Every finding on record at La Esperanza Home Health, Inc.

It is required that each patient’s individualized written plan of care reflects patient and family goals, 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 4 of 14 (29%) clinical records reviewed revealed the agency did not ensure the plan of care (POC) included planned interventions and goals based on problems identified in the initial and updated comprehensive assessments. Clinical Record 1: The patient's date of election was 08/31/2023. The primary hospice diagnosis was Alzheimer's disease, unspecified. The RN Recertification visit dated 04/26/2024 and the Skilled Nursing Visit dated 06/11/2024 documented that the patient was incontinent of bowel and bladder, chair-bound/bed-bound, and had a fall risk of 8/10, with a score of 4 or greater considered at risk for falling. The Plan of Care order dated 05/02/2024 and 06/13/2024 lacked problems, interventions, and goals for risk for falls and risk for impaired skin integrity. Clinical Record 6: The patient's date of election was 07/11/2024. The primary hospice diagnosis was chronic systolic (congestive) heart failure. The RN Initial Assessment visit dated 07/11/2024 documented that the patient was recently hospitalized for acute respiratory failure, aspiration precautions, bilateral pulmonary effusions, septic shock, congestive heart failure, acute myocardial infarction, and E. coli infections. The patient was short of breath with moderate exertion. The medication profile documented the patient taking Farxiga for diabetes mellitus type 2 and Nitroglycerine 0.4mg/hour 1 patch daily. The Plan of Care order dated 07/11/2024 for the benefit period 07/11/2024-10/08/2024 lacked specific problems, interventions, and goals for altered respiratory, cardiovascular, and diabetes. Clinical Record 13: The patient's date of election was 12/02/2023. The primary hospice diagnosis was a secondary malignant neoplasm of bone marrow. The RN Initial Assessment visit dated 12/02/2023 documented that the patient was incontinent of bowel and bladder, bedbound, had contractures to bilateral legs, was agitated, had dyspnea at rest, had rales and rhonchi to all lung fields, had a MAHC-10 fall risk score of 8/10, and had five deep tissue injury pressure sores to the right hip, coccyx, left ankle, left midfoot, and the left anterior foot. The Plan of Care orders dated 12/02/2023 for the benefit period 12/02/2023-01/30/2024 lacked problems, interventions, and goals for impaired skin integrity, altered respiratory function, agitation, and fall risk. Clinical Record 14: The patient's date of election was 11/01/2023. The primary hospice diagnosis was a malignant carcinoid tumor of the stomach. The RN Initial Assessment visit dated 11/01/2023 documented that the patient was incontinent of bowel and bladder, bedbound, had a fall risk score of 9/10, combative and agitated, had swelling and weeping edema to the right upper arm, and an unstageable pressure ulcer to the right heel. The Skilled Nursing Visit dated 11/13/2023 documented that the patient had 2+ edema to the upper arms, had an unstageable pressure ulcer to the right heel, was incontinent of bowel and bladder, and was bedbound. The Plan of Care orders dated 11/01/2023 and 11/17/2023 for the benefit period 11/01/2023-01/29/2024 lacked problems, interventions, and goals for risk for impaired skin integrity, edema, safety due to combativeness and agitation, and fall risk. During a joint review of the record and an interview on 10/03/2024, the Administrator confirmed that there was no documented evidence that the plans of care included problems, goals, and interventions for the problems identified in the assessments.

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 clinical record review, document review and interview. In 2 of 3 (67%) home visit observations revealed the agency did not ensure the staff followed the hand hygiene policy. Agency policy, "Hand Hygiene Policy No. IC.15", dated 12/15/2022, stated in part, "Hand Hygiene with Soap and Water. Staff will identify and gather appropriate supplies. Staff will wet hands and wrists with water using temperature that is comfortable. Staff will apply the amount of product recommended by the manufacturer to hands and rub hands together vigorously for at least 15 seconds (with the recommendation of 20 seconds, but either time is acceptable), covering all surfaces of the hands and fingers. Staff will rinse hands and wrists thoroughly with water. With hands held upright, staff will dry hands and wrists thoroughly with a clean paper towel. They will use a paper towel to turn off the faucet. Hand Hygiene with an Alcohol-based Hand Rub. Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water in most clinical situations due to evidence of better compliance compared to soap and water. Staff may use an alcohol-based hand rub for routinely decontaminating hands in the clinical situations described below: after removing gloves." Home Visit 1/Clinical Record 4: During the home visit on 10/02/2024 with the Registered Nurse (RN) (Personnel Record 5), the RN was observed to wash their hands with soap and water. After rinsing the hands, the RN turned off the faucet before drying the hands. Home Visit 2/Clinical Record 2: During the home visit on 10/02/2024 with the Registered Nurse (RN) (Personnel Record 5), the RN was observed to check the patient's feet with gloves on. The RN removed the gloves and donned a new pair without washing their hands. During an interview on 10/02/2024, the Administrator agreed the staff did not follow the hand hygiene policy.

It is required that the hospice documents and demonstrates viable and ongoing efforts to recruit and retain volunteers. This standard was not met as evidenced by document review and interview. Upon reviewing the volunteer program, the documentation lacked evidence of recruitment and retention efforts for volunteers. During an interview on 10/03/2024, the Administrator confirmed that recruitment and retention efforts were not documented for 2024. Upon reviewing the volunteer program, the documentation lacked evidence of recruitment and retention efforts for volunteers.

It is required that the hospice is primarily engaged in providing the following care and services in a manner consistent with accepted standards of practice: Physical therapy, occupational therapy, and speech-language pathology services. This standard was not met as evidenced by document review and interview. Upon reviewing the contracts, there was no documented evidence of a contractual agreement for occupational therapy or speech-language pathology services. During an interview on 10/01/2024, the administrator said they had an additional contract for Physical Therapy (PT) but did not have contracts for Occupational Therapy (OT) and Speech-language Pathology (SLP). He said that they had not needed to use OT or ST in the past and so they did not have a contract yet. The agency does have a home health that is in the same building and uses the same employees. They offer PT, ST, and OT through their home health and they could be utilized if needed. At the time of the survey there was not a written agreement available for OT or SLP services. Upon reviewing the contracts, the documentation lacked occupational therapy and speech-language pathology services.