Every finding on record at Md Preferred Hospice, Inc.

Observed in HR File Review. In 3 of 7 HR files reviewed, it was noted the organization had failed to provides ongoing education and training to all staff, individuals providing services under arrangement, and volunteers that are consistent with their roles and responsibilities in an emergency. For example, during HR file review of HR#1 Medical Director,HR#7 LVN, and HR#5 CHHA, there were no evidence documented of biennial EM training received from the organization. This finding was discussed and validated by the Administrator/DPCS.

Observed in Record Review. In 1 of 6 active patient records reviewed, it was noted the hospice written hospice elan of care includes all services needed for the palliation and management of the terminal illness and related conditions, including the medications and treatment necessary to meet the patient’s needs. For example in RRHV#2, during medication reconciliation, it was noted the patient has three PRN pain medications, Acetaminophen 500 mg 1 tablet PO every 6 hours PRN is intended for mild pain, and Tramadol Hydrochloride 50 mg 1 tab PO 3x a day as needed for severe pain; however, the order for Morphine did not include a defined parameter for its use. This finding was discussed and validated by the Administrator/DPCS>

Observed in Record Review. In 1 of 3 active patient records with hospice aide services, it was noted the organization had failed to ensure that the written patient care instructions for a hospice aide must be prepared by a registered nurse who is responsible for the supervision of a hospice aide. For example in RRNHV#1, based on record reviewed, it was noted the patient has been taking Eliquis, an anti-coagulant medication. Although the patient receives hospice aide services for personal care, the aide care plan did not include instructions regarding bleeding precautions or reporting any signs of bleeding. This finding was discussed and validated by the Administrator/DPCS.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted the organization had failed to ensure that the patient records contains clinical information such as list of medications, including dose, strength, frequency, route, date and time of administration for prescription and nonprescription medications, herbal products, and home remedies that relate to the patient's care, treatment, or services. For example in RRHV#2, during medication reconciliation, it was noted the Morphine Sulfate dosage listed in the medication profile did not match the medication label. Based on staff interview, she confirmed to the surveyor that the correct dose should be half a tablet, not one and a half tablets. This was discussed and validated by the Administrator/DPCS..

Observed in Record Review. In 7 of 7 patient records reviewed, for active patients, the surveyor noted that for HV#1/RR#1, HV#2/RR#2, HV#3/HV#3, RR#4, RR#5, RR#6, and RR#7 the goals were not consistently individualized for example, in HV#1/RR#1 a goal stated In 1 to 2 weeks and throughout cert period pt. will have adequate food and fluids as tolerated or desired and be able to eat 2 to 3 full meals per day with no incidence of aspiration. Patient was only eating sips and bites. Additionally, there were no short-term goals at start of care to address issues of immediate needs such as understanding medication management, symptom management, pain management, mobility or oxygen safety, most were to be achieved in two weeks or for the duration of the certification period. This was verified by the CEO/Administrator.

Observed in Record Review. In 4 of 7 patient records reviewed, of active patients, the surveyor noted that for HV#2/RR#2 there were orders for a Foot Care Service to evaluate the patient and set up treatment, this was not added to the plan of care. For HV#3/RR#3, the patient was on oxygen for dyspnea, but this was not addressed on the plan of care. For RR#4 and RR#5 both patients were on oxygen but there were no problems on the plan of care addressing oxygen use or safety. Findings were verified by the CEO/Administrator.

Observed in Record Review. In 1 of 5 patient records reviewed, with the Hospice Aide, the surveyor noted that for RR#5, one Hospice Aide Supervisory visit was completed 18 days apart, then the next was completed 22 days apart, not the required 14 days. This was verified with the CEO/Administrator.