Every finding on record at Med Care Hospice, Inc.

Observed in Record Review. In 3 of 8 patient records reviewed, it was noted that the 8 page consent form/benefit election had not been signed by the patient or a legal representative. In all three records the patient name was hand printed on the form but there was no signature. Review of agency policy Hospice Benefit Election stated the patient, caregiver, legal representative will sign the election form. This was discussed with the RN present for survey.

Observed in Record Review. In 3 of 8 patient records reviewed, it was noted that narrative notes for certification and recertification were copied and pasted into the record. For example, in record review for home visit #3, record review #1 and #2, the MSW narrative note was identical on recertification and initial assessment. Additionally, for record review #2 the skilled nursing narrative was identical on recertification and initial assessment. This was discussed with the RN present on survey.

Observed in Record Review. In 4 of 8 patient records reviewed, it was noted that in record review for home visit #2 the plan of care did not include any problems or interventions for chronic constipation which was documented in the IDG notes. In record review #1 the plan of care did not include any problems or interventions for documented issues of constipation, anxiety, increased blood pressure, onset of pain which were documented on the IDG notes. In record review #2 the plan of care did not include any problems or interventions for documented issue of onset of pain as documented in the IDG notes. In another example, it was noted that in record review for home visit #1 the plan of care was not updated to include a problem for constipation that was reported in two different IDG notes. This was discussed with the RN present on survey.This was reviewed with the RN present on survey.

Observed in Record Review. In 2 of 8 patient records reviewed, it was noted that the plan of care did not contain all orders. For example, it was noted in record review #1 that there were no treatment orders for oxygen. There was an order for the concentrator but there was no liter flow rate or delivery method stated. Skilled nursing notes on admission assessment and subsequent visit notes indicated that the patient was using oxygen. In record review #4 there was no location of where to apply Voltaren gel. This was confirmed by the RN present in the office.

Observed in Document Review. During discussion with the Alternate DPCS and review of QAPI meeting minutes, it was noted that there had not been any PIP's initiated for the past 12 months. This was confirmed by the RN on site during survey and the Alternate DPCS.

Observed in Patient Home. In 2 of 3 home visits conducted, the LVN was observed spraying his equipment with Lysol disinfectant spray. He was also observed placing the equipment into his nursing bag while it was still wet. This was observed on home visit #1 and #2. Review of agency policy and discussion with the RN on site during the visit indicated that alcohol pads were to be used.

Observed in Tracer Activities. During discussion with Volunteer Coordinator and document review it was noted that there was no documentation of recruitment efforts for the volunteer program. This was discussed with the RN present on survey.

Observed in HR File Review. In 2 of 8 HR files reviewed, it was noted that for both the hospice Medical Director and the Alternate Medical Director there was no documentation in the HR file of orientation to the hospice organization. This was confirmed by the RN present on survey.

Observed in Record Review. In 4 of 8 patient records reviewed, it was noted in record review #1 there was an order to remove foley catheter on the visit after admission however there was no documentation in the record that the foley was removed. This was reviewed with the RN present on the survey. In record review #1 and #2, the IDG notes indicated that the patient had a thyroid impairment however this was not on the diagnosis list and there was no thyroid medication listed in the record. In record review for home visit #2 it was noted that there was documentation of the patient using oxygen on IDG notes over a period of three months however the patient did not have oxygen ordered or in use. In record review for home visit #3 it was noted that on the same date the nurses note on the IDG stated that the patient was wandering however the MSW note stated patient was bedbound. This was discussed with the RN present on the survey.

Observed in Document Review. In review of contract for the provision of durable medical equipment, it was noted that the company was not accredited by any accrediting organization. This was confirmed by the RN present on the survey.