Every finding on record at Lighthouse Hospice Care, Inc.

Observed in Record Review. In 1 of 2 live discharge records reviewed, the patient revoked the hospice benefit to seek aggressive treatment in record RRDC#2 however a revocation document was not signed. This RFI was confirmed by the Administrator/Director of Patient Care Services.

Observed in Record Review. In 1 of 2 live discharge records reviewed, the patient was discharged for extended prognosis in record RRDC#1. An Advanced Beneficiary Notice was signed instead of the required Notice of Medicare Non-Coverage. This RFI was confirmed by the Administrator/Director of Patient Care Services.

Observed in Record Review. In 10 of 10 active patient records reviewed, a majority of goals in the plan of care were not measurable. Here are some examples. Patient will achieve the optimum level of safety on a daily basis. Patient will achieve optimum level of comfort and safety on a daily basis. Patient will achieve optimum level of comfort thru pharmacological and non-pharmacological intervention. Patient will achieve and or maintain optimum level of oxygenation. Promote comfort, prevent infection, and support wound healing while maintaining patient dignity and comfort. This last statement was created seven months ago and the only active goal in record RRHV#1. This RFI was reviewed with the Administrator/Director of Patient Care Services.

Observed in Record Review. In 3 of 10 active patient records reviewed, the organization did not ensure that plans of care included measurable outcomes. In records RRHV#1, RRNHV#1, RRNHV#5, and RRNHV#7 there are currently no active problems or goals. This RFI was reviewed with the Administrator/Director of Patient Care Services.

Observed in Record Review. In 6 of 7 active patient records reviewed where aide services were provided, aide supervision was not documented every 14 days. In record RRHV#3 supervisory visits were late 4 times between 15 and 42 days. In record RRNHV#2 supervisory visits were late 4 times between 15 and 25 days. In record RRNHV#3 a visit was late 1 time in 15 days. In record RRNHV#4 a visit was late 1 time in 16 days. In record RRHV#5 visits were late 2 times between 16 and 43 days. In record RRNHV#6 visits were late 4 times between 15 and 28 days. This RFI was reviewed with the Administrator/Director of Patient Care Services.

Observed in Record Review. In 2 of 10 active patient records reviewed, certificates of terminal illness did not include subjective and objective information to support patient life expectancies of six months or less at recertification. For example, records RRHV#2, RRHV#3 contained the following statement: Multiple comorbidities and the patient has demonstrated significant functional and clinical decline over the past months. There were metrics quantifying decline in the face-to-face documents, but these were not included in the certificates. This RFI was reviewed with the Administrator/Director of Patient Care Services.

Observed in Patient Home. In 3 of 3 home visits conducted, comfort kits with controlled drugs were ordered when the patient was admitted. The Surveyor observed that there was no policy and procedure on the management and disposal of these drugs in the patient's binder. This RFI was reviewed with the Administrator/Director of Patient Care Services.

Observed in Patient Home. In 2 of 3 home visits conducted, the Surveyor noted the clinicians for HV #1 and HV #2 utilized a single compartment bag without a designated clean and dirty area per the HCO policy. This was validated with the RN present during the visit and the Director of Patient Care Services.

Observed in Patient Home. In 2 of 3 home visits conducted, the Surveyor noted the medication list in the electronic medical record (EMR) had not been updated to identify the medications the patient was currently being administered. For example, in HV #2, the EMR had been missing the medications: Lactulose (started 2 months ago), Robitussin DM, Vitamin C, Vitamin B-Complex, and Multi-Vitamin. HV #3 the Medication list had an incorrect dosage and frequency for Senna which had been 1 tab QD, but had been changed over a month ago to 2 tabs BID, and Megace, which had also been changed from 1 tab BID to 1 tab TID. The medication list was also missing Dayquil that the care giver had been administering as needed. This was validated with the RN present during the home visit.