Every finding on record at Living Angels Hospice Care

Observed in Record Review. In 1 of 10 patient records reviewed, During RR#5 it was noted lack of an initial bereavement assessment documented in the medical record. This was discussed with the Administrator.

Observed in Record Review. In 4 of 10 patient records reviewed, Review of the following records documented many of the patient/family goals were either generic, not measurable or not individualized. During RR#3 it was assessed by the RN at the initial evaluation that the patient was imminently terminal, however goals were written to be accomplished throughout the certification or by the next IDG. For example: participate management activities and a balanced plan of activities and rest to prevent stress throughout the cert period. The patient will maintain or achieve a slight increase in activity tolerance evidenced by an acceptable level of fatigue/weakness maintain and improve functional abilities through maintaining normal functioning and alignment, preventing edema of extremities, and preventing complications of immobility during hospice stay. During RR#4 it was noted the goals were generic and were not individualized. For example: Patient will reduce discomfort with improved bowel elimination status with the help of proper diet in this certification period. -Patient will be free from signs and symptoms of urinary infection, distention, or retention with in hospice stay. -Increase strength/energy for functional activities and patient will remain safe from any fall or injury in this certification period. Patient will exhibit minimal or reduced confusion, memory loss, and cognitive disturbances with the use of medication as interventions during hospice stay. Pt will have adequate food and fluids as tolerated or desired with in hospice stay. During RR#1 it was noted some goals were generic, not individualized and not meaurable. For example: ADL needs are met., pt will verbalize and/or express decreased episodes of chest pain. Pt will maintain optimum peripheral circulation. During RR#2 it was noted the following goals were not measurable: Optimal bowel elimination and comfort. -Pt/Family/PCG will verbalize having elimination needs met at an acceptable level. -Promote optimal rest status for Pt/Family/PCG. During RR#7 it was noted goals without a measurable time frame to assess progress as follows: Pt will maintain good peripheral circulation; Patient will maintain BP within individually acceptable range. Pt/Family/PCG will verbalize having urinary elimination needs met at an acceptable level. This was discussed with the Administrator.

Observed in Record Review. In 1 of 10 patient records reviewed, During HV#2 record review it was noted interventions in the POC did not reflect the patient clinical skin condition. The skin was assessed as intact without any breakdown or wounds documented. The interventions added to the POC were: Assess changes in wound status - check size, integrity, location, type/stage, signs and symptoms of infection, drainage, effectiveness of current treatment. This was discussed with the Administrator. Observed in Record Review. In 1 of 10 patient records reviewed, During HV#1 record review it was noted the MSW documented during an IDG meeting the end of July 2024, an update to the POC that included in-person monthly visits to provide emotional support and other necessary psychosocial assistance. It was noted MSW interventions were not added to the POC. This was discussed with the Administrator.

Observed in Record Review. In 1 of 10 patient records reviewed, During HV#1 record review it was noted the MSW visited the patient in July 2024, the day of a scheduled IDG meeting. The frequency of visits on the POC for the MSW was documented as declined and was not updated to reflect the visit that documented the MSW would continue in-person monthly visits to provide emotional support and other necessary psychosocial assistance. This was discussed with the Administrator.

Observed in Record Review. In 2 of 10 patient records reviewed, During RR#2 it was noted the patient was prescribed Pradaxa 110mg 2x/day. The POC lacked interventions and goals for S/S bleeding and bleeding precautions. During RR#6 it was noted the patient was prescribed Warfarin daily. The POC lacked interventions and goals for S/S bleeding and bleeding precautions. This was discussed with the Administrator.

Observed in Record Review. In 1 of 10 patient records reviewed, During RR#1 it was noted a comm note that the patient was c/o nausea and vomiting in June 2024. An SN visit was provided to assess with documentation that the IDG was notified. The nausea and vomiting deficit were not added to the POC for continued assessment, interventions and goals. This was discussed with the Administrator.

Observed in Record Review. In 1 of 10 patient records reviewed, During RR#3 it was noted orders for the following were obtained during the initial RN assessment: Right foot wound. Cleanse with wound cleanser, pat dry. Apply Triple Antibiotic ointment. Cover with kerlix dressing daily and as needed when soiled or dislodged x 21 days then re eval. Stage 2 coccyx pressure sore: Cleanse with wound cleanser ,pat dry. Apply Medihoney. Cover with bordered dressing daily and as needed when soiled or dislodged x 21 days then re eval. There is lack of SN documentation after the initial RN assessment of wound care being performed for the next 4 days prior to the patient's discharge. This was discussed with the Administrator.

Observed in Patient Home. In 1 of 3 home visits conducted, During HV#1 it was noted the SN after disinfecting equipment used to assess vital signs did not place the equipment on a clean barrier to dry instead placed the disinfected equipment on the same barrier used to place the equipment after use. This was discussed with the Administrator. Observed in Patient Home. In 1 of 3 home visits conducted, During HV#1 it was noted the SN did not disinfect her hands after removing gloves 3 times during a wound care procedure before donning clean pairs. This was discussed with the Administrator.

Observed in Record Review. In 5 of 8 patient records reviewed, receiving aide services. During HV#1 record review it was noted the hospice aide assignment form care plan lacked the order for oxygen 2L/min PRN SOB. The aide plan of care also lacked an update in April 2024 when the patient developed a buttock pressure ulcer with direction to the aide not to remove the dressing and when to notify the RN and lacked an update in July 2024 when the patient sustained a skin tear to the left forearm after a fall at home with direction to the aide not to remove the dressing and when to notify the RN. During RR#3 it was noted an oxygen order on CHHA form was documented by the RN as 2-5L/min PRN without a specific liter flow for the aide to follow. In addition, there is instruction at the bottom of the assignment form to leave the oxygen on during the bath but did not indicate the liter flow. During RR#4 it was noted an oxygen order on CHHA form was documented by the RN as 2-5L/min PRN without a specific liter flow for the aide to follow. In addition, there is instruction at the bottom of the assignment form to leave the oxygen on during the bath but did not indicate the liter flow. During RR#2 it was noted the oxygen order on the aide assignment form was documented, 2-5L/min PRN SOB without a specific liter flow for the aide to follow. During RR#7 it was noted the oxygen order on the aide assignment form was documented, 2-5L/min PRN SOB without a specific liter flow for the aide to follow This was discussed with the Administrator.

Observed in Document Review. There was lack of evidence that the governing body and leadership had established requirements to support patient care treatment and services as evidenced by a conditional finding in 418.56 and 418.100. This was discussed with the Administrator.

Observed in Record Review. In 1 of 14 patient records reviewed, During HV#1 record review it was noted the medication profile in the patient medical record and in the home did not match one of the medication bottle labels. Quetiapine (Seroquel) 25mg, 12.5 mg dose (1/2, 25 mg tab) 2x/day for agitation was documented on the medication profile in the home. The label on the bottle also included take an additional 1/2 tab daily PRN agitation that was omitted on the medication profile. This was discussed with the Administrator.

Observed in Record Review. In 2 of 6 patient records reviewed, who were discharged. During RR#1 it was noted the D/C summary lacked documentation that the hospice informed the attending physician of the availability of a discharge summary. During RR#5 it was noted lack of a D/C summary in the patient medical record. This was discussed with the Administrator.

Observed in Patient Home. In 1 of 3 home visits conducted, During HV#1 it was noted the organization individualized disaster preparedness form was blank in the home folder reviewed. The patient record also lacked a completed individualized disaster preparedness form. This was discussed with the Administrator.