviewed. The plan of care indicated the Medical Social Worker (MSW) was to visit the patient weekly. There was no documented evidence the MSW visited Patient 14 for the weeks of 7/21/22 (date of admission), 7/23/22, 8/6/22, 8/13/22, 8/20/22, and 8/27/22. During an interview with the Administrator on 3/9/23, at 1:35 p.m., she confirmed the plan of care was for the MSW to visit the patient weekly due to the findings of the comprehensive assessment and she confirmed the MSW did not visit the patient weekly. The findings include: On 03/07/23 at 10:35 AM, review of Patient #2s chart revealed a visit frequency for the SN for 1 time a week for 11 weeks and 1 as needed (PRN) visit starting 01/29/23. Review of the benefit period dated 01/13/23 to 04/12/23 revealed 1 extra PRN SN visit the week of 02/05/23 and 1 extra PRN SN visit the week of 02/19/23. During an interview on 03/09/23 at 12:26 PM, the Administrator verified the findings. On 03/08/23 at 9:31 AM, review of Patient #8s chart revealed a visit frequency for the HA for 3 times a week for 12 weeks starting 10/30/22 and the SN for 2 times a week for 12 weeks starting 10/30/22. Review of the benefit period dated 10/24/22 to 01/21/23 revealed the HA made 2 extra visits each week of the certification period without extra orders and the SN missed 1 visit the week of 12/18/22. During an interview on 03/09/23 at 12:56 PM, the Administrator verified the findings. On 03/07/23 at 4:54 PM, review of Patient #9s chart revealed a visit frequency for the SN for 1 time a week for 9 weeks. Review of the benefit period dated 10/10/22 to 12/08/22 revealed 1 missed SN visit the week of 12/04/22. During an interview on 03/09/23 at 12:57 PM, the Administrator verified the findings.

Based on review of the hospice's Quality Assurance Process Improvement (QAPI) data and interview, the hospice had no documentation that the hospice measured, analyzed, and/or tracked adverse patient events, and other aspects of performance that enable the hospice to assess processes of care, hospice services, and operations. --- The findings include: Review of the hospices QAPI data on 03/09/23 at 11:35 AM revealed the hospice had no documentation that the hospice tracked, analyzed and/or investigated adverse patient events to assess the care, services, and operations of the hospice. During an interview on 03/09/23 at 11:40 AM, the Administrator verified the findings.

Based on record review and interview, the hospice failed to ensure bereavement services were available to the family up to one year post death based on the patient's bereavement plan of care for 1 of 2 deceased patients. (Patient #11) --- The findings include: On 03/08/23 at 10:00 AM, review of Patient #11s chart revealed the patient expired on 04/27/22. Review of the patients bereavement plan of care revealed there was no documentation that the patient's plan of care was completed based on services and frequencies outlined in the plan of care. During an interview on 03/09/23 at 1:00 PM, the Administrator verified the findings.

Based on record review and interview, the hospice failed to provide on-site supervision of the Hospice Aide (HA) by a Registered Nurse (RN) every 14 days for one of 14 patient records reviewed. (Patient #1) --- The findings are: On 3/7/23 at 12:00 PM, review of Patient #1s record revealed an HA was part of the patient's plan of care and visiting the patient five days a week. There was no documented evidence that a Registered Nurse provided on-site hospice aide supervisory visits every 14 days from 2/16/23 to 3/6/23. During an interview with the Administrator on 3/9/23 at 1:15 PM, the Administrator confirmed an RN did not conduct on-site supervision of the hospice aide every 14 days from 2/16/23 to 3/6/23.

Based on record review and interview, the hospice failed to assess the effectiveness of new medications to treat symptoms for one of 14 patient records reviewed. (Patient #1) --- The findings are: On 3/7/23, at 12:15 PM, review of Patient #1s record revealed a document, titled, ";Patient Communication," dated 2/26/23, that revealed ";Patients daughter called to report that the patient has not had a bowel movement in 3 days. She also states that pt (patient) is complaining of nausea. Senna (laxative) 8.6-50 mg (milligrams) take 2 tabs (tablets) PO (orally) daily PRN (as needed) for constipation ordered per standing orders. Compazine 10 mg (milligrams) take 1 tab PO every 6 hours PRN ordered per standing orders for nausea...". There was no documented evidence the effectiveness of the medication was assessed after the new medications were initiated. During an interview with the Administrator on 3/9/23 at 1:15 PM, the Administrator stated that a nurse should have reassessed the effectiveness of the medication interventions for Patient #1s constipation and nausea.

Based on record review and interview, the hospice failed to complete a Discharge Summary for one of 14 patient records reviewed. (Patient #14) --- On 3/8/23, at 9:58 AM, review of Patient #14's record revealed Patient #14 was admitted on 7/21/22 with a primary diagnosis of Cirrhosis of the Liver (damage to the liver). Review of the hospice's document, titled, "Discharge - Live," dated 8/31/22, showed, "...Patient discharged for cause today...". There was no Discharge Summary in the record. On 3/9/23, at 1:35 p.m., an interview was conducted with the Administrator who confirmed there was no Discharge Summary completed for Patient #14.