Every finding on record at Loyal Hospice & Palliative Care, LLC

Observed in Record Review. In 1 of 14 patient records reviewed, it was noted that for HOSNHVRR#6 the RN did not visit the patient at least every 15 days to perform comprehensive assessment. For example, the LPN was the primary nurse seeing the patient and the RN visits were done at the end of October, the first of December then 3 weeks later in December. This was confirmed by the DON and administrator assisting with record review.

Observed in Record Review. In 5 of 14 patient records reviewed, it was noted that goals stated on the hospice plan of care were not timed or measurable. For example, in HOSDCRR#1 and HOSRRNHV# all goals were stated as Ongoing. In record review for home visits #1 and #2 it was noted that some goals were also stated as ongoing and some were not measurable. For example, Caregiver will verbalize non verbal pain cues, Patient will have symptoms of fluid volume controlled within limits of the disease, Caregiver will verbalize plan for skin integrity, Anxiety will be absent or reduced to an acceptable level, Caregiver will verbalize understanding of expected decline. This was also noted in HOSNHVRR#4 where all goals were stated as ongoing. This was discussed with the administrator.

Observed in Patient Home. In 2 of 2 home visits conducted, by the same LPN, she was observed using hand gel after removal of gloves and prior to entering her nursing bag. She did not rub the gel until it was completely absorbed but instead was observed waving her hands to dry them. This was discussed with the DON and administrator upon return to the office.

Observed in Record Review. In 3 of 14 patient records reviewed, it was noted that the aide care instructions did not include specific instructions for the hospice aide. For example, in HOSRRNHV#1 the patient had a wound present at the start of care and also developed additional wounds during the course of care however there were no instructions to the aide that indicated the presence of the wounds or how to manage them during bathing. In another example, in HOSRRNHV#2 the patient was ordered oxygen continuously at 2 L/min. In another example in HOSRRNHV#5 the patient was recieving oxygen at 3L/nc continuously. In both examples the aide instruction sheet did not contain any instructions for the aide regarding the use of oxygen during the shower. This was discussed with the administrator who provided assistance with record reviews.

Observed in Document Review. During discussion with the administrator and review of the Volunteer Services program it was noted that the required 5% of the total patient care hours were not provided. In the past 10 months the rate was documented in the QAPI program at 1.65%.

Observed in Document Review. During opening conference with the administrator and the Director of Nursing for the hospice program it was noted that there was no alternate physician designated by the hospice to assume the responsibility of the medical director. This was discussed with and confirmed by the administrator.

Observed in Record Review. In 2 of 2 patient records reviewed, that were live discharges, it was noted that there was a discharge note form however it did not include a summary of the patient's care including treatments, symptoms and pain management. This was discussed with the administrator assisting with record review.

Observed in Tracer Activities. Leaders did not provide sufficient staffing as evidenced by the organization did not have an Alternate Medical Director ,which resulted in a Condition Level deficiency at 418.102