Every finding on record at Parrish Palliative and Hospice Care of Ohio, LLC

Observed in Record Review. In 6 of 10 patient records reviewed, it was noted that the comprehensive assessment was not completed no later than five calendar days after the election of hospice care. For example, in record RRHV#3 the initial bereavement assessment was dated on day 13 of care. In records RRNHV#2 the initial bereavement assessment was dated on day 13, record RRNHV#3 day 9, record RRNHV#4 day 8, record RRNHV#5 day 16 and RRNHV#6 day 7. All with not documentation to hold assessment until later dates. This was confirmed with the owner/RN present.

Observed in Record Review. In 1 of 1 patient records reviewed, for transfer discharge, it was noted that the record was in accurate. For example in record RRDC#2 two nurse notes dated 12/7 and 12/8 both stated Patient admitted yesterday to (name) hospital. This was confirmed with the owner/RN present.

Observed in Record Review. In 9 of 10 patient records reviewed, it was noted that the written plan of care was not individualized. For example in record RRHV#1 Provide positive/enjoyable experiences for resident that do not involve overly demanding tasks and stress. during hospice care. and Lay a foundation for reasonable staff and family expectations concerning the resident's capacities and needs during hospice care. In multiple records the identical goal was found Patient's quality of life will be at an optimal level during hospice care. with no individualization of what an optimal level would be for the individual patients. Record RRHV#2, RRNHV#5 and RRNHV#4 All hospice disciplines will implement safety precautions as indicated within 60 days. and Support resident who has declined in order to lessen the likelihood of complications during hospice care. This was discussed with the owner/RN present.

Observed in Record Review. In 10 of 10 patient records reviewed, it was noted that the plan of care did not include all needed items. For example in record RRHV#3 a supplemental order read Add 10 PRN visits for change on status with no discipline stated. In records RRHV#1-3 and RRNHV#1-7 the plan of care stated Plus PRN visits for Symptom Management on all the records with no specific number of PRN visits and no discipline stated. This was discussed with the owner/RN present.

Observed in Patient Home. In 2 of 3 home visits conducted, it was noted that the organization had not implemented infection prevention and control activities when cleaning and disinfecting equipment. For example during visit RRHV#2 and RRHV#3 the nurses placed equipment on paper towels and used the same area for both clean and dirty. Also, during RRHV#2 the nurse placed the B/P cuff back into it's container after use then removed it, cleaned it and put back in the container. This was discussed with the owner/RN.

Observed in Record Review. In 2 of 2 patient records reviewed, for bereavement care it was noted that the plan of care was incomplete. For example, in records RRBR#1 and #2 bereavement interventions were documented, however there was no documentation of bereavement goals in the care plans. This was confirmed with the owner/RN present.

Observed in Record Review. In 10 of 10 patient records reviewed, it was noted that the individualized emergency management plan was incomplete. For example, records RRHV#1, 2,3 and RRNHV#1-7 did not have the Individual Emergency Plan document in the record. There was a screen from the EHR that had some information, however this did not include information such as an emergency contact and alternate location. During visits RRHV#1-3 it was noted that there was not Individual Emergency Plans in the homes. This was confirmed with the owner/RN present.