Every finding on record at Morning Star Palliative and Hospice Inc.

Observed in Record Review. In 2 of 10 patient records reviewed, the organization did not assess and reassess its patients by ensuring the hospice's interdisciplinary group (IDG) updated the comprehensive assessment in collaboration with the patient's attending physician no less than every 15 days. In RRHV#1 and RRNHV#7, multiple IDG notes did not include updates to the comprehensive assessment/plan of care by the MSW. This was reviewed and verified with the Administrator.

Observed in Record Review. In 2 of 10 patient records reviewed, the organization did not plan the patient's care by ensuring the plan of care included all services needed for the palliation and management of the terminal illness and related conditions. The patient's plan of care did not include the medication and treatment orders necessary to meet the patient's needs. In RRHV#3, the plan of care included the indwelling Foley catheter order Change Foley Catheter routine monthly per protocol and PRN when dislodged or leaking continuously. The order did not include the size of catheter, with RN assessment notes indicating the patient had a size 16 and 18 catheter at different points during the course of hospice care. In RRNHV#3, the patient's plan of care indicated the orders: Insulin Lispro 100unit/mL Solution for Injection 100 U Inj Sol Subcutaneous as sliding scale; and Lantus 100units/ml for Injection (OptiClik cartridge) 10 units Inj Sol Subcutaneous for diabetic. The insulin orders did not include the detailed sliding scale or the frequency for the Lantus. This was reviewed and verified with the Administrator.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization did not reduce the risk of infections associated with equipment, devices, and supplies. In RRHV#3, infection prevention and control activities were not implemented when cleaning and performing disinfection of the medical/care equipment. The RN cleaned the care equipment (BP cuff, stethoscope, temporal thermometer, pulse oximeter) with a cleaning cloth and immediately placed the wet items into the field bag. The nurse did not know the contact time for the cleaning product used was two (2) minutes per instructions for use (IFU). This was reviewed and verified with the Director of Patient Care Services.

Observed in Record Review. In 1 of 10 patient records reviewed, the organization did not assess and reassess its patients by ensuring the Medical Director reviewed the patient's clinical information before the recertification for the patient. In RRNHV#5, the patient's recertification period started six (6) days prior to the survey date and the Medical Director had not reviewed, completed, and signed the certificate of terminal illness (CTI). The CTI was completed/signed by the Medical Director by end of day. This was reviewed and verified with the Administrator.

Observed in Record Review. In 1 of 2 patient records reviewed, the organization did not inform the receiving/attending physician of the availability of a discharge summary that included the patient's medical and health status at the time of discharge. In RRDC#1, upon the patient's revocation from hospice to seek aggressive treatment, it was noted the receiving/attending provider was not informed that the Hospice Discharge Summary was available upon request. This was reveiwed and verified with the Director of Patient Care Services.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization did not coordinate the patient's care, treatment, or services based on the patient's needs by providing the Residential Care Facility (RCFE) the names and contact information of hospice staff involved in the care of the patient. In RRHV#1, in the hospice binder at the facility it was noted the page that outlined the hospice staff involved in the patient's care did not include the names and contact information of the RN, Hospice Aide, and MSW. This was reviewed and verified with the Director of Patient Care Services.

Observed in Patient Home. In 3 of 3 home visits conducted, the organization did not manage safety/security risks by taking action to minimize identified risks. In RRHV#1, the oxygen concentrator was stored appropriately in the patient's bedroom. A second concentrator and E-Tank was stored in a small cluttered clothes closet in the patient's room. The LVN indicated the oxygen equipment was assessed/checked regularly, but the nurse and facility staff was not aware that oxygen equipment/tanks were to be stored in an open ventilated area as required by policy. The oxygen equipment was relocated from the closet prior to the end of the visit. In RRHV#2, the patient was on continuous oxygen. Upon entry to the home, it was noted the operating oxygen concentrator was located on the porch outside in 100+ degree temperature, with the oxygen tubing running under the door to the patient. When asked by the surveyor where the back-up E-tank was stored, the facility staff indicated it was stored in an outside garden shed. After education was provided by the surveyor, the facility caregivers relocated the patient's oxygen concentrator and E-Tank inside the home prior to the end of the visit. In RRHV#3, it was noted the patient had an order for prn oxygen for shortness of breath, but had not required the oxygen to-date. The concentrator and E-Tank were stored in a closed cluttered closet in the patient's bedroom. After education was provided by the surveyor, the RN relocated the oxygen concentrator and tank, with education provided to the caregiver. This was reveiwed and verified with the Director of Patient Care Services.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization did not implement the infection prevention and control activities it had planned to minimize, reduce, or eliminate the risk of infection. In RRHV#3, the organization's Bag Technique policy and procedure indicated the field bag was to contain a designated clean and dirty area; with the clean area for unused or cleaned supplies/equipment, and the dirty area for contaminated materials/used equipment. The RN's field bag had a broken zipper and open side pouches. All supplies/equipment were placed in open compartments with no clear designation for clean and dirty per policy. This was reviewed and verified with the Director of Patient Care Services.