Every finding on record at Millennium Hospice Agency, LLC

Observed in Individual Tracer. In 8 of 14 patient records reviewed, The surveyor observed in review of medication profile that multiple medications for pain had been ordered without orders designating when to take which pain medication. For example on multiple records the patient had both hydrocodone and morphine sulfate ordered PRN for pain without further guidelines. This issue was discussed and confirmed with organization leadership.

Observed in Individual Tracer. In 2 of 3 home visits conducted, The surveyor observed that even though on visit 2 smoking had been identified as an issue on oxygen risk assessment that the staff had not documented education and understanding of education by patient and family. Further on visit 1 the surveyor observed that the risk assessment had not identified standing oxygen as an issue or provided education, but a few weeks into care it was observed as documented in nursing note with statement patient had not wanted to move standing oxygen tanks. The surveyor did not observe and documentation to patient of what could be the outcome of leaving oxygen standing. This issue was discussed and confirmed with SN of home visit and organization leadership.

Observed in Record Review. In 2 of 11 charts reviewed, the comprehensive assessments were not completed by all disciplines in accordance to the organizational policy PE.1, page 1-A: The Interdisciplinary Group (IDG) in . . . will complete the comprehensive assessment no later than five (5) calendar days after the election of the hospice benefit. Identified in RR#7, the Medical Social Worker did not complete the initial psychosocial assessment until day 6. Identified in RR#8, the Chaplain did not complete the initial Spiritual Assessment until day 6. This was reviewed and validated with the Administrator.

Observed in Record Review. In 1 of 11 patient records reviewed, a Registered Nurse (RN) did not visit the hospice patient every 15 days to conduct an updated comprehensive assessment per organizational policy PE.1-Patient Assessments, page 2, B: The update to the comprehensive assessment will be completed as frequently as the condition of the patient requires, but no less frequently than every fifteen (15)days. Reviewed in the record for HV#2, a Registered Nurse visit was not made until 16 days after the initial start of care Comprehensive Visit. This was reviewed and validated with the Administrator.

Observed in Individual Tracer. In 1 of 2 Bereavement Records reviewed, the plan of care was not followed. Identified in Bereavement Record #2, the plan of care was for telephone calls to the bereaved at 1, 3, 6, and 9 months post patient death. There was no telephone call documented for the 3rd month per plan of care. This was reviewed and validated with the Administrator.

Observed in Patient Home. In 1 of 3 home visits conducted, the clinician failed to follow the organizational Bag Technique policy IC.12, page 2, E - The bag is placed on a clean, safe surface in the home, . . . , Bags should never be placed on the floor. Observed in HV#2, the Licensed Vocational Nurse (LVN) placed the bag on the ground outside the home in the driveway, proceeded to take the bag into the home, and place the bag on the patient's bedroom floor during the patient assessment, and then placed the bag on the kitchen area floor while completing a medication reconciliation and documenting without wiping down the bag at any opportunity during the visit. Also observed during HV#2, the RN had not established the clean and dirty areas of the bag. According to policy IC.12, page 2, A - Consider and treat the selected bag as a clean area at all time. Observed during the visit, the LVN failed to clean her notebook trapper, and tablet device post use before returning them into the same area as her cleaned stethoscope and blood pressure cuff. This was reviewed and validated with the Administrator and Alternate Administrator. Observed in Patient Home. In 3 of 3 home visits conducted, the clinicians failed to follow the organization’s established procedures for cleaning reusable medical equipment. Per policy EC.12-Equipment Maintenance: “Agency will maintain equipment owned and/or utilized by Agency staff, in accordance with manufacture’s written guidelines. When no written guidelines exist, the agency will establish appropriate procedures. . . “. The established procedures outlined in the organization’s “Cleaning of Equipment Competency” includes: Stethoscope: “Between each patient . . . bell/diaphragm, and tubing with alcohol pad”; Blood Pressure Cuff: “detergent and water”; Tape Measure/Wound Measurer: “wipe vigorously with alcohol pad”; Pulse Oximeter: “After each use wipe finger/ear probe with alcohol pad”; Thermometer: “wipe with alcohol” Observed in HV#1, the Registered Nurse used a “Lysol” brand wipe to clean her manual blood pressure cuff, infrared thermometer, stethoscope, pulse oximeter and a retractable measuring tape, after use. Observed in HV#2, the LVN cleaned the following reusable equipment with a “Clorox” brand wipe: manual blood pressure cuff, infrared thermometer, stethoscope, retractable tape measurer, and pulse oximeter. Observed in HV#3, the Hospice Aide, cleaned the following with a “Sani-cloth” wipe: an electronic upper arm blood pressure cuff, and infrared thermometer. This was reviewed and validated with then Administrator and the Alternate Administrator. Observed in Patient Home. In 2 of 2 home visits observed, the clinicians failed to perform hand hygiene according to organizational policy IC.3 For example, observed in HV#2, the Licensed Vocational Nurse did not remove gloves following the patient assessment and perform hand hygiene prior to cleaning the reusable medical equipment, per policy, IC.3, page 3, 5: Staff may use an alcohol-based hand rub for routinely decontaminating hands in the clinical situations . . .After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient. Observed in HV#3, the Hospice Aide turned off the faucet with her right thumb prior to drying her hands with a paper towel failing to follow policy IC.3, page 2, E-Staff will dry hands and wrists thoroughly with a clean paper towel. They will use a paper towel to turn off the faucet. This was reviewed and validated with the Administrator and Alternate Administrator.

Observed in Patient Home. In 2 of 2 home visits where medication reconciliation was completed, the medication record was not accurate. For example in HV#1, Morphine Sulfate Extended Release 30mg tablets was in the home and being taken every 8 hours. This medication was not listed on the organizations medication profile. In HV#2, Gabapentin 300mg capsule, 1 each day was listed on the patient's current medication profile, but was not currently being taken by the patient. This was reviewed and validated with the Alternate Administrator.