Every finding on record at Longevity Hospice, Inc.

Observed in HR File Review. In 5 of 8 HR files reviewed, the organization had not provided emergency preparedness training to staff, volunteers, and individuals providing on-site services under arrangement at the following intervals: at least every two years. This training was not documented in the files for the Administrator, LVN2, Chaplain, MSW nor Medical Director who had all worked for the organization for more than two years at the time of the survey.

Observed in Record Review. In 4 of 11 patient records reviewed, the hospice’s interdisciplinary group did not update the comprehensive assessment in collaboration with the patient’s attending physician as frequently as the patient’s condition required, but no less than every 15 days. In the charts for HV#1, HV#3 and RR#6, the MSW had not documented input into the IDG meeting/update of the POC. In the chart for HV#2, no documented input from the MSW for multiple IDG's; no input from Chaplain for at least one IDG in the past calendar quarter. Observed in Record Review. In 4 of 11 patient records reviewed, the update of the comprehensive assessment was not based on changes that had taken place since the initial assessment and did not include information about the patient’s progress toward desired outcomes and a reassessment of the patient’s response to care. In the charts for HV#1 there was no documentation regarding the patients wounds, nor progress toward goals for any discipline. In the chart for HV#2, there was no documentation of progress toward goals. In the chart for HV#3, target dates had simply been moved forward rather than documenting progress toward goals. For example, a sleep issue which had been identified more than 5 months prior to this survey read Report feeling of being rejuvenated after sleep and established an effective sleep pattern within 60 days Pcg will verbalized understanding the use of new medication for sleep comfort with a target date into each new benefit period without addressing progress. In the chart for RR#3, the IDT notes did not address progress toward goals.This was discussed with the DPCS.

Observed in Record Review. In 1 of 11 patient records reviewed, the hospice had not provided education and training to the primary caregiver to the responsibilities assigned to him or her in the plan of care. In the chart for RR#2, there was no indication that the caregiver was taught how to apply Nystatin powder and Lotramin cream twice/day for 19 days when it was added to the patient's plan of care. This was discussed with the DPCS.

Observed in Record Review. In 7 of 11 patient records reviewed, the written plan of care was not based on the patient’s goals and the time frames, settings, and services required to meet those goals. In the chart for HV#1, the most recent recertification plan of care included goals that were not measurable, Facilitate an optimal spiritual environment to begin the bereavement process for the family with pastoral support and/or were not updated with progress toward goals in that it was simply updated with a new target date Patient will have optimum level of oxygen -Pt/Pcg will verbalize understanding of oxygen use, medication and treatment orders within 4-6 weeks or every certification period. In the chart for HV#3, the goals were not measurable and some target dates prior to current benefit period. An example included Facilitate an optimal spiritual environment to begin the bereavement process for the family. The goal for the patient’s sleep problem was targeted for within 60 days for the PCG to verbalize understanding of medication prescribed for sleep comfort. In the chart for RR#1, the goals had not been individualized to the importance of attaining the goal. Examples included for the patient’s pain problem - Patient will remain pain free as much as possible during care period. -Keep pain below SIT level for comfort -Patient/family will verbalize understanding of medication orders and side effects within 4-6 weeks and every certification period. For the oxygen safety issue - PCG will verbalize understanding of how and when to give oxygen with the target date the end of the benefit period. In the chart for RR#3, there were no goals that pertained to the MSW services being provided to the patient; goals were not measurable and/or did not have an individualized target date. These findings also applied to RR#4 and RR#8. In the chart for RR#6, the potential for pain was added at the SOC, however there was no target date/time for actual attainment of relief from pain. The only target date for this problem was 4-6 weeks for the patient/PCG to verbalize understanding of orders/side effects. This was discussed with the DPCS.

Observed in Record Review. In 1 of 11 patient records reviewed, the plan of care (POC) did not include all services needed for the palliation and management of the terminal illness and related conditions. In the chart for HV#1, the original POC did not include any orders for SN frequency of visits. This was discussed with the DPCS.

Observed in Record Review. In 5 of 11 patient records reviewed, the POC did not include all treatments necessary to meet the patient's needs. In the chart for HV#1, the POC did not include the patient's peritoneal dialysis that the PCG manages, nor the blood glucose checks that the PCG also manages. In the chart for HV#2, the patient was at risk for falls. The care plan was non-specific and did not include the specific interventions that were observed to be in place during the home visit, including a bed alarm, side rails, padded rail on one side of the bed, getting the patient bathed and dressed before breakfast as that prevented his attempts to rise to go to the dining area, etc. In the charts for RR#3, RR#5 and RR#7 the MSW was seeing the patients, however the POC did not contain interventions specific to MSW services. In the chart for RR#5, there were incomplete orders on the POC. There was an order written for Foley catheter insertion kit which was missing the size of the catheter and balloon, and no actual order to catheterize the patient. The patient was assessed to be at risk for pressure ulcer development, however there were no interventions related to this potential problem. In the chart for RR#7, the patient was assessed to have a PICC line present upon admission as well as subsequent SN notes. This was not addressed on the hospice POC; there were no orders for PICC line care, flushes, etc. Additionally, there is notation regarding the patient’s blood sugar readings. This treatment was not addressed on the POC. An order was obtained for compression arm sleeve and compression socks, however the frequency /duration of these treatments was missing. This was discussed with the DPCS.

Observed in Record Review. In 4 of 11 patient records reviewed, the plan of care was not revised based on information from updates to the patient’s comprehensive assessment and did not address the patient’s progress toward goals and outcomes. In the chart for RR#4, orders were obtained to increase RN visits from once for the initial assessment, however this order was never added to the POC to update it. Thus, in the final benefit period, more than 11 months post admission, the POC still stated RN once for initial assessment, when the RN was actually seeing the patient every 14 days. This also applied to RR#7, RR#6 and RR#5. Additionally in RR#5, last POC update/IDG did not capture the new orders to change to CC level of care. This was discussed with the DPCS.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization had not provided the patient with care, treatment, or services according to his or her individualized plan of care. In the chart for HV#2, the Chaplain was ordered monthly. There was no Chaplain visit provided during the month of November 2021 as discussed with the DPCS. In the chart for HV#3, Spiritual Care was ordered monthly. There have been no documented visits for four months.

Observed in Data Session. The number and scope of annual performance improvement projects was not based on the patients’ needs and internal organization needs. The projects did not reflect the scope, complexity, and past performance of the organization’s services and operations. While the organization had collected, aggregated and analyzed data in an organization wide manner, there were no performance improvement projects actually identified and implemented as confirmed with the Administrator and DPCS.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization had not implemented its infection prevention and control activities, including surveillance, to minimize, reduce, or eliminate the risk of infection. During HV#1, the LVN placed his clinical bag on the floor of the patient's home. Organizational policy N-120, Nursing Bag, required the bag to be placed on a clean dry surface. Additionally, the dressings that were removed from the patient were placed in the garbage. Policy N-100 stated Dressings that are soiled with blood or drainage should be placed in an approved biohazardous waste container. Policy N-120 Nursing Bag - there was no indication what solution should be used to clean equipment; no mention of following manufacturer's guidelines, All items removed from the bag should be cleaned before returning to the bag. This was discussed with the DPCS and Administrator.

Observed in HR File Review. In 1 of 8 HR files reviewed, the organization had not oriented staff on relevant policies and procedures, including those related to infection prevention and control and assessing and managing pain. Completion of this orientation was not documented in the file for the Medical Director as confirmed with the Administrator and DPCS.

Observed in HR File Review. In 1 of 1 HR files reviewed, for a hospice aide, a registered nurse had not completed the competency evaluation. In the file for the Aide, the initial competency assessment document was signed off by the aide herself in the column on the form for the preceptor to sign and date each individual competency. The RN signed the back of the multiple page document only. This was discussed with the DPCS.

Observed in Record Review. In 2 of 11 patient records reviewed, the RN had not supervised the hospice aide at least every 14 days. In the charts for HV#1, the RN sees the patient every 14 days, however at the time of this survey, it had been more than 30 days since the last documented supervisory visit. Supervisory visits had also not occurred every 14 days in the chart for RR#3. This was confirmed with the DPCS.

Observed in Document Review. In 1 of 3 contracts reviewed, the written agreement with an outside agency providing contracted services for the hospice did not include a stipulation that services will be delivered in accordance with the patient’s plan of care. This requirement was missing in the contract for the pharmacy as discussed with the Administrator and DPCS.

Observed in HR File Review. In 1 of 8 HR files reviewed, the organization had not oriented staff on relevant policies and procedures, specific job duties. Completion of this orientation was not documented in the file for the Medical Director as confirmed with the Administrator and DPCS.

Observed in HR File Review. In 1 of 8 HR files reviewed, staff competence was not initially assessed and documented as part of orientation. In the file for the Medical Director, the form utilized by the organization included a column for the preceptor to document date and initials of the evaluator, however this column was blank for all competencies, required as well as non-required. This was discussed with the DPCS and Administrator.

Observed in Record Review. In 4 of 11 patient records reviewed, the patient record did not contain specific notes on care, treatment and services. In the chart for HV#1, the SN is not documenting the care provided to the patient's wounds. During the most recent recertification assessment, the nurse documented SN performed wound care as directed by PCP Patient with two wounds, however both are indicated as resolved on the wound flow sheet; unable to tell which wound was treated. Both wounds indicated as resolved on the flow sheet were observed by this surveyor during the home visit. The same documentation practice was present at every SN visit reviewed for the current benefit period. In the chart for RR#1, the documentation by the SN on administration of meds was incomplete. Morphine given as prescribed every 30 minutes as needed to manage pain. and Gave breathing treatment via nebulizer mask. In the chart for RR#6, the SN documentation of medication administration during continuous care did not include the route. Also, during the last 2.5 hour visit, there were no specific times of administration. Patient medicated with PRN morphine 10mg every 30 minutes prior to providing care for patient. Patient tolerated care well. Narcotic/drug disposal was not addressed during the death visit. In the chart for RR#8, the wound care documentation was incomplete. “wound care was done”.This was discussed with the DPCS.

Observed in Record Review. In 11 of 11 patient records reviewed, at the time when controlled medications were first ordered, authorized staff had not documented in the patient’s record that the written policies and procedures for managing controlled medications were provided and discussed. This was not present in any patient chart. Controlled medications were ordered for all patients as part of the patient's comfort pack at admission. The information is present in the patient educational materials provided by the organization. This was discussed with the DPCS and Administrator.

Observed in Document Review. In 1 of 1 contracts reviewed, for inpatient care, the written agreement for hospice care provided to residents of a SNF, NF, or Intermediate Care Facility did not include the manner in which the SNF, NF, or ICF/IID and the hospice will communicate with each other and will document the communications to make sure the needs of the patients are met 24 hours a day. This was confirmed with the Administrator and DPCS.

Observed in Document Review. In 1 of 1 contracts reviewed, for inpatient services, the written agreement for hospice care provided to residents of a SNF, NF, or Intermediate Care Facility did not a provision stating the hospice assumes responsibility for determining the appropriate course of hospice care, including the decision to change the level of services provided. This was confirmed with the Administrator and DPCS.

Observed in Document Review. In 1 of 1 contracts reviewed, for inpatient services the written agreement for hospice care provided to residents of a SNF, NF, or Intermediate Care Facility did not include a provision stating that the hospice will report all mistreatment, neglect, or verbal, mental, sexual, and physical abuse to the SNF, NF, or ICF/IID administrator within 24 hours of the hospice becoming aware of the alleged violation, including injuries of unknown source, and misappropriation of patient property by anyone unrelated to the hospice . This was confirmed with the Administrator and DPCS.