Every finding on record at Pathway Hospice LLC

Based on observations, review of patient charts, and interview, the hospice failed to ensure updated medication records for 3 of 3 patient records. (Patient #9, #10, and #11) The findings include: Patient #9 Review of Patient #9's chart on 2/23/2022 at 3:15 PM and an observation visit on 2/22/2022 at 2:15 PM revealed the hospice medication profile showed Zoloft 50 mg (milligram) 1 tablet by mouth every day starting 10/12/2020. Zoloft 50 mg (milligram) 1 tablet by mouth every day starting 10/12/2020 was not listed on the patient's medication administration record (mar) in the facility where the patient resided. On 2/24/2022 at 9:42 AM, the Administrator verified the finding. Patient #10 Review of Patient 10's chart on 2/23/2022 at 3:15 PM and an observation visit on 2/22/2022 at 2:15 PM revealed the hospice medication profile showed Memantine Hydrochloride 5 mg 1 tablet by mouth daily, Tresiba 100 units/mL(milliliters) solution 10 units subcutaneous daily and Vitamin D 3 25 mcg tablet by mouth daily. Memantine, Tresiba and Vitamin D 3 was not listed on the patient's mar in the facility where the patient resided. On 2/24/2022 at 9:23 AM, Administrator verified the finding. Patient #11 Review of Patient 11's chart on 2/23/2022 at 3:43 PM and an observation visit on 2/22/2022 at 4:05 PM revealed the hospice medication profile showed Colace sodium 100 mg capsule 1 capsule by mouth twice a day, MiraLax powder 17 grams by mouth once a day and ZyrTEC 10 mg tablet 1 tablet by mouth once a day. Colace, MiraLax and ZyrTEC was not listed on the patient's mar in the facility where the patient resided. Ascorbic Acid tablet 500 mg 1 tablet by mouth twice a day and Flagyl Tablet 500 mg inject 4 tablets intradermally everyday shift to sprinkle in wounds every day was listed on the patient's mar in the facility but Ascorbic Acid and Flagyl were not listed on the hospice medication profile. Clonazepam 1 mg tablet 1 tablet by mouth every 12 hours was listed on the hospice medication profile, but was listed as Clonazepam 1 mg by mouth three times a day on the mar where the patient resided. On 2/24/2022 at 9:50 AM, Administrator verified the finding.

Based on patient chart review and interview, the hospice failed to provide an initial bereavement risk assessment for 4 of 11 patient charts. (Patient #2, #3, #8, and #10) The findings include: Patient #2 Review of Patient #2's chart on 2/22/2022 at 10:07 AM revealed there was no documentation of an initial bereavement risk assessment. On 2/24/2022 at 10:12 AM, the Administrator confirmed the finding. Patient #3 Review of Patient #3's chart on 2/23/2022 at 11:33 AM revealed there was no documentation of an initial bereavement risk assessment. On 2/24/2022 at 10:03 AM, the Administrator confirmed the finding. Patient #8 Review of Patient #8's chart on 2/23/2022 at 2:24 PM revealed there was no documentation of an initial bereavement risk assessment. On 2/24/2022 at 11 AM, the Administrator confirmed the finding. Patient #10 Review of Patient #10's chart on 2/23/2022 at 3:15 PM revealed there was no documentation of an initial bereavement risk assessment. On 2/24/2022 at 9:23 AM, the Administrator confirmed the finding.

Based on patient chart review and interview, the hospice failed to ensure individualized patient visits by using excessive Pro Re Nata(PRN) visits by the Registered Nurse (RN) and the Licensed Medical Social Worker (LMSW) and failed to update the patient's Plan of Care as visits were needed for 8 of 11 patient charts reviewed. (Patient #3, #4, #5, #6, #7, #8, #9, and #10) The findings include: Patient #3 Review of Patient #3's chart on 2/23/2022 at 11:33 AM revealed the patient's start of care(soc) was 9/16/2021 and the patient expired 12/6/2021. Review of the patient's "Initial Plan of Care" revealed LMSW visits 1 x(times)/mo(month) x 3 mos with 10 PRN visits. The LMSW visited the patient on 9/20/2021, 10/25/2021 and 11/9/2021 with no prn visits used. On 2/24/2022 at 10:03 AM, the Administrator revealed "They make their own schedules, but that seems like a lot." Patient #4 On 2/23/2022 at 12:14 PM, review of Patient #4's chart revealed the patient's start of care was 12/21/2021 with RN visit schedule for 1 visit per week for 9 weeks with 12 PRN visits. The RN visited the patient on 1/3/2022, 1/11/2022, 1/18/2022, 1/24/2022, 1/31/2022, 1/7,2022 and 1/14/2022. The RN made PRN visits on 1/6/2022, 1/13/2022, 1/21/2022, 128/2022, 2/3/2022, 2/10/2022 and 2/18/2022 which were not reported in the narrative as visits needed for emergent service. On 2/24/2022 at 10:20 AM, the Administrator revealed "She should have updated the plan of care to visit schedule twice a week instead of using PRN visits." Patient #5 On 2/23/2022 at 12:56 PM, review of Patient #5's chart revealed the patient's Plan of Care dated 1/22/2022 showed RN visit schedule 1 x/wk x 14 weeks with PRN x 15 for crisis intervention. On 2/24/2022 at 10:44 AM with the Administrator, he/she revealed "They make their own schedules, but that seems like a lot." Patient #6 On 2/23/2022 at 1:28 PM, review of Patient #6's chart revealed the patient's Plan of Care dated 1/07/2022 revealed RN visit schedule 1 x/wk x 10 weeks with PRN x 15 for crisis intervention, and LMSW visit schedule 1 x/mo x 3 mos with PRN x 10. On 2/24/2022 at 10:50 AM, the Administrator revealed "They make their own schedules, but that seems like a lot." Patient #7 On 2/23/2022 at 1:28 PM, review of Patient #7's chart revealed the patient's Plan of Care dated 1/04/2022 revealed LMSW visit schedule 1 x/mo x 2 mos with PRN x 15. On 2/24/2022 at 10:52 AM, the Administrator revealed "They make their own schedules, but that seems like a lot". Patient #8 On 2/23/2022 at 2:24 PM, review of Patient #8's chart revealed the patient's Plan of Care dated 12/03/2021 revealed LMSW visit schedule 1 x/mo x 4 mos with PRN x 10. On 2/24/2022 at 11:00 AM, the Administrator revealed "They make their own schedules, but that seems like a lot." Patient #9 On 2/23/2022 at 2:52 PM, review of Patient #9's chart revealed the patient's Plan of Care dated 1/30/2022 revealed RN visit schedule 1 x/wk x 9 weeks with PRN x 10. On 2/24/2022 at 9:42 AM, the Administrator revealed "They make their own schedules, but that seems like a lot." Patient #10 On 2/23/2022 at 3:15 PM, review of Patient #10's chart revealed the patient's Plan of Care dated 12/14/2021 revealed LMSW visit schedule 1 x/mo x 4 mos with PRN x 10. On 2/24/2022 at 9:23 AM, the Administrator revealed "They make their own schedules, but that seems like a lot."

Based on observations and interview, 2 of 2 Registered Nurses (RN) failed to follow accepted principles for infection control during the provision of patient care. (RN#1 and #2) The findings include: Patient #10 Observations of RN #1 during a visit on 2/22/2022 between 2:15 PM and 2:45 PM revealed RN #1 wore the face mask underneath his/her nose during the entire visit and never attempted to reposition the mask. RN #1 placed the nurse supply bag on the Patient #10's bed without using a barrier, placed clean equipment removed from the equipment bag and the soiled equipment used in the provision of patient care on the same clean barrier. RN #1 placed the hand sanitizer on the patient's bed without using a barrier. RN #1 placed all soiled equipment into the equipment bag without sanitizing the equipment. RN #1 reached into his/her pocket with soiled hand to retrieve the telephone, touched the telephone to chart, and then replaced telephone into his/her pocket without sanitizing the telephone. On 2/24/2022 at 9:23 AM, the Administrator verified the finding. Patient #11 Observations of RN #2 during a visit on 2/22/2022 between 3:25 PM and 3:54 PM revealed RN #2 failed to sanitize the equipment used in the provision of patient care before placing the soiled equipment into the nurse bag. RN #2 removed the electronic device from the nurse bag with soiled hands, set the electronic device on the patient's overbed table, and when finished set the electronic device on the facility's nurse station counter without using a barrier. RN #2 did not sanitize the electronic device before replacing the electronic device into the nurse bag. On 2/24/2022 at 9:50 AM, the Administrator verified the finding.

Based on review of patient charts and interview, the Registered Nurse (RN) failed to provide comprehensive assessments and documentation of weekly wound measurements for 3 of 3 patients requiring wound care. (Patient #2, #3, and #11) The findings include: Patient #2 Review of Patient #2's chart on 2/22/2022 at 10:07 AM revealed the patient was admitted on 12/1/2021 with a Stage 4 Pressure wound of the sacrum measuring 8 cm(centimeters) by 5 cm by 3 cm. There was no documentation of weekly wound measurements for the weeks of 12/6/2021, 12/13/ 2021, and 12/20/2021. On 2/24/2022 at 10:12 AM, the Administrator verified the findings and reported the hospice wound policy required weekly wound measurements. Patient #3 Review of Patient #3's chart on 2/23/2022 at 11:33 AM revealed the RN charted the patient had two skin tears of sacrum on 10/19/2021. There was no weekly documentation for measurements of the skin tears. On 2/24/2022 at 10:03 AM, the Administrator verified the finding and reported the hospice wound policy required weekly wound measurements. Patient #11 Review of Patient #11's chart on 2/23/2022 at 3:43 PM revealed Patient #11 was admitted on 5/19/2021 with unstageable wounds of posterior lower back, right lateral hip and plantar surface of right fifth toe. Patient #11 was recertified on 8/4/2021 with wounds of right posterior leg, right distal toe, left posterior thigh, and right medial hip, and all listed as necrotizing fasciitis. Patient #11 was recertified on 1/5/2022 with 5 wounds listed as Stage 3 pressure ulcers but no locations identified. There was no documentation at any visits of wound measurements over the 40 weeks that Patient #11 was under hospice care. On 2/24/2022 at 9:50 AM, the Administrator verified the findings and reported the hospice wound policy required weekly wound measurements.

Based on review of the hospice personnel files and interview, the hospice failed to provide documentation of education or training for the hospice bereavement coordinator for grief and loss. The finding includes: Review of the hospice's personnel files on 2/24/2022 at 11:44 AM revealed the hospice failed to provide documentation for training in grief and loss for the hospice's bereavement counselor. During an interview with bereavement counselor on 2/23/2022 at 11 AM, the counselor reported the hospice had not provided him/her training specifically on grief and loss.

Based on patient chart review and interview, the Registered Nurse (RN) failed to provide patient specific instructions for the Certified Nurse's Aide's (CNA) assignments for 6 of 9 patients receiving hospice aide services. (Patient #2, # 4, #8, #9, #10, and #11) The findings include: Patient #2 On 2/22/2022 at 10:07 AM, review of Patient #2's chart revealed CNA visits 3 times a week with hospice aide assignments that were vague with nonspecific instructions regarding the patient's schedule for bed baths, diaper change, clean fingers and toes, and applying lotion. On 2/24/2022 at 10:07 AM, the Administrator confirmed the finding. Patient #4 On 2/23/2022 at 12:14 PM, review of Patient #4's chart revealed CNA visits 3 times a week with hospice aide assignments that were vague with nonspecific instructions regarding the patient's spa tub bath schedule and clean fingers and toes. On 2/24/2022 at 10:20 AM, the Administrator confirmed the finding. Patient #8 On 2/23/2022 at 2:24 PM, review of Patient #8's chart revealed CNA visits 2 times a week with hospice aide assignments that were vague with nonspecific instructions regarding the patient's personal care. The only instructions on the hospice aide assignment were "Ambulate with partial assist" and "Meet all personal care, safety, and comfort needs". On 2/24/2022 at 11:00 AM, the Administrator confirmed the finding. Patient #9 On 2/23/2022 at 2:52 PM, review of Patient #9's chart revealed CNA visits 5 times a week with hospice aide assignments that were vague with nonspecific instructions regarding the patient's schedules for bed bath/partial/complete bath, change bed linen, shampoo patient hair, clean and file fingernails, encourage fluids, and brush teeth. On 2/24/2022 at 9:42 AM, the Administrator confirmed the finding. Patient #10 On 2/23/2022 at 3:15 PM, review of Patient #10's chart revealed CNA visits 3 times a week with hospice aide assignments that were vague with nonspecific instructions regarding provide incontinence care as needed, schedules for assist with tub/shower bath, assist with ambulation, bath of choice as requested, and shampoo and fingernail care. On 2/24/2022 at 9:23 AM, the Administrator confirmed the finding. Patient #11 On 2/23/2022 at 3:43 PM, review of Patient #11's chart revealed CNA visits 2 times a week with hospice aide assignments that were vague with nonspecific instructions regarding schedules for bed bath and orders for shampoo hair 2 times a week. Patient #11 was observed to be bald. On 2/24/2022 at 9:50 AM, the Administrator confirmed the finding.