Every finding on record at Maximum Quality Hospice, LLC

Observed in Document Review. In 1 of 12 patient records reviewed, the social worker failed to complete their initial assessments within five days after the election of hospice. For example, in RRNHV#4 the assessment was not completed until approximately 20 days after the election of benefits. This finding was reviewed and discussed with the DON.

Observed in Record Review. In 1 of 12 patient records reviewed, the agency failed to ensure that the medication orders obtained. For example, in RRNHV#5 Hydrocodone/apap 5/325mg 1 tablet oral every 6-8 hours as needed for pain was included in the admission assessment nursing note; however it was omitted from the medication profile. This was reviewed and discussed with the DON. Observed in Record Review. In 5 of 12 patient records reviewed, the agency failed to include interventions for safety precautions related to bleeding precautions for a patient on anticoagulants. For example, the hospice survey observed, in RRHV#3, RRNHV#3, RRNHV#4 and RRNHV#5, the medication profile included Eliquis 2.5 mg tablet -Instructions: 1 tablet oral twice a day; however, intervention for bleeding precautions were not included in the POC. In addition, in RRNVH#1, that the medication profile included Xarelto 20 mg tablet Instructions: 1 TABLET ORAL DAILY; however, goals for bleeding, precautions were not included in the POC. These findings were reviewed and discussed with the DON.

Observed in Record Review. In 2 of 12 patient records reviewed, the agency failed to address a high-risk medication in the plan of care and failed to demonstrate safe management/education/monitoring related to anticoagulant therapy. For example, the hospice survey observed, in RRHV#3, the medication profile included Eliquis 2.5 mg tablet -Instructions: 1 tablet oral twice a day; however, interventions for bleeding precautions were not included in the POC.

Observed in Record Review. In 12 of 12 patient records reviewed, the nurse surveyor noted that the IDG nursing summaries were not incorporated into the patient's clinal records; however, the documentation was retained in a binder. For example, this was identified in all patient records reviewed, HOS RRVH#1,HOS RRVH#2,, HOS RRVH#3, HOS RRNVH#1, HOS RRNVH#2, HOS RRNVH#3, HOS RRNVH#4, HOS RRNVH#5, HOS RRNVH#6, HOS RRNVH#7, RRDC#1 and RRDC#2 . This was reviewed and discussed with the DON.

Observed in Record Review. In 1 of 11 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 treatments necessary to meet the patient's needs. In RR#7, the plan of care for the patient with a recent urinary tract infection included the order to change the indwelling #18/Fr Foley catheter monthly and prn. The size of the catheter balloon and indications for the prn changes were not included in the plan of care/order. This was reveiwed and verified with the Director of Nursing.

Observed in Patient Home. In 2 of 3 home visits conducted, the organization did not implement the infection prevention and control activities it had planned, including standard precautions. In HV#1, after assessing the reddened areas on the patient's perineum, the skilled nurse did not decontaminate hands after removing gloves, and between glove changes per the organization's policy and procedure. In HV#2, the hospice aide did not perform hand hygiene between glove changes while bathing and providing personal care to the patient. This was reveiwed and verified with the Director of Nursing.

Observed in Record Review. In 9 of 11 patient records reviewed, entries in the patient record were not authenticated per the organization's policy and current accepted standards of practice. In review of the record for HV#1, HV#2, RR#1, RR#2, RR#3, RR#5, RR#6, RR#7, and RR#8, the MD narrative note on the Certificate of Terminal Illness (CTI) was authenticated as composed by the physician with the MD's written signature and date. It was noted the narrative note entry was written by a scribe. This entry did not include authentication of the signature and title of the individual who completed the entry into the hospice record based on the information composed by the physician. This was reveiwed and verified with the Administrator.

Observed in Record Review. In 1 of 2 hospice live discharge records reviewed, the organization did not give information regarding provided care, treatment, or services to other service providers upon discharge/transfer of the patient. In RR#5, there was no documentation that the Discharge Summary was provided to the receiving hospital/provider. This was reviewed and verified with the Director of Nursing.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization did not take action to minimize identified safety risks. In HV#1, it was noted there were two (2) oxygen E-tanks in the home. One tank was stored upright, secured in a stand. The second E-tank was sitting up-right unsecured. The tank was placed on its side on the floor, and secured between furniture prior to leaving the home. Review of safe oxygen tank storage with the aide and family member was also performed. This was reveiwed and verified with the Administrator, who then contacted the equipment/oxygen provider.

Observed in Patient Home. The organization did not plan the patient's care. The plan of care did not include all information related to medications necessary to meet the patient's needs for management of the terminal illness and related conditions. In reviewing the medication profile/list for HV#1 with the skilled nurse and family caregiver, it was noted the written order for Lorazepam 2mg/ml was to give 0.5ml every 6-8 hours for anxiety/restlessness. It was confirmed by the skilled nurse and family caregiver that the Lorazepam was being administered as needed every 6-8 hours. The as needed frequency indication was not included in the current order. This was reviewed and confirmed with the Director of Nursing.

Observed in Patient Home. The organization did not implement the infection prevention and control activities it had planned by using standard precautions to protect against possible exposure to infectious agents. During HV#1, the skilled nurse perform hand hygiene using hand gel. After completing an inspection/assessment of the patient's feet, the nurse removed the exam gloves, used only a small amount of gel, quickly rubbed hands together, and continued on with the visit. Hand hygiene was not in compliance with CDC guidelines, per organizational policy. This was reviewed and confirmed with the Director of Nursing.