Every finding on record at On Time Hospice Care Inc.

Upon client record review, 4 of 11 (Patient #2,5,6,7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2 Order states SN to report to MD if DSP greater than 90mmhg or less than 50mmhg. Visit note on 11/3/22 documented b/p 155/97, no documentation that MD was notified of elevated result. Patient #5 Order states SN to report to MD if DSP greater than 90mmhg or less than 50mmhg. Visit Note on 9/26/22 documented b/p 147/96, visit note on 10/3/22 documented b/p 143/92, visit note on 11/21/22 documented b/p 130/94. No documentation that MD was notified of elevated results. Patient #6 Order states SN to report to MD if DSP greater than 90mmhg or less than 50mmhg. Visit note on 11/29/22 documented b/p 142/105, no documentation that MD was notified of elevated result. Patient #7 Order states SN to report to MD if SBP greater than 160mmhg or less than 90mmhg. Visit note on 11/3/22 documented b/p 161/78, no documentation that MD was notified of elevated result.

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 #1, 2, 3 LVN went from the dirty part of her bag into the clean part of her bag without using hand sanitizer. LVN went in and out of bag without using hand sanitizer.