Every finding on record at Nurses Care Hospice, Inc.

Observed in Record Review. In 12 of 14 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. During review of records 1-11, and 13 it was noted that goals did not have time frames according to the patients individualized plan of care. For example in record 11 all goals had dates 5 days from beginning of certification period and included care planning for pain, falls prevention, and nutrition. This was confirmed by the DPCS.

Observed in HR File Review. In 2 of 5 HR files reviewed, Staff did not participate in ongoing education and training to maintain or increase their competency and, as needed, when staff responsibilities change. During review of HR files 1 and 4 it was noted that there was no documentation of annual education, This was verified by the Administrator.

Observed in Record Review. In 2 of 11 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including the following: - A statement of the scope and frequency of the services necessary to meet the patient’s and family’s need. For example, in the record review of HV#1, the SN visit frequency was two times per day for 90 days. The SN visited the patient two times per week. This was reviewed and validated with the Administrator/Director of Patient Care Services (DPCS) who stated this was an error. In RR#2, the Spiritual Counselor frequency was one time per month for 90 weeks. This was reviewed and validated with the Administrator/DPCS who stated this was an error.

Observed in Patient Home. In 2 of 2 home visits with blood pressure measurement, the organization did not follow accepted standards of practice to prevent the transmission of infections and communicable diseases. For example, in HV#2 and HV #3 the LVN did not follow organization policy for cleaning of blood pressure cuff. The Infection Control Policy stated blood pressure cuff should be cleaned with soap and water, alcohol, or per manufacturers guidelines. The manufacturers guidelines stated to clean with nonvolatile cleaner. The LVN used a Super Sani wipe. In addition, the Super Sani manufacturers guidelines for contact time is two minutes. On HV #3 the LVN wiped her equipment and placed it into her bag without waiting two minutes. This was reviewed, discussed and validated with the Administrator/Director of Patient Care.

Observed in HR File Review. In 5 of 5 HR files reviewed with employment greater than one year, During review of HR# 2 (Licensed Vocational Nurse), HR# 3 (Medical Director), HR# 7 (Administrator/Director of Patient Care Services/Registered Nurse), HR# 20 (Bereavement Coordinator/Volunteer Coordinator/Chaplain), and HR# 19 (Medical Social Worker), it was noted the organization had not ensured the staff were competent to perform their responsibilities in accordance with the organization's policy Competency Assessment. For example: review of the organization's Competency Assessment policy revealed that ongoing assessments included the competency assessment was to be completed at least one time per year using the competency skills performance checklist. In addition, the annual performance evaluation included that the staff demonstrate their core competencies in specific areas related to their job description. Review of the personnel records revealed no documentation of annual competency assessments or core competencies. This was reviewed, discussed, and validated by the Administrator/Director of Patient Care Services.

Observed in Record Review. In 2 of 11 patient records reviewed, the patient record did not contain the following clinical information: A list of medications, including dose, strength, frequency, route, date and time of administration for prescription and nonprescription medications, herbal products, and home remedies that relate to the patient's care, treatment, or services. For example, on record review of HV #1 it was observed that the medication profile and physician order for Morphine was inaccurate. The frequency was written as every four hours. This was discussed with the Director of Patient Care Services (DPCS) and validated that it was a comfort kit medication that should have been written for every four hours as needed. During HV#3 record review, the medication list contained an order for Scopolamine intradermal rather than transdermal. This was reviewed, discussed and validated with the Administrator/DPCS.

Observed in Patient Home. In 3 of 3 home visits conducted, the organization did not provide a copy of its written policies and procedures on the management and disposal of controlled medications to the patient or patient representatives. For example, on HV#1, HV#2, HV#3, the policy was not in the admission packet or home folders. This was reviewed, discussed and validated with the Administrator/Director of Patient Care Services(DPCS).