Every finding on record at Lynncare Hospice Services, LLC

Observed in Emergency Management Session. Identified during the review of the Emergency Mangement plan, the organization's plan does not include how they will inform state and local officials of any on-duty staff or patients that they are unable to contact. This was reviewed and validated with the Administrator.

Observed in Patient Home. In 1 of 2 home visits conducted by skilled nurses, the hospice did not conduct a patient-specific comprehensive reassessment that identified the patient's need for care including the severity of symptoms and factors that alleviate or exacerbate physical symptoms. Observed in RR HV#1, the patient was wearing bilateral forearm sleeves that the Registered Nurse (RN) shared were in place due to a history of bruising to the patient's arms, and to reduce additional bruising to the arms. During the patient assessment, the RN did not remove the sleeves to visualize the condition of the patient's skin. This was reviewed and validated with the Administrator/Director of Nursing and the Alternate Administrator.

Observed in Record Review. In 2 of 9 active patient records reviewed, the organization did not ensure that the individual plans of care included all of the services needed for the palliation and management of the terminal illness and related conditions. For example, in RR HV#1, the patient was admitted two years prior to the survey and had no mortuary/burial plans identified during the initial psychosocial assessment, nor were there any updates evident in the patient's chart, yet this need was not been included in the plan of care. Also, during the home visit conducted for RR HV#1, the patient was wearing bilateral sleeves to his forearms due to a history of bruising/skin integrity issues, yet Skin Integrity was not included as a need in the plan of care. Reviewed in RR NHV#6, it was identified during the initial psychosocial assessment that the patient had no mortuary/burial plan, but this need was not included in the plan of care. This was reviewed and validated with the Administrator.

Observed in Patient Home. In 2 of 3 home visits conducted, the organization did not use standard precautions to reduce the risk of infections in accordance with organizational policy Hand Hygiene: 2. Procedures for Performing, and 3. Indications for Hand Hygiene. Observed in RR HV#1, the Registered Nurse did not perform hand hygiene prior to donning gloves and completing the patient's assessment. Observed in RR HV#2, the Licensed Vocational Nurse performed hand hygiene with soap and water, but did not have a paper towel available so she turned off the faucet with her wrist/forearm and dried her hands on the patient's cloth hand towel in the kitchen. This was reviewed and validated with the Administrator/Director of Nursing and the Alternate Administrator. Observed in Patient Home. In 1 of 3 home visits conducted, the organization did not ensure the implementation of its infection prevention and control activities to minimize, reduce, or eliminate the risk of infection. Observed in RR HV#2, the Licensed Vocational Nurse(LVN) did not follow the organization's policy - Bag Technique - 1 Upon arrival: . . . c. Remove supplies/equipment needed for the visit,. Instead the LVN donned gloves, and retrieving one piece of reusable medical equipment at a time to assess the patient, repeatedly returning to the bag with contaminated/used gloves each time she needed a different piece of equipment to complete the assessment. This was reviewed and validated with the Administrator.

Observed in Tracer Activities. Identified during the review of the organization's volunteer program, there were no documented volunteer recruitment or retention efforts made since the previous survey date. This was reviewed and validated with the Administrator.

Observed in Tracer Activities. Identified during the review of the organization's admission packet provided for Surveyor review, and those present in each of the home visits conducted, the organization did not provide a copy of its written policies and procedures on the management and disposal of controlled medications. This was reviewed and validated with the Administrator.

Observed in Tracer Activities. The organization did not provide patient education and training to meet each patient's needs and abilities. Identified during review of the organization's admission packet provided for Surveyor review and those present in each of the home visits conducted, there was no evidence of providing education on the following: Disposal of Controlled Medications, or the potential safety risks associated with the use of side rails/restraint-like medical equipment. Observed in all three home visits conducted, RR HV#1, RR HV#2, and RR HV#3, the patients were bedbound with bilateral full side rails in the up position. This was reviewed and validated with the Administrator.

Observed in Record Review. 1 of 2 live discharge records reviewed, the organization did not comply with law and regulation, or in accordance with the organization's policy - Discharge from Hospice Care - Discharge Notice: G. A hospice will ensure delivery of the Discharge Notice, and if Medicare recipient the Notice of Medicare Non-Coverage . . . no later than five days before the date on which the patient will be transferred or discharged. Identified in RR DC#1, the patient was discharged due to no longer being terminal on the same date as receiving the Discharge Notice and Notice of Medicare Non-Coverage. This was reviewed and validated with the Administrator.