Every finding on record at Oasis Hospice

Observed in Record Review. In 4 of 4 patient records reviewed, the organization failed to ensure the plan of care reflect patient and family goals that were specific, measurable, and time-bound. Throughout all patient records reviewed the goals were not individualized, specific, measurable and time-bound. For example goals that were not measurable in RRNHV#4 the SC goal Daughter verbalized ongoing concerns regarding patient’s condition and expressed emotional difficulty surrounding the progression of decline. Chaplain observed heightened emotional attachment and signs of denial regarding terminal status. Daughter remained present and attentive throughout visit. In RRNHV#2 an example was POC/SN will correctly verbalize understanding of pt fear of the inability to communicate (e.g. non verbal, paralyzed) In RRNHV#1 an example was the need for care when pt is walking with walker ,will be expressed by SN on each visit , to prevent falls. In RRNHV#3 the SC POC goals did not include a time frame, the Target Date was left blank. Further examples can be seen throughout the records. These observations were confirmed and discussed with the Administrator present.

Observed in Record Review. In 3 of 4 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. In review of RRNHV#1 the patient was being seen by spiritual care and medical social worker monthly yet there was no documentation of spiritual and/or psychosocial care plans established to guide the care. Also in RRNHV#1 the patient had 2 falls, 1 day after another, and the POC did not reflect the new fall issue. In RRNHV#2 the medical social worker was seeing the patient monthly but no psychosocial care plan had been established. In RRNHV#3 the social worker POC goal and interventions were Resolved with no updated/new goals or interventions. This was confirmed and discussed with the Administrator present.

Observed in Record Review. In 2 of 2 patient records reviewed, where the addendum was elected, the organization failed to respect the patient's right to participate in decisions about their care, treatment, or services. On review of RRNHV#4 the patient/caregiver elected on admission to receive the notice of non-covered items, services, or drugs yet the addendum was not presented to the patient/caregiver until day 11 after benefit election. In RRNHV#7 the notice of non-covered items, services, or drug was elected on admission yet was not documented as presented to the patient/caregiver until day 17. These observations were reviewed with the DPCS and Administrator.

Observed in Record Review. In 3 of 10 patient records reviewed, the organization failed to conduct and document a a patient-specific comprehensive assessment that included an initial bereavement assessment of the need of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. On review of RRNHV#4, RRHV#3, and RRHV#1 there was no documentation that an initial bereavement risk assessment had been conducted. This observation was reviewed with the DPCS.

Observed in Record Review. In 10 of 10 patient records reviewed, the organization failed to ensure the plan of care reflect patient and family goals that were specific, measurable, and time-bound. Throughout all patient records reviewed there goals that were noted to not be individualized, specific, measurable and time-bound. examples of goals that were not measurable in RRHV#1 were Achieve and maintain peripheral circulation for Pt comfort. -Pt/pcg will verbalize/express understanding of medication /treatment orders and side effects. -PCG will give medication as ordered, and report to hospice as needed. In RRHV#2 an example was Facilitate bowel elimination and comfort. Facilitate bowel movement. Pt/cg will verbalize/express understanding of medication/treatment orders and side effects. Pt will be encouraged to eat. In RRHV#3 an example was maintain mobility and independence. -Minimize complications due impaired mobility. -Pt/pcg will verbalize/express understanding of medication /treatment orders and side effects. -PCG will contact hospice for assistance. Further examples can be seen throughout the records. These observations were reviewed with the DPCS and Administrator.

Observed in Record Review. In 9 of 10 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. In review of RRHV#2, RRNHV#4, and RRHV#3 the patient was being seen by spiritual care and medical social worker monthly yet there was no documentation of spiritual and/or psychosocial care plans established to guide the care. In RRNHV#5 and RRNHV#7 the medical social worker was seeing the patient monthly but no psychosocial care plan established. In RRHV#1 the documentation noted cough with wheezing with the addition of prednisone, and diarrhea with changes to the scheduled lactulose but the changes in patient status was not reflected in the care plans. Further, the condom catheter was no longer in use but the care plan remained open and did not reflect the change. In RRNHV#5 the patient documentation of severe pain with multiple changes in medications was not reflected in the care plans. The patient was on Eliquis but no bleeding precautions or care plan to address the risk. The documentation noted 4+ edema with related comfort issues but no care plan to address the edema. In RRNHV#6 there was documentation of a skin tear with treatment but no care plan specific to the issue to guide the care. In RRNHV#7 the documentation noted allergy issues with addition of pseudoephedrine and dizziness with adding Meclizine but the issues were not reflected on the plan of care. In RRNHV#8 there was documentation of pain issues with multiple narcotics and addition of Morphine ER scheduled but no pain care plan open. In RRNHV#9 there was documentation of issues with pain, constipation, and respiratory issues with oxygen use yet no care plans established for pain, gastrointestinal, and respiratory. These observations were reviewed with the Director of Clinical Services, and Administrator.

Observed in Record Review. In 5 of 10 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions to include mediations and treatments to meet the patients needs. On review of RRNHV#4 there was an incomplete order for wound care that read Clean with normal saline, pat dry with 4 x 4 gauze, apply thin layer triple antibiotic ointment and foam dressing. The order did not have a location, frequency or who was to preform the care. In RRHV#3 the patient was diabetic and there was a goal related to blood glucose monitoring and the intervention noted follow lab orders as specified and report results to MD yet there were no orders for blood glucose monitoring on the record. In RRNHV#5 there was a paracentesis drain with orders to drain 3 times a week yet no specific orders for who was to perform the draining. There were no orders for drain site care nor was the drain care specifically reflected on the care plans. In RRNHV#6 there was documentation of a stage 2 wound to the buttocks on admission but no wound care orders on the record. Also in RRNHV#6 there was an order for care of a skin tear that was incomplete as it had no frequency or who to preform the care. In RRNHV#8 the patient had documentation of a foley catheter but no orders for the catheter nor was the foley reflected in the care plans. These observations were reviewed with the DPCS and Administrator.

Observed in Record Review. In 7 of 10 patient records reviewed, the revised plan of care failed to include information from the patient's updated comprehensive assessment and did not note the patient's progress toward outcomes and goals specified in the care plan. In RRHV#3 the care plans were not noted to be updated based on the patient's progress toward goals as the care plans goals and interventions remained the same IDG to IDG without update based on progress toward goals. Most goals were established on admission and were unchanged to date of survey. Further examples of care plan unchanged based on the patient's progress to goals could be seen in RRHV#2, RRHV#1, RRNHV#4, RRNHV#5, RRNHV#6, and RRNHV#7. These observations were reviewed with the DPCS and Administrator.

Observed in Record Review. In 2 of 10 patient records reviewed, the organization failed to ensure written patient care instructions were prepared by the registered nurse. In review of RRHV#1 the aide assigned plan of care noted the patient with a condom catheter and assigned the tasks of replacing the catheter, recording the urine output, and emptying the urine bag. On discussion with the hospice aide the patient's condom catheter had been discontinued quite some time ago and she was no longer providing the condom catheter care. The RN had not updated the aide assigned tasks to remove the ordered care. In RRNHV#8 the patient had a foley catheter yet no foley care was assigned for the aide. Further, there was no assignment of a bath for the patient yet the aide was providing bathing each visit. These observations were reviewed with the Director of Nursing.

Observed in Record Review. In 1 of 8 patient records reviewed, with aide services provided, the organization failed to ensure the hospice aide provide services that were ordered by the physician in the plan of care. On review of RRNHV#8 the Aide's documentation noted foley care was provided along with a sponge bath, yet in the aide assignment foley care and bathing were not assigned tasks per the plan of care. This observation was reviewed with the DPCS and Administrator.

Observed in Leadership Session. There was no evidence that the governing body and leadership had established requirements to support patient care treatment and services as evidenced by the leadership did not ensure that the Conditions of Participation for 418.56 was met per policy as determined through observations, documentation, and staff interviews.

Observed in Individual Tracer. In 5 of 11 patient records reviewed, the social workers and nurses had determined patients and caregivers had not made plans for mortuary follow up after death. The social worker did not develop a care plan for mortuary planning and funeral planning for the following records: HV2, RR2, RR3, RR4, RR7. This was verified with the Director of Patient Care.

Observed in Individual Tracer. In 2 of 3 home visits conducted, the staff failed to perform hand hygiene consistent with the agency's policy on hand hygiene. In HV1 the nurse did not use a towel to turn off the faucet. In HV2 the aide reentered her bag without sanitizing her hands. This was verified with the Director of Patient Care.

Observed in Individual Tracer. In 7 of 11 patient records reviewed, the agency did not write specific patient care instructions for the aide. During a home visit with the aide, HV2, the aide removed the oxygen from the patient for greater than 20 minutes. The patient was on continuous oxygen and the care plan did not address whether the oxygen could be removed for the bath. In addition, the registered nurse did not prepare specific written patient care instructions for the aide in HV #1, HV #2, HV #3,RR#1, RR#2, RR#4, RR #5, specifying temperature parameters on when to report abnormal findings. This was verified with the Director of Patient Care Services.

Observed in Individual Tracer. In 4 of 11 patient records reviewed, of which four were discharged records the agency did not prepare a complete discharge summary. In following records: RR5, RR6, RR7,and RR8 the discharge summary did not include a summary of the patient's stay including treatments, symptoms, and pain management. This was verified with the Director of Patient Care.

Observed in Individual Tracer. In 2 of 3 home visits conducted, the hospice did not address potential threats to the safety of the patients, others, and property. In HV1 the back up oxygen tanks were stored in closet with the doors shut and the nurse, who accompanied the surveyor to locate the tanks, did not re-educate the caregiver on safe storage. In HV2 the smoke detector battery was signaling a low battery and there was no reeducation regarding replacing battery to ensure continuing function. This was verified with the Director of Patient Care.