Every finding on record at Platinum Hospice Care, Inc

Based on observation, interview, and record review, the hospice facility failed to review and maintain the patient's accurate current medication profile for one of two patients (Patient 1). This failure has the potential in placing the patient at risk for medication errors and adverse drug reactions. Findings: A review of Patient 1's Patient Profile indicated, a start of care (SOC) date of 11/15/21, with a diagnosis that included Alzheimer's disease (a progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment). A review of Patient 1's Plan of Care (POC) for the re-certification period from 4/14/22 to 6/12/22, indicated an order for skilled nurse (SN) to visit 2 times a week and 1 additional visit per week as needed for nine weeks. On 5/2/22, at 11:00 a.m., a home visit was conducted at Patient 1's residence with the Registered Nurse (RN 1). Patient 1 was observed lying on her bed, RN 1 proceeded to render care. On 5/2/22, at 11:25 a.m., the RN 1 was observed cleaning up and putting away equipment. Patient 1' medications were not checked. RN 1 stated she was done with her visit. RN 1 was asked to show the medications the Patient 1 was taking. RN 1 referred to small, clear, individualized containers, given to her by Patient 1's caregiver. It was observed the containers showed to have pills of different sizes and color inside them. The containers were not labeled. On 5/2/22, at 11:26 a.m., RN 1 was observed looking at the pills in the bottles. RN 1 did not have the medication list to refer to. RN 1 stated, "these are her morning pills, they are docussate sodium, gabapentin, oxybutynin, donezepil, tramadol, raloxifene, and calcium. These other ones are for the evening, these are tramadol, gabapentin, oxybutynin." On 5/2/22, at 11:30 a.m., additional medications were observed placed on the kitchen counter. The medications were labeled containers provided by the pharmacy. RN 1 read the labels on each container as follows: Alprazolam 0.25 mg (milligrams) po (by mouth) twice a day for anxiety. Clonidine 0.1 mg tab 1 tab po once a day or as needed for hypertension. Gabapentin 300 mg 1 capsule po twice a day for pain. Oxybutynin 5 mg 1 tab po twice a day for overactive bladder. Dorzolamide 2% ophthalmic solution. One a day, one drop into both eyes for glaucoma. Timolol Maleate 0.5% ophthalmic solution once day 1 drop into both eyes. Tylenol 500 mg as needed for headache. RN 1 stated Dorzolamide 2% ophthalmic solution expired date was on November 2020. Timolol 0.5% ophthalmic solution expiration date was July 2021. RN 1 stated medications are reviewed and checked "once in a while, we know the patient, we had the patient for a long time and we know which medications she was on". When asked how she verifies the medications the patient was taking if containers were not labeled, RN 1 stated, "because we look at the medication list". When asked how she would know if the medication had expired and the medications were not in the original container from the pharmacy, RN 1 stated, "I don't". RN 1 stated if nurse's checked medications regularly they would have noticed the expired medications. A review of Patient 1's undated medical record titled, "Current treatment/medication/DME list", revealed medication "Donezepil Hydrochloride (for Alzheimer's) 5 mg tablet, 1 tablet by mouth once a day," and "Santyl 250 unit/g Topical ointment daily for wound care" was listed twice. The reported Tylenol 500 mg by mouth taken as needed for headache was not included in the medication list. The following medications were listed but not verified during the visit: "Mupirosin 2% topical every other day for skin infection" " Wound wash saline top spray 0.9% topical every other day wound cleansing" "Decussate Sodium 100 mg 1 softgel by mouth twice a day laxative" "Donezepil hydrochloride 5 mg 1 tablet by mouth once a day Alzheimer's" "Omeprazole 20 mg 1 capsule by mouth once a day" for stomach reflux. "Raloxifene hydrochloride 60 mg by mouth once a day" for osteoporosis. These medications were not listed and updated in the medication profile for Patient 1. During an interview on 5/4/22, at 3:08 p.m., the Director of Nursing (DON) stated staff needed to review the medication profile every visit . The DON stated the nursing staff need to check to see if there are changes such as new orders, or discontinued orders that way they can update the medication list or call the physician for orders. The DON stated checking expiration dates on the vials is an expectation because if patient takes expired medications "it's a disaster". The DON stated if medications are not reviewed on every patient visit the agency does not have the right information when discussing the care during the interdisciplinary team meetings, impacting the care of the patient. A review of the HA's undated policy and procedure titled, "Medication Profile", indicated "Patients receiving medications administered by hospice will have a current, accurate medication profile in the clinical record. Medication profiles will be updated for each change to reflect current medications and new and/or discontinued medications".

Based on observation, interview, and record review, the facility failed to provide instructions to the patient and family member regarding medication storage for one of two sampled patients (Patient 1). This failure has the potential in placing the patient at risk for medication errors and adverse drug reactions. Findings: A review of Patient 1's Patient Profile indicated, a start of care (SOC) date of 11/15/21, with a diagnosis that included Alzheimer's disease (it is a progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment). During a review of Patient 1's Plan of Care (POC), for the re-certification period from 4/14/22 to 6/12/22, indicated an order for skilled nurse (SN) to visit 2 times a week and 1 additional visit per week as needed for nine weeks. On 5/2/22, at 11:00 a.m., a home visit was conducted at Patient 1's residence with the Registered Nurse (RN 1). During a concurrent observation and interview on 5/2/22, at 11:25 a.m., RN 1 was asked to show the medications Patient 1 was taking. RN 1 referred to small, clear, individualized containers, provided by Patient 1's caregiver. The containers showed to have pills of different sizes and color inside them. The containers were not labeled. RN 1 stated the family organized the pills into individual containers to give to the patient during the month because it was easier to give medications, so doses are not forgotten. The RN 1 stated the family threw away the medication containers received from the pharmacy. During an interview on 5/4/22, at 3:19 p.m., the Director of Nursing (DON) stated medication teaching was done by the nurse on initial assessment and onward. The DON stated the topics discussed regarding medications include side effects, purpose, how to take it, and frequency. The DON stated "we tell them not to throw away empty prescription containers so the nurse can review it, so the nurse can reconcile with the medication list, especially narcotics and to assess if patient is taking the medications correctly." A review of the HA's undated policy and procedure titled, "Medication management/high risk/reconciliation", indicated "Clients/family members will be education about proper medication storage in the home as needed. In the event that emergency medications are kept in the home, location of the medication and proper storage guidelines will be identified and documented ...If specific medications or solutions are needed to prepare medications, these must be accurately labeled with contents, expiration date and warnings as necessary".

Based on observation, interview and record review, the facility failed to ensure the plan of care (POC) for wound care management identified the specific days for each disciplines to perform the wound care treatment for one of two sampled patients (Patient 1). This failure has the potential to affect the patient's wound care needs will not be implemented and will not be met. Findings: A review of Patient 1's medical record disclosed a start of care (SOC) date of 11/15/21, with a diagnosis that included Alzheimer's disease (it is a progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment). A review of Patient 1's POC for the re-certification period from 4/14/22 to 6/12/22, indicated an order for skilled nurse (SN) to visit 2 times a week and 1 additional visit per week as needed for nine weeks. The POC for this certification period also identified LVN visits twice a week + 1 PRN for pain management and comfort measures. Further record review indicated an order dated 3/14/22, for wound care to cleansed wound and periwound area with NS 9%, pat and dry, protect periwound area with non-sting skin barrier, apply dime size thickness of Santyl ointment, cover with adaptic, secure with mepilex foam dressing. A review of Patient 1's medical record titled, "Visit Report", dated 4/26/22, indicated "treatment plan ...clean wound with NS (normal saline) or soapless, cleanser and pat dry ...DO NOT remove primary dressing (non-adherent pad). May remove secondary dressing (foam or abd pad) when saturated. Provider to change dressing ...provider to visit on Tuesday, agency nurse to visit on other days." On 5/2/22, at 11:00 a.m., a home visit was conducted at Patient 1's residence with the Registered Nurse (RN 1). Patient 1 was observed lying on her bed, RN 1 proceeded to render care to the patient. On 5/2/22, at 11:00 a.m., RN 1 stated Patient 1 was receiving wound care treatment three times a week. RN 1 stated the wound care specialist provided wound care for Patient 1 every Tuesday and the LVN provided wound care treatment twice during the week on Wednesdays and Fridays, and one additional PRN (as needed) visit every week. RN 1 stated she was not going to provide wound care this visit because wound care was already done last Saturday. On 5/5/22, at 3:30 p.m., the DON stated the wound care specialists provided wound care as well as the LVN. The DON stated the POC should indicate the wound care being provided by both LVN and the wound specialist. The DON stated the POC was supposed to reflect the services the nurses are doing and should reflect the most current wound treatments being provided. A review of the HA's undated policy and procedure titled, "The Plan of Care", indicated "The care provided to the patient must be in accordance with the plan of care ...Procedure ...4. The plan of care will identify the patient's needs and services to meet those needs ...It must state, in detail, the scope and frequency of services need to meet the patient's and family/caregiver's needs."

Based on interview and record review, the hospice agency failed to provide volunteer services as required to one of two patients ( Patient 2). This deficient practice had the potential of not meeting the patient's hospice care needs identified to be provided by the volunteer services. Findings: A review of Patient 2's admission record indicated the patient was admitted to the hospice agency on 9/2/2021, with primary diagnosis of senile degeneration of brain. A review of the "Initial orders and Plan of Care" dated 3/16/2022, indicated the SN visit frequency for Patient 2 was once a week and one visit as needed for symptom management, nursing assessment of patient/caregiver needs, evaluation of patient/caregiver response to effectiveness of intervention, development of patient/cg care plan/intervention in collaboration with interdisciplinary team (IDT). It indicated the volunteer services was "Declined". However, there was no signature of the physician in the "Initial orders and Plan of Care" the service was declined. On 5/4/2022, at 10:45 a.m., during a joint home visit with LVN 1, Patient 2 was observed lying in a bed and Family member 2 was next to the Patient. At 11:25 a.m., during an interview with Family member 2, he stated the hospice staff did not inform and offer the volunteer service. During a concurrent interview with Patient 2, he stated he would like to have volunteer service. On 5/5/2022, at 3:50 p.m., during a telephone interview with the volunteer coordinator, she stated she was the only volunteer hired by the hospice. The volunteer coordinator further stated the volunteer services had been suspended since COVID 19 outbreak, so the volunteer service had not been explained and offered to all the patients/family. On 5/5/2022, at 4 p.m., during an interview with the administrator, he also stated the volunteer services had not been explained and not offered during the COVID 19 pandemic. A review of the agency's policy of "Volunteer Services" revised on the year of 2017 indicated the hospice will provide volunteer services under the direction of a volunteer coordinator and with the assistance of trained volunteers.