Every finding on record at Innovative Nursing Solutions and Hospice Care LLC

Based on record review, family and staff interviews, and review of agency policy, it was determined that the hospice agency failed to respond promptly to the patients request for Foley catheter (the tube that carries urine out of the body) leakage, and symptoms management for one patient (P) (P#5) of 16 sampled patients (P#1, P#2, P#3, P#4, P#5, P#6, P#7, P#8, P#9, P#10, P#11, P#12, P#13, P#14, P#15, P#16). --- Findings Include: Record review of P#5 revealed that the family of P#5 called the hospice agency on 1/21/2023 at 1:30 p.m., and that P#5s Foley catheter was leaking. Registered Nurse (RN) AA did not visit P#5 until 6:30 p.m., five hours after the family phone call. RN AA failed to respond promptly in a timely manner to the patients request. On 8/22/2023 at 2:08 p.m., an interview conducted with the Administrator revealed that she did not know why RN AA went to visit P#5 at 6:30 p.m., and that RN AA has resigned. The Administrator called RN EE, who was the on call nurse, and left a voice message for her with no response. On 8/23/23 at 11:00 a.m., an interview conducted with P#5s family revealed that although RN AA came late on 1/21/2023 at 6:30 p.m. and replaced the Foley catheter, the hospice agency staff were professional and very supportive. Agency policy was not available prior to survey exit.

Based on record review, staff interviews, and review of agency policy, it was determined that the hospice agency failed to ensure that the initial comprehensive assessment was completed within 48 hours after the election of hospice care for one patient (P) (P#6) of 16 sampled patients (P#1, P#2, P#3, P#4, P#5, P#6, P#7, P#8, P#9, P#10, P#11, P#12, P#13, P#14, P#15, P#16). --- Findings Include: Review of the document titled, ";RN Initial/Comprehensive Assessment" for P#6, revealed the admission date 4/10/2023 and the electronic signature date signed by Registered Nurse (RN) BB 4/13/2023. The clinical record lacked documentation regarding the staff's delay in completing the assessment within 48 hours after the election of hospice care. In an interview on 8/24/2023 at 12:18 p.m., the Administrator revealed that she did not know why the RN BB did not complete the admission within the required 48 hours after the physicians order was received. The Administrator revealed that RN BB was not working with the agency anymore. The Administrator additionally confirmed that the surveyors have been provided with all patient record documentation prior to survey exit. Agency policy was not available prior to survey exit.

Based on observation, and staff interviews, it was determined that Certified Nursing Aide (CNA) FF failed to follow standard precautions to prevent the transmission of infectious and communicable diseases by using dirty water during bed bath for one Patient (P) (P#1) of two home visits (P#1, P#3). --- Findings include: During a home visit with P#1 on 8/22/2023 at 9:05 a.m., surveyor observed CNA FF perform bed bath care to P#1. During the bathing procedure CNA FF washed P#1's face, chest, arms/hands, abdomen, legs, feet and genital area. CNA FF turned P#1 on side washed back of neck, back and anal/peri area (area of skin between the genitals and the anus) using dirty water. CNA FF failed to change wash cloth or water. On 8/23/2023 at 9:45 a.m. an interview conducted with CNA FF revealed that the bathroom is down the hall and that she did not want to carry the water and acknowledged that the water was dirty. On 8/23/2023 at 2:00 p.m. an interview was conducted with the Administrator who acknowledged that CNA FF failed to follow acceptable standards for infection control to prevent transmission of infectious and communicable diseases.

Based on record reviews and staff interviews, it was determined that the agency failed to ensure the plans of care which contained verbal orders were signed by the physician in a timely manner for four patients (P) (P#7, P#9, P#11, P#12), of 16 sampled patients (P#1, P#2, P#3, P#4, P#5, P#6, P#7, P#8, P#9, P#10, P#13, P#14, P#15, P#16). --- Findings include: 1. Review of a plan of care for P#7 admitted to hospice on 5/26/2022, (certification period of 7/20/2023 to 9/17/2023), revealed that the physician failed to sign the plan of care. The agency failed to obtain the physician's signature on plan of care that contained verbal orders. 2. Review of the plan of care for P#9 admitted to hospice on 3/13/2023 (certification period of 8/21/2023 to 10/19/2023), revealed that the physician failed to sign the plan of care. The agency failed to obtain the physician's signature on plan of care which includes verbal orders. 3. Review of the plan of care for P#11 admitted to hospice on 4/5/2023 (certification period of 7/4/2023 to 10/1/2023), revealed that the physician did not sign the plan of care. The agency failed to obtain the physician's signature on plan of care which includes verbal orders. 4. Review of the plan of care for P#12 admitted to hospice on 2/16/2023 (certification period of 8/15/2023 to 10/13/2023), revealed that the physician did not sign the plan of care. The agency failed to obtain the physician's signature on plan of care which includes verbal orders. On 8/23/2023 at 1:07 p.m., an interview was conducted with Registered Nurse (RN) CC who acknowledged the plan of care that includes verbal orders was not countersigned by the physician. On 8/23/2023at 1:30 p.m., an interview conducted with RN DD revealed that she was not aware that the plan of care contained verbal orders that were not signed by physician. On 8/23/2023 at 1:30 p.m., an interview was conducted with Administrator who confirmed that the plan of care contained verbal orders that were not signed by physician.

Based on record review, staff interviews, and review of agency policy, it was determined that the hospice agency failed to ensure that the criminal background check was included in contract agreement between hospice agency and company that the agency used for meals services for 16 patients (P) (P#1, P#2, P#3, P#4, P#5, P#6, P#7, P#8, P#9, P#10, P#11, P#12, P#13, P#14. P#15, P#16) of 16 sampled patients (P#1, P#2, P#3, P#4, P#5, P#6, P#7, P#8, P#9, P#10, P#11, P#12, P#13, P#14. P#15, P#16). --- Findings include: Record review of hospice agency contract binder revealed that the agency has a contract agreement for meal service signed on April 3, 2023. The agency failed to include criminal background check written in the agreement. On 8/22/2023 at 12:38 p.m., an interview was conducted with the Administrator who revealed that she was not aware of criminal background checks missing in the contract agreement with meals services. Agency policy was not available prior to survey exit.