Every finding on record at Noble Hospice Care Inc

Upon patient record review, 2 of 14 (Patient #3,6) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #3: There is evidence in the medical record, the patient had weight loss of 8 lbs. prior to admission. Nutrition was not identified as a problem on initial plan of care. Patient #6: There is evidence in the medical record, the patient was on Eliquis on admission. Bleeding risk was not on the initial plan of care.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions Patient #4: Upon observation, during the home visit, the RN reached into the nursing bag clean area multiple times to retrieve equipment while taking vital signs, without washing his hands.

Upon patient record review, 1 of 14 (Patient #6) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #6: There is evidence on admission the patient was on Eliquis. Bleeding precautions was not on the Aide plan of care.

Upon patient record review, 3 of 13 records (Patient #1,#4,#11) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. Patient #1: Documentation by the nurse dated 4/4/22 indicated that Clearlax was changed to prn. There was not evidence that this medication was revised from routine to prn on the med profile. Corrected on site. Patient #4: The record indicated an order for Lidocaine patch 4%, apply 1 patch daily as needed . Remove after 12 hours. There was not evidence of a location on the med profile. Patient #11: The record indicated Miralax 17 Gm daily. Mix with juice or water. There was not evidence of a quantity of the diluent on the med profile.

Upon patient record review, 3 of 11 records (Patient #1,#4,#11) did not have evidence the plan of care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #1: Documentation by the nurse dated 4/4/22 indicated that Clearlax was changed to prn. There was not evidence in the orders that this medication was revised from routine to prn. Corrected on site. Patient #4: The record indicated an order for Lidocaine patch 4%, apply 1 patch daily as needed . Remove after 12 hours. There was not evidence of a location in the order. Patient #11: The record indicated an order for Miralax 17 Gm daily. Mix with juice or water. There was not evidence of a quantity of the diluent in the order.

Upon client record review, 4 of 13 records (Patient #2,5,6,10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2: The record indicated that the spiritual care counselor conducted a telehealth visit on 4/9/22. There was not evidence that the plan of care included telehealth visits. Patient #5: The record indicated that the spiritual care counselor conducted telehealth visits on 1/12/22, 2/18/22, and 3/23/22. There was not evidence that the plan of care included telehealth visits. Patient #6: The record indicated that the spiritual care counselor conducted telehealth visits on 2/4/22, and 3/21/22. There was not evidence that the plan of care included telehealth visits. Patient #10: The visit frequency for the skilled nurse was 2-3/week and 1 prn. The record indicated that the skilled nurse conducted 4 scheduled visits for the week beginning on 2/20/22 (2/20/22, 2/22/22, 2/24/22, and 2/26/22).

Upon personnel record review, 2 of 7 applicable records (Personnel #3,#11) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel #3: There was not evidence of a skills competency for the volunteer coordinator. Corrected on site. Personnel #11: There was not evidence of a skills competency for the bereavement coordinator. Corrected on site.

Upon patient client record review, 5 of 11 records (Patient #1,#3,#5,#6,#7) did not have evidence that each patient record contains a signed election statement in accordance with 418.24. Patient #1: The benefit of election statement had both boxes checked indicating that the patient/representative wished to receive the 'Notification of non-covered items,' and declined to receive the 'Notification of non-covered items.' In addition , the effective date of the election was indicated as, 'once the patient is discharged from home health.' There was not evidence of a date. Patient #3,#5,#6,#7: The record indicated that the patient/representative elected to receive the 'Notification of non-covered items.' There was not evidence that this document was delivered.

Upon patient client record review, 1 of 11 records (Patient #1) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Patient #1: Documentation by the spiritual care counselor indicated, "94 year old with a primary diagnosis of pylonephritis." Other documentation in the record indicated that the patient was admitted with a hospice primary diagnosis of Alzheimer's Disease. Corrected on site.

Upon SNF/NF contract review, 1 of 1 applicable contract (Hayward Convalescent) did not have evidence that specifies the provision of hospice services in the facility, including: A provision that the SNF/NF or ICF/IID immediately notifies the hospice if: • A significant change in a patient's physical, mental, social or emotional status occurs • Clinical complications appear that suggest a need to alter the plan of care • When a need to transfer a patient from the SNF/NF or ICF/MR arises, and the hospice makes arrangements for, and remains responsible for, any necessary continuous care or inpatient care necessary related to the terminal illness and related conditions • A patient dies Corrected on site.

Upon SNF/NF contract review, 1 of 1 applicable contract (Hayward Convalescent) did not have a provision stating that the hospice reports all alleged violations involving mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property by anyone unrelated to the hospice to the SNF/NF administrator within 24 hours of the hospice becoming aware of the alleged violation. Corrected on site.