Every finding on record at Miracle Mile Hospice Care, Inc.

Observed in Patient Home. In 1 of 3 home visits, and subsequent record review, the surveyor noted that the organization failed to update the plan of care, at least every 15 days or as frequently as needed, to include all services needed for the palliation and management of the terminal illness and related conditions. For example, in HOSHV#1, the surveyor observed the aide having difficulty safely assisting the patient with transferring from the rolling walker into the shower. Surveyor observed that the patient had an unsteady gait and was having difficulty taking minimal steps to the shower, and patient required a two-person assist to lift the patient's feet up from the floor over into the raised shower base. Additionally, it required a three-person assist to transfer patient from the shower. When the surveyor asked the aide if it has been difficult to transfer patient into and from the shower in previous visits, the aide responded yes; however, the aide had not reported the difficulty with transfers to the nurse, in order for the aide care plan to be updated to reflect the appropriate care for bathing and level of assistance required for transfers. This was reviewed with the Administrator and Clinical Manager.

Observed in Record Review. In 1 of 10 records reviewed, the surveyor noted that the organization failed to collaborate in the care of the patient and coordinate their efforts to support the goals outlined in the plan of care. For example, in HOSHV#1, the surveyor observed the aide having difficulty safely assisting the patient with transferring from the rolling walker into the shower. Surveyor observed that the patient had an unsteady gait and was having difficulty taking minimal steps to the shower, and patient required a two-person assist to lift the patient's feet up from the floor over into the raised shower base. Additionally, it required a three-person assist to transfer patient from the shower. When the surveyor asked the aide if it has been difficult to transfer patient into and from the shower in previous visits, the aide responded yes; however, the aide had reported the difficulty with transfers to the nurse, in order for the aide care plan to be updated to reflect the appropriate care for bathing and level of assistance required for transfers. This was reviewed with the Administrator and the Clinical Manager.

Observed in HR File Review. In 2 of 12 HR files reviewed, the surveyor noted that the organization failed ensure that staff are competent to perform their responsibilities by assessing and documenting competencies annually, per the organizations policy. For example, in HR#3 and HR#4, there was no documentation to validate that competencies were assessed for 2023 and 2024. This was reviewed with the Administrator and the Director of patient Care Services.

Observed in Record Review. In 1 of 10 records reviewed, the surveyor noted that the organization failed to ensure that the registered nurse prepared, and updated, the written patient care instructions for the hospice aide. For example, in HOSHV#1, the surveyor observed the aide having difficulty safely assisting the patient with transferring from the rolling walker into the shower. Surveyor observed that the patient had an unsteady gait and was having difficulty taking minimal steps to the shower, and patient required a two-person assist to lift the patient's feet up from the floor over into the raised shower base. Additionally, it required a three-person assist to transfer patient from the shower. During subsequent record review for HOSHV#1, the surveyor noted that the section for transfers on the aide plan of care was blank and did not indicate the level of assistance required. This was reviewed with the Administrator and Clinical Manager.

Observed in Record Review. In 1 of 10 records reviewed, the surveyor noted that the organization failed to maintain complete and accurate patient record. For example, in HOSNHV#4, the nurse did not enter documentation in the record in a timeframe defined by organizational policy; the documentation for the visit was completed 10 days after the visit was completed. This was reviewed with the Administrator and the Director of Patient Care Services.

Observed in Record Review. In 2 of 11 patient records reviewed, the patient was no informed of their financial responsibility prior to the start of care. In all records reviewed, the surveyor noted the election of benefit/consent for service did not inform the patient of their financial responsibility in a dollar amount. This was confirmed with the Director of Nursing.

Observed in Record Review. In 1 of 11 patient records reviewed, the written plan of care was not based on the patient's goals and the time frames, settings and services required to meet those goals. In HV #1, the surveyor noted the second certification plan of care included the following non-measurable goals: Agitation of the patient will be decreased and manageable in the next two weeks. Constipation will be controlled with planned interventions. This was confirmed with the Director of Nursing.

Observed in Record Review. In 1 of 11 patient records reviewed, the plan of care did not include interventions to manage pain and symptoms. In RR #4, the surveyor noted the patient was identified as having anxiety; however there were no interventions on the plan of care to address this identified need. This was confirmed with the Director of Nursing.

Observed in Record Review. In 1 of 11 patient records reviewed, the plan of care did not include measurable outcomes anticipated from implementing and coordinating the plan of care. In RR #2, the surveyor noted the plan of care included a visit frequency for medical social worker and spiritual coordinator; however, there were no goals or interventions identified for these services. This was confirmed with the Director of Nursing.

Observed in Record Review. In 1 of 11 patient records reviewed, the plan of care did not include all drugs and treatment necessary to meet the needs of the patient. In HV #1, the surveyor noted the plan of care ordered for Lumigan eye drops did not specify which eye(s) to administer. In addition, the medication order for lisinopril was prn; however, there was no indication given. This was confirmed with the Clinical Manager.

Observed in Record Review. In 1 of 2 bereavement records reviewed, In BRV #2, the hospice surveyor noted the Bereavement Coordinator planned phone calls to bereaved; however, the bereavement plan did not specify the frequency of those phone calls. This was confirmed with the Bereavement Coordinator.

Observed in Record Review. In 2 of 2 patient records reviewed where the patient received aide services, a registered nurse did not prepare written patient care instructions for the hospice aide. In HV #1 and HV #2, the surveyor noted the aide plan of care did not include oxygen precautions; however, the patient was on oxygen. This was confirmed with the Director of Nursing. In HV #2, the surveyor noted the aide plan of care did not include precautions related to the pressure ulcer on the coccyx. This was confirmed with the Director of Nursing.

Observed in Record Review. In 1 of 3 home visits conducted, the clinical record did not include a complete list of medications. In HV #3, the surveyor noted the medication profile omitted the medication diclofenac gel as needed; which daughter reported the patient had taken for greater than one year. This was confirmed with the Clinical Manager. Observed in Record Review. In 2 of 11 patient records reviewed, the patient record did not contain all clinical information. In HV #3, the surveyor noted the oxygen safety assessment indicated the patient smoked and there were smoking materials in the home; however, in discussion with the RN who performed the assessment, this was inaccurate documentation. This was confirmed with the Director of Nursing. In Rr #6, the surveyor noted the nurse failed to document the assessment of the PEG tube site and the tracheostomy site as part of the comprehensive assessment. This was confirmed with the Director of Nursing.

Observed in Record Review. In 3 of 11 patient records reviewed, the individualized emergency plan did not address the patient's use of assistive devices and activity level.In RR #2, RR #3 and RR #5, the surveyor noted the individualized emergency plan did not specify the patient's assistive device needs in the event of evacuation. This was confirmed with the Director of Nursing.

Observed in HR File Review. In 1 of 8 HR files reviewed, criminal background check was not obtained within 3 months of the date of employment. In HR #5, the surveyor noted the criminal background check for the medical social worker was not completed until 12 months after the medical social worker was hired. This was confirmed with the HR Specialist.