Every finding on record at Nurses Plus Hospice, Inc.

Observed in Record Review. In 4 of 10 records reviewed, surveyor noted that the organization failed to implement a plan of care that includes all services needed for the palliation and management of the terminal illness and related conditions. For example, in HOSRRHV#1, the plan of care included genitourinary, psychiatric, and ADL problems which each had appropriate goals, however, there were no interventions listed to manage the problems. In HOSRRHV#2 orders were written for wound care to the coccyx, however, there was no wound care/impaired skin integrity problem/goals/interventions added to the plan of care. In HOSRRNHV#6, the plan of care included genitourinary and psychiatric problems which each had goals, however, there were no interventions listed to manage the problems. In HOSRRDC#1, orders were written for Bactrim and Keflex for management of upper respiratory infections and Trazadone for impaired sleep pattern, however, there were no care plan problems for upper respiratory infection/sleep impairment with goals/interventions added to the plan of care This was reviewed with The Administrator.

Observed in Patient Home. In 1 of 3 home visits, the surveyor noted that the organization failed to conduct a patient-specific assessment per the patient's plan of care. For example, in HOSHV#1, the clinician did not perform a full body skin assessment on a bed bound patient per the patient's plan of care to assess patient's skin each visit, increasing the risk for skin integrity impairment/breakdown. This was reviewed with the Administrator.

Observed in Patient Home. In 1 of 3 home visits, the surveyor noted that the organization failed to implement activities for the prevention and control of infections and communicable diseases. For example, in HOSHV#1, the nurse failed to disinfect hands after providing care to the patient and returning equipment used to equipment bag per the organization's hand hygiene and bag technique policy. This was reviewed with the Administrator.

Observed in Record Review. In 8 of 8 patient records reviewed, The HCO did not ensure patient care plan goals were individualized, measurable, and include appropriate time frames. Examples include the following: Instruct cg to notify hospice if there are any signs or symptoms of a UTI, monitor for any changes, Caregivers to be educated to notify hospice if anyone presents with any COVID-19 symptoms, educate on importance of encouraging oral hydration as means to promote normal BM habits, SN to ensure at each visit that pressure relieving mattress is functioning, SN to review with family and facility that decreased appetite is normal with terminal conditions and not to force patient to eat at each visit, Caregivers to keep patient clean every day. Encourage patient to eat small meals frequently as opposed to large meals. Patient will be educated on elevating legs while sitting. These stated goals do not contain specific information, including time frames, that can be accurately measured to assist organizational staff in determining whether the patient is progressing towards achieving their goals. These findings were reviewed, discussed, and validated with the organization’s Administrator/DPCS.