Every finding on record at Ph Healthcare Services, Inc

Based on review of the hospice's Emergency Preparedness Program (EPP) and interview, the hospice failed to include all employees in the hospice's EPP communication plan call list. The finding includes: On 3/25/2022 at 11:48 AM, review of the hospice's EPP revealed the hospice communication call tree did not include physicians or volunteers. On 3/25/2022 at 12:30 PM, Registered Nurse (RN) #4 reported, "We do not have them in the call tree" and verified the finding.

Based on review of the hospice's Emergency Preparedness Program (EPP) and interview, the hospice failed to provide documentation of its bi-annual tabletop training. The finding includes: On 3/25/2022 at 11:48 AM, review of the hospice's EPP revealed the hospice was unable to provide documentation of its tabletop training for staff. On 3/25/2022 at 12:30 PM, Registered Nurse (RN) #4 reported "I thought we didn't need one with 4 hurricanes (natural disasters) last year.

Based on observations and chart review, the hospice Registered Nurse (RN) failed to provide an accurate updated medication profile in the home for 1 of 3 patients observed in home visits. (Patient #6) The finding includes: Patient #6 During a surveyor attended home visit on 3/23/2022 between 8:15 AM and 9:30 AM, observations revealed during medication overview with caregiver that discrepancies existed between the hospice medication profile and medications the patient's takes in the home. Patient takes Alogliptin 6.25 mgs(milligrams) by mouth daily, Metaprolol 25 mgs by mouth daily, and Folic Acid 1 mg by mouth daily. Alogliptin 6.25 mgs(milligrams) by mouth daily, Metaprolol 25 mgs by mouth daily, and Folic Acid 1 mg by mouth daily were not listed on the hospice's medication profile for the patient. The patient reported taking Melatonin 5 mgs by mouth at night, but hospice profile showed Melatonin 3 mgs at night starting 10/1/2021. On 3/25/2022 ay 9:35 AM, RN #1 verified the findings.

Based on observations, chart reviews, and interview, the hospice Registered Nurse (RN) failed to document weekly wound measurements for 2 of 5 patients receiving wound care. (Patient #6 and Patient #13) The findings include: Patient #6 A surveyor attended home visit on 3/23/2022 between 8:15 AM and 9:30 AM revealed Patient #6 had wounds on the sacrum and within the abdominal fold. On 3/23/2022 at 10:50 AM, review of the patient's chart revealed no wound measurements were recorded in the patient's chart. On 3/25/2022 at 9:35 AM, RN #1 verified the finding. Patient #13 On 3/24/2022 at 10:16 AM, review of Patient #13's chart revealed the patient was admitted to hospice service on 10/7/2021 with diagnosis of senile degeneration of the brain and has wounds of right great toe, groin, sacrum, and right buttocks. No wound measurements are recorded in the patient's chart. The patient resides in a facility. In an interview on 3/24/2022 at 4:00 PM with RN #1, he/she revealed, "Facility does all wound care". On 3/24/2022 at 4:00 PM, RN #1 verified the finding.

Based on chart review and interview, the hospice Interdisciplinary Team (IDT) failed to provide information showing progress towards the goals specified in the patient's Plan of Care (POC) for 13 of 13 patients. (Patient #1 through #13). The findings include: On 3/23/2022 and 3/24/2022 review of 13 of 13 patient charts revealed there was no documentation by the IDT of the patient's progress towards individualized patient centered goals. On 3/25/2022 at 3:30 PM, Registered Nurse #1 reported "Our computer system shows goals, but the computer system doesn't have a way to document the patient's progress."

Based on observations and interview, the hospice staff failed to follow standards of practice for infection control to prevent cross transmission of infectious agents in the home setting by 2 of 2 Registered Nurses (RN). (RN #2 and #3) The findings include: Patient #4 During a surveyor attended home visit on 3/22/2022 between 1:02 PM and 1:42 PM, observations showed RN #2 reaching into his/her uniform pocket for a pen, using the pen wearing a glove and then placed the pen back into his/her uniform pocket without sanitizing the pen. During interview on 3/24/2022 at 3:10 PM, RN #1 reported "Should have cleaned the pen." Patient #5 During a surveyor attended home visit on 3/22/2022 between 2:44 PM and 3:22 PM, observations showed RN #3 reached into his/her uniform pocket for a pen, used the pen but failed to sanitize the pen before replacing the pen back into his/her uniform pocket. During an interview on 3/25/2022 at 9:31 AM, RN #1 reported "Should have cleaned the pen."

Based on personnel file review and interview, the hospice failed to provide education or training in grief and loss for the manager of staff providing bereavement services to hospice patients and their families. The finding includes: During an interview with the bereavement counselor on 3/23/2022 at 11:35 AM, the bereavement counselor reported that he/she manages the chaplain and Medical Social Worker (MSW) staff for the hospice. The Licensed Medical Social Worker (LMSW) reported that he/she has not had specific grief and loss training other than normal LMSW training and the hospice had not provided specific training. During review of the hospice's personnel files on 3//25/2022 at 11:02 AM, it was revealed the hospice failed to provide documentation for training in grief and loss for their bereavement counselor manager.

Based on patient chart reviews and interview, the Registered Nurse (RN) failed to provide patient specific instructions for the Certified Nurse's Aide's (CNA) assignments for 5 of 10 patients receiving aide services. (Patient #1, # 2, #6, #9 and #13) The findings include: Patient #1 On 3/23/2022 at 3:30 PM, review of Patient #1's chart revealed the Hospice Aide Visit Assignment had no baseline visit frequency for tasks performed. On 3/24/2022 at 3:52 PM, RN #1 reported "There should be frequencies", and verified the finding. Patient #2 On 3/24/2022 at 12:17 PM, review of Patient #2's chart revealed the Hospice Aide Visit Assignment had no baseline visit frequency for tasks performed. On 3/24/2022 at 3:32 PM, RN #1 reported "There should be frequencies", and verified the finding. Patient #6 A surveyor attended home visit on 3/23/2022 between 8:15 AM and 9:30 AM revealed the CNA reported using "Nizoral shampoo once a week and regular dandruff shampoo twice a week" per patient request. Review of the Hospice Aide Visit Assignment reports revealed "Hair Care: Comb/brush; Shampoo-q(every) visit as pt(patient) allows use Nizoral shampoo". Review of the Hospice Aide Visit Assignment also reported "Skin Care: apply Nystatin powder to abd(abdominal) folds". The Hospice Aide was observed applying Cavilon No Sting barrier spray, then Nystatin powder to the abdominal fold. On 3/23/2022 at 10:50 AM, review of the patient's chart revealed documentation that the RN completed training of the hospice aide for skin care, but the RN failed to update the Hospice Aide Visit Assignment. On 3/25/2022 at 9:35 AM, RN #4 verified the finding. Patient #9 On 3/24/2022 at 8:27 AM, review of Patient #9's chart revealed the Hospice Aide Visit Assignment had no baseline visit frequency for "Shave Face Pro Re Nata (PRN)" and "Change linen as needed". On 3/24/2022 at 3:45 PM, RN #1 reported "There should never be PRN frequencies", and verified the finding. Patient #13 On 3/24/2022 at 10:16 AM, review of Patient #13's chart revealed the Hospice Aide Visit Assignment had no documentation that the patient had an indwelling urinary catheter. During an interview on 3/24/2022 at 4:00 PM, RN #1 reported "We missed that" and verified the finding.