Every finding on record at Newport Hospice Care

Observed in Record Review. In 5 of 5 patient records reviewed, the organization failed to ensure the written plan of care include individualized patient goals that were specific, measurable, and time bound. For example, on all records reviewed there were goals that were not specific, measurable and time bound. In RRHV#1 an example was Facilitate bowel movement -Pt xxx/Family/PCG will verbalize having elimination needs met at an acceptable level. and Promote rest status for Pt XXX/Family/PCG. In RRNHV#2 a goal was Pt will maintain optimum peripheral circulation. -Pt/pcg will verbalize/express understanding of medication /treatment orders and side effects of metoprolol 25 mg The target date for verbalizing understanding for medications was for over a three 3 month period. In RRNHV#3 an example was Facilitate bowel elimination and comfort and PCG will verbalize having elimination needs met at an acceptable level. Further examples could be seen in RRNHV#4 and RRNHV#5. These observations were reviewed with the Administrator/Owner and Alt Administrator.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization had not informed the patient/family written information about its policies on advance directives. In review of the hospice binder for RRHV #1 there was no evidence of the organization's written policies or information on advance directives. The hospice binder did not include the materials that the organization usually provides to patients and families on admission. This was discussed with the Administrator/Owner.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization had not provided the patient/family with information about the scope of services that the hospice would provide and any limitations on those services. In review of the hospice binder for RRHV #1 and in discussion with the patient's primary caregiver/daughter there was no evidence that the organization had provided information regarding the scope or frequency of services. The daughter stated that she did not know the purpose of the hospice program or when hospice staff would visit. This was discussed with the Administrator/Owner.

Observed in Record Review. In 1 of 14 patient records reviewed, the organization did not complete the comprehensive assessment no later than five calendar days after the election of hospice care. In review of the medical record for RRHV #3 the psychosocial assessment was completed 12 days following the election of the hospice benefit. This was discussed with the Administrator/Owner and DPCS.

Observed in Record Review. In 14 of 14 patient records reviewed, the organization did not provide care in accordance with their Bereavement Services Policy No. 2-010.1 which states an initial bereavement risk assessment will be completed by the hospice social worker at the time of admission to hospice. Although all bereavement risk assessments were completed, in review of the medical record RRNHV #1 the bereavement risk assessment was completed by the Bereavement/Volunteer Coordinator who is not a hospice social worker. This also occurred in review of medical records for an additional 13 records which were reviewed.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization had not provided education and training to the primary caregiver(s). In review of the hospice binder in the home for RRHV #1 and in conversation with three of the patient's daughters there was no evidence that the hospice had provided education and training on medications, symptom management, an individual emergency plan, basic home safety practices, and advance directives. The hospice binder did not include the materials that the organization usually provides to patients and families on admission. This was discussed with the Administrator/Owner.

Observed in Record Review. In 8 of 10 patient records reviewed, the written plan of care did not include patient specific goals, time frames and services to meet those goals. For example, in review of the medical record for RRHV #3 the care plan included a problem for Pain with the goal: Pt/Family/PCG will verbalize confidence in the management of patient`s pain. However failed to identify what the patient's goal was for pain and a time frame for which to achieve the goal. This was also observed in review of the medical records for RRNHV #1, RRNHV #2, RRNHV #3, RRNHV #4, RRNHV #5, RRNHV #6 and RRNHV #7. This was discussed with the Administrator/Owner and DPCS.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization had not coordinated their efforts to support the goals outlined in the plan of care. For example, for RRHV #1 the patient's primary caregivers/daughters who were also nurses reported that the patient was unable to swallow the oral medications that the hospice had provided and that at the time of admission to hospice they had requested medications to be provided in liquid form however they still had not received them. This was discussed with the Administrator/Owner.

Observed in Data Session. The hospice organization had been collecting data but it was not being aggregated, trended or analyzed so therefore it was not being utilized to identify areas for process improvement. This was discussed with the Administrator/Owner, Administrator Designee and DPCS.

Observed in Patient Home. In 1 of 3 home visits conducted, staff failed to perform hand hygiene consistent with the organization's standard precautions policy. For RRHV #2 the RN failed to perform hand hygiene after contact with the patient's bed and before donning gloves. The surveyor also noted that upon completion of the dressing change the RN moved the clean and packaged dressing supplies without first removing the gloves used in performing the dressing change and performing hand hygiene. This was discussed with the RN and the Administrator/Owner.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization had not provided education and training to the primary caregiver(s). In review of the hospice binder in the home for RRHV #1 and in conversation with three of the patient's daughters there was no evidence that the hospice had provided education and training on infection prevention and control and safe use of durable medical equipment including home oxygen. The hospice binder did not include the materials that the organization usually provides to patients and families on admission. Additionally, the organization had not provided an individualized emergency plan for the patient/family in the event of a natural disaster or emergency. The surveyor also noted that for RRHV #2 and RRHV #3 the organization had not provided an individualized emergency plan. This was discussed with the Administrator/Owner.

Observed in Leadership Session. The governing body/leadership did not ensure the implementation of policies and procedures that guide and support patient care, treatment, or services as evidenced by the Conditions of Participation 418.56, that was not met as determined through observations and review of documentation and organizational policies. This was discussed with the organization's Administrator/Owner.

Observed in Record Review. In 1 of 3 patient records reviewed, of deceased patients, the medical record did not include complete and accurate documentation of the events. In review of the medical record for RRHV #1 the sequencing of the documentation by the LVN at the time of death indicated that the LVN pronounced the death of the patient when the Medical Director confirmed that he had pronounced the death of the patient. The LVN documented that she, responded to call that patient was breathing rapidly at 40-44 RR. Patient noted unresponsive and not breathing on arrival, SN assessment done upon arrival, no signs of life, unresponsive to verbal, tactile, and pain stimuli, cool to touch. No BP 0, HR 0, RR 0, pupils dilated and fixed, nonreactive to light and accommodation, pronounced dead at 0602, and then notified the Medical Director of the assessment. This was discussed with the Administrator/Owner.