Every finding on record at Nola Sjh II, LLC

Based on record reviews and interviews, it was determined the agency failed to ensure care and services were provided in accordance with the patients plan of care for 5 (Patient #3, Patient #6, Patient #7, Patient #8, and Patient #13) of 19 patients reviewed for care and services. Findings included: --- Patient #3 Review of Patient #3s Hospice Plan of Care for the certification period of 10/24/2024 through 01/21/2025 revealed Patient #3 was to receive hospice aide services once a week for one week, then three times a week for twelve weeks. Review of Patient #3s record revealed the following: -the only hospice aide visit completed the week of 11/03/2024 through 11/09/2024 was conducted on 11/04/2024; -the only hospice aide visit attempted the week of 11/10/2024 through 11/16/2024 was a missed visit documented on 11/13/2024; and, -the only hospice aide visit completed the week of 12/01/2024 through 12/07/2024 was conducted on 12/02/2024. There was no documented evidence, and the agency presented no documented evidence, hospice aide visits were completed per the plan of care for Patient #3. In an interview on 12/02/2024 at 2:36 PM, S1Executive Director (ED) indicated the agency had no documentation for the reason as to why hospice aide visits were not completed per the plan of care for Patient #3. Patient #6 Review of Patient #6s Hospice Plan of Care for the certification period of 09/26/2024 through 12/24/2024 revealed Patient #6 was to receive hospice aide services twice a week for twelve weeks starting 09/29/2024. Review of Patient #6s record revealed the only hospice aide visit completed for the week of 10/06/2024 through 10/12/2024 was completed on 10/08/2024. There was no documented evidence, and the agency presented no documented evidence, hospice aide visits were completed per the plan of care for Patient #6. In an interview on 12/02/2024 at 2:47 PM, S1ED indicated the agency had no documentation for the reason as to why the second hospice aide visit was not completed per the plan of care for Patient #6. Patient #7 Review of Patient #7s Hospice Plan of Care for the certification period of 09/18/2024 through 12/16/2024 revealed Patient #7 was to receive skilled nursing services twice a week for twelve weeks. Review of Patient #7s record revealed, in part: -the only skilled nurse visit completed for the week of 09/29/2024 through 10/05/2024 was conducted on 09/30/2024; -the only skilled nurse visit completed for the week of 10/06/2024 through 10/12/2024 was conducted on 10/10/2024; -the only skilled nurse visit completed for the week of 10/20/2024 through 10/26/2024 was conducted on 10/23/2024; -the only skilled nurse visit completed for the week of 11/10/2024 through 11/16/2024 was conducted on 11/13/2024; and, -the only skilled nurse visit completed for the week of 11/24/2024 through 11/30/2024 was conducted on 11/25/2024. Review of Patient #7s Client Coordination Note Report dated 11/04/2024 revealed a registered nurse visit was missed on 10/03/2024 because the registered nurse was scheduled off during the week. Review of Patient #7s Client Coordination Note Report dated 11/04/2024 revealed a registered nurse visit was missed on 10/11/2024 due to registered nurse completing a visit on 10/10/2024; therefore, it was a duplicated visit. There was no documented evidence, and the agency presented no documented evidence, skilled nurse visits were completed per the plan of care for Patient #7. In an interview on 12/12/2024 at 2:49PM, S1ED indicated the reasons documented in Patient #7s Client Coordination Note Reports for missed visits on 10/03/2024 and 10/10/2024 were not appropriate, and Patient #7s visits should have been completed. S1ED further indicated the agency had no documentation for the reason as to why the skilled nurse visits were not completed per the plan of care for Patient #7. Patient #8 Review of Patient #8s Hospice Plan of Care for the certification period of 09/08/2024 through 12/06/2024 revealed Patient #8 was to receive hospice aide visits three times a week for thirteen weeks. Review of Patient #8s record revealed the only hospice aide visits completed the week of 09/15/2024 through 09/21/2024 were conducted on 09/17/2024 and 09/18/2024. Review of Patient #8s Physician Order dated 11/07/2024 revealed Patient #8s hospice aide services were decreased to twice a week. Review of Patient #8s record revealed no documented evidence hospice aide visits were completed the week of 11/10/2024 through 11/16/2024. There was no documented evidence, and the agency presented no documented evidence, hospice aide visits were completed per the plan of care for Patient #8. In an interview on 12/12/2024 at 3:00 PM, S1ED indicated the agency had no documented evidence the hospice aide visits were conducted per the plan of care and/or the reason as to why the visits were not completed as required for Patient #8. Patient #13 Review of Patient #13s Physician Order dated 11/04/2024 revealed Patient #13 was to receive skilled nursing services three times a week. Review of Patient #13s record revealed, in part, -the only documented skilled nurse visits completed for Patient #13 the week of 11/17/2024 through 11/23/2024 were completed on 11/19/2024 and 11/21/2024; -the only documented skilled nurse visit completed for Patient #13 the week of 11/24/2024 through 11/30/2024 was completed on 11/27/2024; and, -the only documented skilled nurse visits completed for Patient #13 the week of 12/01/2024 through 12/07/2024 were completed on 12/03/2024 and 12/06/2024. Review of Patient #13s Physician Order dated 11/05/2024 revealed Patient #13 was to receive hospice aide services twice a week. Review of Patient #13s record revealed, in part, no documented evidence hospice aide visits were completed for Patient #13 for the weeks of 11/03/2024 through 11/09/2024 and for the week of 11/10/2024 through 11/16/2024. There was no documented evidence, and the agency presented no documented evidence, hospice aide and skilled nurse visits were completed per Patient #13s physicians orders. In an interview on 12/12/2024 at 3:36 PM, S1ED indicated the agency had no documented evidence the skilled nurse nor the hospice aide had completed visits per Patient #13s physicians orders.

Based on record review and interview, it was determined the agency failed to ensure the skilled nurse measured wounds upon identification and weekly thereafter for 1 (Patient #8) of 1 sampled patients reviewed for wound assessment. Findings included: --- Review of the Wound Ostomy and Continence Nurses Society's Guidelines revealed assessment and documentation of wound status, which included comprehensive clinical data demonstrating evidence of progress in healing or failure to heal. Comprehensive wound assessment included: dimensions and depth; presence, location and depth of any sinus tracts or undermining areas; status and characteristics of the wound bed; volume, color, and odor of exudates; evidence of infection in surrounding tissues. Further review revealed when recorded over time this information can be used to track the progress of wound healing. Review of Patient #8s Physician Order dated 12/02/2024 revealed, in part, the skilled nurse was to cleanse Patient #8s stage II (open area of the skin caused by pressure) pressure ulcer of the left medial (area of the leg toward the middle of the body) leg with wound cleanser, pat dry, and apply mesalt (dressing that absorbs drainage) to the wound bed and cover with a mepilex border (foam dressing). Review of Patient #8s Visit Note Report dated 12/02/2024 revealed, in part, the skilled nurse documented a new wound to Patient #8s left medial leg stage II. Further review revealed the only measurement obtained was a depth of 0.3 centimeters. There was no documented evidence, and the agency presented no documented evidence, Patient #8s left medial leg wounds length and width was measured as required. There was no documented evidence, and the agency presented no documented evidence, the skilled nurse had measured Patient #8s left medial leg wound since identification of the wound on 12/02/2024. In an interview on 12/12/2024 at 3:00 PM, S1Executive Director indicated the agency had no documentation Patient #8s left medial leg wound had been measured upon identification and weekly as required.

Based on record review and interview, it was determined the agency failed to ensure the registered nurse supervised the hospice aide at least every 14 days for 2 (Patient #12 and Patient #13) of 13 patients reviewed for hospice aide supervisory visits. Findings included: --- Patient #12 Review of Patient #12s Hospice Plan of Care for the certification period of 10/26/2024 through 12/24/2024 revealed, in part, Patient #12 was to receive hospice aide services three times a week for eight weeks starting 10/27/2024. Review of Patient #12s record revealed Patient #12 received hospice aide services three times a week from 11/10/2024 through 12/06/2024. Further review revealed the only documented evidence of a hospice aide supervisory visit completed between 11/10/2024 through 12/072024 was documented on 11/12/2024 and 12/03/2024, which was 21 days apart. There was no documented evidence, and the agency presented no documented evidence, the registered nurse had completed a hospice aide supervisory visit every 14 days as required. In an interview on 12/12/2024 at 3:32 PM, S1Executive Director indicated the agency failed to ensure hospice aide supervisory visits were completed every 14 days as required. Patient #13 Review of Patient #13s Physician Order dated 11/05/2024 revealed Patient #13 was to receive hospice aide services twice a week. Review of Patient #13s record revealed Patient #13 received hospice aide services twice a week from 11/17/2024 through 12/07/2024. Further review revealed the only documented hospice aide supervisory visits completed were on 11/19/2024 and 11/21/2024. There was no documented evidence, and the agency presented no documented evidence, a hospice aide supervisory visit was completed after 11/21/2024. In an interview on 12/12/2024 at 3:36 PM, S1Executive Director indicated the agency had no documented evidence the registered nurse had completed a hospice aide supervisory visit by 12/05/2024 as required.

Based on record review and interview, the facility failed to ensure the care plan was revised: 1. Every certification period (Patient #3); 2. When the patients level of care was changed from routine home care to respite (Patient #3); and 3. When the patients level of care was changed from respite to general inpatient care (Patient #3). This deficient practice was identified for 1 (Patient #3) of 3 (Patient #1, Patient #2, and Patient #3) sampled patients reviewed for care and services per the plan of care. Findings: --- Review of Patient #3s Hospice Certification and Plan of Care for certification period of 04/20/2022 to 06/18/2022 revealed Patient #3s start of care date was 04/20/2022. Further review revealed a hospice registered nurse was to evaluate Patient #3 and develop a nursing plan of care during this certification period. Review of Patient #3s Hospice Recertification Orders revealed orders to continue with plan of care for the following certification periods, in part: -Order dated 06/04/2022 for certification period of 06/19/2022 to 08/17/2022; -Order dated 08/10/2022 for certification period of 08/18/2022 to 10/16/2022; -Order dated 10/05/2022 for certification period of 10/17/2022 to 12/15/2022; -Order dated 12/01/2022 for certification period of 12/16/2022 to 02/13/2023; -Order dated 01/30/2023 for certification period of 02/14/2023 to 04/14/2023; -Order dated 04/12/2023 for certification period of 04/15/2023 to 06/13/2023; -Order dated 06/07/1012 for certification period of 06/14/2023 to 08/12/2023; -Order dated 08/02/2023 for certification period of 08/13/2023 to 10/11/2023; and -Order dated 10/11/2023 for certification period of 10/12/2023 to 12/10/2023. Review of Patient #3s record revealed Patient #3 received in-patient respite services from 11/17/2023 to 11/22/2023, and 12/01/2023 to 12/05/2023. Review of Patient #3s record revealed Patient #3 received general in-patient care for respiratory distress and complicated administration of medications from 12/06/2023 to 12/08/2023 when Patient #3 expired. Further review of Patient #3s record revealed no documented evidence and the provider presented no documented evidence that Patient #3s plan of care had been revised for the above certification periods, nor had the plan of care been revised for the change in level of care to respite and general in-patient care. In an interview on 12/13/2023 at 10:26 a.m., S1Senior Regional Director of Operations stated the last plan of care developed for Patient #3 was for the certification period of 12/17/2021 to 03/16/2022. S1Senior Regional Director of Operations stated all future certification periods for Patient #3, the facility only obtained orders to continue the plan of care; therefore, the plans of care for all other certification periods and changes of level of services did not have revised plans of care. S1Senior Regional Director of Operations further stated Patient #3s plans of care should have been revised and updated every certification period, with the change to and from respite services, and with admission to general in-patient care.

Based on record review and interview, the facility failed to ensure: 1. The registered nurse (RN) completed and made available a patients assessment for the continuation of care (Patient #1); 2. The RN documented and communicated physician orders to the oncoming shifts nurse in a timely manner (Patient #1); and 3. The RN communicated with the physician for orders (Patient #1). This deficient practice was identified for 1 (Patient #1) of 3 (Patient #1, Patient #2, Patient #3) sampled patients reviewed for care and services. Findings: --- 1. Review of Patient #1s RN Hospice Start of Care Visit Note Report dated 11/21/2022 revealed the initial patient assessment was started on 11/21/2022 at 7:30 a.m., and was left incomplete, and was not resumed until 11/22/2022 at 9:23 a.m. In an interview on 12/13/2023 at 1:27 p.m., S1Senoir Regional Director of Operations stated the facility had no documented evidence if the original assessment was completed upon admission and/or what information was communicated to the RN who assumed care of Patient #1 after the admission RN. 2. Review of Patient #1s Verbal Certification of Terminal Illness Order dated 11/21/2022 revealed the order was not signed by the nurse or placed into the electronic or paper record until 11/22/20222 at 12:58 p.m. Review of Patient #1s Patient #1s Hospice Certification and Plan of Care for certification period of 11/21/2022 to 02/18/2023 revealed orders for care and the following medications: Lorazepam (medication used to treat anxiety) 0.5 milligram (mg) one tablet every 12 hours as needed for anxiety; MS Contin (opioid medication used to treat pain) 15 mg one tablet twice a day for pain; and Ondansetron (medication used to treat nausea and vomiting) 8 mg one tablet every 8 hours as needed for nausea and vomiting. Further review revealed the order was not signed by the nurse or placed into the electronic or paper record until 11/22/20222 at 12:58 p.m. In an interview on 12/12/2023 at 3:43 p.m., S2RN stated one of the night shifts she worked Patient #1 came in with a caregiver, however she stated she did not assume his care because she was not aware of Patient #1 having any legal paperwork, admission orders, or plan of care. In an interview on 12/13/2023 at 1:27 p.m., S1Senoir Regional Director of Operations stated the registered nurse should have placed the orders for the certification of terminal illness and plan of care with medications into the computer system for oncoming staff to be aware of the care and which services needed to be provided to Patient #1. 3. In an interview on 12/12/2023 at 3:43 p.m., S2RN stated one of the night shifts she worked Patient #1 came in with a caregiver, however she stated she did not assume his care because she was not aware of Patient #1 having any legal paperwork, admission orders, or plan of care. S2RN further stated she had not contacted the physician for orders since she did not assume his care. In an interview on 12/13/2023 at 1:27 p.m., S1Senoir Regional Director of Operations stated if S2RN should have contacted the physician for admission orders and medication orders for Patient #1 when S2RN was unable to verify orders for care.

Based on record review and interview, the facility failed to ensure: 1. The registered nurse (RN) routinely assessed a patient for changes in condition (Patient #1); 2. The RN contacted the physician to obtain orders for care (Patient #1); and 3. The RN documented all activity which occurred on her shift (Patient #1). This deficient practice was identified for 1 (Patient #1) of 3 (Patient #1, Patient #2, Patient #3) sampled patients reviewed for care and services. Findings: --- Review of the Louisiana Administrative Code Chapter 39 Legal Standards of Nursing Practice revealed, in part: -Standard Number 1: Collection and Recording Individual's Health Status A. Data concerning an individual's health status must be systematically and continuously collected, recorded, and communicated in order to determine nursing care needs, according to the following criteria. 1. The priority of data collection is determined by the individual's immediate condition and needs. 2. The collection and recording of data provides for systematic collection, frequent updating, accessibility, and appropriate confidentiality. -Standard Number 4: Implementation of Nursing Care Plan A. The plan for nursing care is implemented according to the following criteria. 1. Nursing actions are consistent with the plan for nursing care. 2. Interventions are implemented in a safe and appropriate manner. B. Documentation includes, but is not limited to, written records that attest to the care provided to patients based on assessment data and the patient's response to the intervention. Review of Patient #1s record revealed Patient #1 was admitted to the facility on 11/21/2022 at 7:30 p.m. and an initial patient assessment was started by S4RN. Further review of Patient #1s record revealed no documented evidence and the facility did not present any documented evidence of any further assessments or documentation of care until 11/22/2022 at 7:54 a.m. when a Visit Note Report was entered for Patient #1s in-patient death. In an interview on 12/12/2023 at 3:43 p.m., S2RN stated the night Patient #1 arrived at the in-patient hospice with his caregiver, she did not have any consents or admission orders. S2RN stated she did not have any of the information she needed to assume Patient #1s care; therefore, she did not accept the assignment of his care. S2RN stated she had texted someone in administration and was told the facility had orders for Patient #1 but she only had hospital discharge orders. S2RN stated she did not provide care to Patient #1 due to no consents or orders, she did not assess Patient #1, and did not remember contacting the medical director for physician orders. S2RN further stated she did not document on Patient #1 on the night shift he was admitted. In an interview on 12/13/2023 at 1:27 p.m., S1Senior Regional Director of Operations stated S2RN should have assessed Patient #1 and contacted the medical director for admission orders if she did not have orders to provide care to Patient #1. S1Senior Regional Director of Operations further stated S2RN should have completed ongoing assessments completed ongoing assessments during her shift with Patient #1, communicated any changes in condition to the physician, and documented all activities which happened during her shift. In an interview on 12/13/2023 at 1:29 p.m., S3Executive Director/Administrator stated based on the record, S2RN did not follow standards of practice for ongoing assessment, physician notification of patient needs, and documentation of care provided.

Based on record review and interview, the facility failed to obtain medication as ordered by the patients physician for 1 (Patient #1) of 3 (Patient #1, Patient #2, Patient #3) sampled patients reviewed for medications. Findings: --- Review of Patient #1s Hospice Certification and Plan of Care for certification period of 11/21/2022 through 02/18/2023 revealed the following medications were ordered, in part, Lorazepam (medication used to treat anxiety) 0.5 milligram (mg) tablet by mouth every 12 hours as needed for anxiety; MS Contin (opioid medication used to treat pain) 15 mg one tablet by mouth two times a day for pain; and Ondansetron (medication used to treat nausea/vomiting) 8 mg one tablet by mouth every 8 hours as needed for nausea or vomiting. There was no documented evidence and the provider did not present any documented evidence that the above mentioned medications were obtained. In an interview on 12/12/2023 at 10:18 a.m., S1Senior Regional Director of Operations stated he spoke with the pharmacy responsible for providing the medications for Patient #1, and the pharmacy did not have any documented evidence any medications were ever filled for Patient #1. S1Senior Regional Director of Operations further stated the facility had no further documented evidence medication was received as ordered by the physician for Patient #1.