Every finding on record at Loving Touch Hospice and Palliative Care Incorporated

Observed in Record Review. In 1 of 10 patient records reviewed, the organization did not assess/reassess the patient according to defined timeframes. In RRHV#1, the Spiritual Care Counselor did not complete/document the initial assessment within five days after the election of hospice benefit. The spiritual assessment was completed/dated nine (9) days after the patient's election of hospice, with no information documented as to the reason for the delay. This was reveiwed and verified with the Director of Nursing.

Observed in Record Review. In 2 of 10 patient records reviewed, the organization did not assess/reassess its patients by ensuring the hospice interdisciplinary group updated the comprehensive assessment in collaboration with the physician as frequently as the patient's condition required and at least every 15 days. In RRHV#2, the registered nurse performed aide/LVN supervisory visits only and but did not complete/document an assessment of the patient for 27 days. In RRNHV#5, the RN did not complete an assessment of the patient for 21 days. This was reveiwed and verified with the Director of Nursing.

Observed in Record Review. In 1 of 10 patient records reviewed, the organization did not plan the patient's care by ensuring the plan of care included all services needed for the palliation and management of the terminal illness and related conditions, including medications and treatments necessary to meet the patient's needs. In RRNHV#6, the patient's plan of care included an equipment order for a home oxygen concentrator, but there was no order for oxygen administration for the patient documented. This was reveiwed and verified with the Director of Nursing.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization did not implement the infection prevention and control activities it had planned, including standard precautions to protect against possible exposure to infectious agents. In RRHV#2, the registered nurse did not perform hand hygiene and change gloves after removing dressings from the patient's stage 4 pressure wounds, then reaching into the open field bag, and cleaning the wounds with normal saline and applying clean dry dressings. The RN's practices were not consistent with the organization's policy and CDC guidelines for hand hygiene. This was reviewed and verified with the Director of Nursing.

Observed in Record Review. In 1 of 9 patient records reviewed, the organization did not plan the patient's care, by ensuring the registered nurse responsible for the hospice aide supervision prepared written patient care instructions for the aide. In RRHV#2, the patient's Foley catheter was discontinued as noted in the hospice plan of care, but the hospice aide assignment was not updated by the registered nurse. The aide care plan continued to included care tasks to be completed by the hospice aide related to the urinary catheter. This was reviewed and verified with the Director of Nursing

Observed in Record Review. In 1 of 10 patient records reviewed, the organization did not ensure the medical director, physician member of the interdisciplinary team, or physician designee reveiwed the patient's clinical information and completed/signed the Certificate of Terminal Illness (CTI) prior to recertification. In RRHV#3, there was no CTI completed and signed by the Medical Director prior to the start of the third hospice certification period. This was reviewed and verified with the Director of Nursing.

Observed in Record Review. In 1 of 14 patient records reviewed, the patient record did not contain information that reflected the patient's care, treatment, and services, including complete documentation of all services and events provided directly or by arrangement. In RRNHV#4, the patient's hospice record did not include evaluations, treatments, and/or progress notes from the general inpatient (GIP) care provided by arrangement in the skilled nursing facility. This was reveiwed and verified with the Director of Nursing.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization did not provide education and training based on each patient's needs and abilities, including procedures to follow if care, treatment, or services were disrupted by a disaster or emergency. In RRHV#1, the family caregiver indicated the family had a plan for the bed-bound patient on oxygen in the event of an emergency/disaster (to shelter in place), but the Individual Emergency/Disaster Plan in the hospice home binder was blank, with education and training not provided and documented with the patient/family per organizational policy and process. This was reviewed and verified with the Director of Nursing.

Observed in Patient Home. In 2 of 3 home visits conducted, the organization did not implement its infection prevention and control activities to minimize, reduce or eliminate the risk of infection. In RRHV#2 and RRHV#3, the nurse did not perform bag technique per organizational policy. The nurse placed clean and used care equipment (blood pressure monitor, stethoscope) on the open field bag during the visit, with the bag remaining unzipped and opened to the environment when the nurse entered and exited the patient's residence. This was reviewed and verified with the Director of Nursing.