Every finding on record at Liberty Health Services, Inc.

Observed in Individual Tracer. It was observed on HV#1 that the nurse did not conduct medication reconciliation as required by organization policy. This was verified with the interim DPCS who was also on the visit.

Observed in Record Review. It was found on review of BR#3 T03210 that the initial bereavement assessment was not complete. Several areas on the assessment were not addressed such as Mental status, spiritual, impression of high or low status or risk factors for the family member. This was verified with the interim Administrator. Observed in Record Review. In 3 of 10 patient records reviewed, It was found on review of RRNHV#5, RRNHV#6 and RRNHV#7 that the initial bereavement assessment was not complete. Multiple areas on the documents were left blank. Examples: Mental, spiritual, risk factors, and impression of high medium or low risk. This was verified with the interim Administrator. The organization has identified this area for improvement and was working on a solution.

Observed in Record Review. In 4 of 10 patient records reviewed, It was found on chart review of RRNHV#2, RRNHV#4, RRNHV#6 and RRNHV#8 that the medication profile was not correct. On RRNHV#1 there was an order for Triple Antibiotic however this medication was not documented on the Medication Profile. On RRNHV#4 the patient was ordered a Z Pack and it was on the medication profile however there were no directions as to how is was to given or how long the patient was to take the medication. RRNHV#6 patient was taking holistic remedies however they were not identified on the Medication Profile. RRNHV#8 patient was ordered Lidocaine however it was not on the Medication Profile. These findings were verified wit the interim Administrator.

Observed in Individual Tracer. It was observed on HV#1 that the patient was on oxygen in a SNF and the concentrator was beside the bed however there was a cart up against the concentrator impeding air circulation. Also observed that the filter on the concentrator was covered in lint and was dark gray in color. The nurse stated that the SNF was responsible for cleaning the filter. This was verified with the interim DPCS who was also on the visit. .

Observed in Record Review. In 1 of 2 patient records reviewed, the organization had not provided the patient with care, treatment, or services according to the patient's individualized plan of care. In the chart for RR#1, the aide frequency did not follow the hospice plan of care. Hospice aide was ordered twice weekly for the first two weeks of care. Aide visits were actually provided once weekly for the first two weeks, at which time the service was discontinued per patient request. This was confirmed with the Administrator.

Observed in Patient Home. In 1 of 1 home visits conducted, the organization had not implemented infection standard precautions to reduce risk of infection. During HV#1, the nurse washed her hands at the kitchen sink, however turned the faucet off with her newly cleansed hands rather than using a towel which was the organization's policy as confirmed with the Administrator. This was discussed with the nurse during the visit.

Observed in Patient Home. In 1 of 1 home visits conducted, the patient record did not contain the following clinical information: A list of medications, including dose, strength, frequency, route, date and time of administration for prescription and nonprescription medications, herbal products, and home remedies that relate to the patient's care, treatment, or services. During HV#1, it was discovered by the LVN and this surveyor that the medications the patient was taking and on the list in the home did not match the hospice plan of care. For example, Trazadone was ordered 50mg - 1/2 tab at HS in November, yet it was not on the list in home and the patient had not been receiving it. Donapezil 5mg 2 tabs at HS was not on the Hospice EMR, yet it was on the list in the home and being administered. MiraLAX was ordered daily; it was being administered 1-3 times daily prn. Norco administered in the home was 5-325 q 6 hours prn and was on the list in the home, yet the hospice EMR/order was for 10-325 q 4 hours prn. The patient's lidocaine patch for pain was ordered daily; was being administered prn. This was discussed with the Administrator.

Observed in Record Review. In 1 of 2 patient records reviewed, at the time when controlled medications were first ordered, authorized staff did not document in the patient’s record that the written policies and procedures for managing controlled medications were provided and discussed. This was discussed with the Administrator.