Every finding on record at Meridian Hospice Care Inc

Observed in Record Review. In 1 of 2 patient records reviewed, where the patient had been discharged from services, the Notice of Medicare Non-Coverage had not been signed 2 days prior to the discharge. in RRDC #1, the patient had signed the NOMNC on the date of DC. This was validated with the Alternate DPCS.

Observed in Record Review. In 1 of 5 patient records reviewed, the Hospice Surveyor noted an RN did not visit the hospice patient every 15 days to conduct an assessment. For example, in RRNHV #5, the RN had not visited the patient since the first week of May (15 days prior). This was validated with the Alternate DPCS.

Observed in Record Review. In 5 of 9 patient records reviewed, the Hospice Surveyor noted the plan of care (POC) had been missing patient specific care needs identified on the initial visit. For example, RRHV #1, the patient had been identified as a high falls risk, and had pulmonary and cardiac issues, however, these had not been included on the POC with goals and interventions. in RRHV #2, the patient had been identified as a high falls risk but this had not been included on the POC. RRNHV #4 there had not been a falls risk assessment completed on the initial evaluation, but the patient had been documented as being a high falls risk. This had not been included on the POC. RRNHV #6, the patient was identified as a high risk for falls, but again, this had not been put on the POC. RRNHV #8 the patient had 5 recent hospitalizations for pneumonia and was started on home oxygen; however, this has not been included on the POC. This was validated with the Alternate DPCS.

Observed in Record Review. In 1 of 5 patient records reviewed, the Hospice Surveyor noted that care had not been provided according to the plan of care (POC). for example, RRNHV #5, the patient had orders for a weekly nursing visit; however, there had been no nursing visit the 2nd week of May. This was validated with the Alt DPCS.

Observed in Patient Home. In 1 of 3 home visits conducted, the Hospice Surveyor observed that the HCO had not ensured the policy related to bag technique and equipment cleaning -9-009.1 to prevent cross-contamination and hospice-acquired infections had been followed. For example, RRHV #1 the RN had a single compartment bag and the equipment utilized during the visit for patient assessment had not been disinfected prior to returning to the clinical bag. Plus the clinicians documentation binder and phone had been set on the patients bed and then on a kitchen table without a barrier, then not disinfected at the end of the patient visit prior to exiting the home. This was validated with the Alternate DPCS. Observed in Patient Home. In 1 of 3 home visits conducted, the Hospice Surveyor noted in RRHV #2, the clinician had used Clorox wipes to disinfect the equipment. The HCO policy specified that alcohol was to be used in equipment disinfection. This was validated with the Alternate DPCS. Observed in Patient Home. In 1 of 3 home visits conducted, the Hospice Surveyor observed the clinician from RRHV #1 had not performed Hand Hygiene as required in their policy 9-0091. The clinician had been observed changing gloves without performing hand hygiene in between glove changes. as described in the policy. The clinician also had not performed hand hygiene prior to entering the clinical bag. This was validated with the Alternate DPCS.

Observed in HR File Review. The Hospice Surveyor noted the Hospice Aide had not had an initial field evaluation to assess direct patient care competence. This was validated with the HR Director.

Observed in Record Review. In 9 of 9 patient records reviewed, the Hospice Surveyor noted no patient or caregiver documented education on the safe use and storage of home oxygen. In RRHV #1, the patient had a home oxygen concentrator and back up tanks. The home oxygen safety assessment had been completed; however, there had been identified fire hazards in the home (unknown what the safety risks had been). There had been no education provided to mitigate the safety concerns, nor any education on the use and storage of the home oxygen. In all other records reviewed, the admitting clinician had marked yes to 'identified fire hazards in the home' but there had been no interventions noted to mitigate these concerns. This was validated with the Alternate DPCS.