Every finding on record at Prayful Hospice LLC

Based on record review and interview, the agency failed in include all services necessary for the palliation and management of the terminal illness and related conditions that included drugs and treatments necessary to meet the needs of the patient in that the plans of care did not include the frequency that wound care treatments were to be performed on 4 (#6, #7, #11, #14) of 6 patient records reviewed where agency nursing staff were performing wound care. The failure placed the patients at risk that the wounds would worsen or become infected. --- Patient #6:Record review for Patient #6 revealed an initial Plan of Care dated 6/28/2024. The Plan of Care indicated that Patient #6 was admitted to the agency's services on 6/28/2024. The Plan of Care listed End-Stage Renal Disease (condition where the kidneys have lost the ability to remove waste and balance fluids) as the terminal diagnosis.  Registered Nurse D conducted a skilled nurse visit on 2/28/2025. Registered Nurse D documented that Patient #6 had a new wound on the right foot and Registered Nurse D cleaned the wound with normal saline, betadine (topical antiseptic solution used to prevent and treat infections on the skin) was applied, and the wound was covered with a dressing. Registered Nurse D wrote a physician order, dated 2/28/2025, that read that Patient #6's wound was to be cleaned with normal saline, apply Betadine, pat dry, and cover with a wound dressing. The order did not include the frequency that the wound care treatment was to be performed to Patient #6's foot.  Patient #6's clinical record contained a Plan of Care dated 3/13/2025. The Plan of Care did not include the frequency that the wound care treatment was to be performed to Patient #6's foot. Patient #6's clinical record contained a Plan of Care dated 3/27/2025. The Plan of Care did not include the frequency that the wound care treatment was to be performed to Patient #6's foot. Wound care was provided at each skilled nurse visit two times a week. Patient #7:Record review of Patient #7's clinical record revealed an Initial Plan of Care dated 9/3/2024. The Plan of Care indicated that Patient #7 was admitted to the agency's services on 9/3/2024. The Plan of Care listed Alzheimer's Disease (disorder that affects the brain causing memory loss, difficulty with language, reasoning, and problem-solving) as the terminal diagnosis. Registered Nurse D conducted a skilled nurse visit on 3/19/2025. Registered Nurse D documented that Patient #7 had a new wound to the left heel and Registered Nurse D cleaned the wound with normal saline, applied Betadine, dried, applied a triple antibiotic ointment, and covered with a dressing.  Registered Nurse D wrote a physician order on 3/19/2025. The physician order read to clean the wound to the left heel with normal saline, apply Betadine, pat dry, apply triple antibiotic ointment and cover with a dressing. The order did not include the frequency that the wound care treatment was to be performed to Patient #7's heel.  Patient #7's clinical record contained a Plan of Care dated 3/27/2025. The Plan of Care did not include the frequency that the wound care treatment was to be performed to Patient #7's heel. Wound care was provided at each skilled nurse visit two times a week. On 4/11/2025 at 9:00 a.m. a home visit was conducted. The surveyor spoke to Patient #7's family member. Patient #7's family member informed the surveyor that Patient #7 went to a respite facility and came back with a bed sore. Patient #7's family member informed the surveyor that the wound was almost healed. Patient #7's family member informed the surveyor that the hospice nurse provides wound care and comes as scheduled. Patient #11:Record review of Patient #11's clinical record revealed an Initial Plan of Care dated 2/28/2025. The Plan of Care indicated that Patient 11 was admitted to the agency's services on 2/28/2025. The Plan of Care listed Senile Degeneration of the Brain (disorders that result in a progressive decline in mental function impacting memory, reasoning, and the ability to perform everyday activities) as the terminal diagnosis.   Registered Nurse D conducted a skilled nurse visit on 3/3/20205. Registered Nurse D documented that Patient #11 had a new wound to the right hand and Registered Nurse D cleaned the wound with normal saline, patted dry, applied Betadine, applied a thin layer of triple antibiotic ointment, and covered with a dressing.  Registered Nurse D wrote a physician order on 3/3/20205. The physician order read to clean the wound with normal saline, pat dry, apply Betaine, apply triple antibiotic ointment and cover with a dressing. The order did not include the frequency that the wound care treatment was to be performed to Patient #11's hand.  Patient #11's clinical record contained a Plan of Care dated 3/13/2025 and a Plan of Care dated 3/27/2025. The Plans of Care did not include the frequency that the wound care treatment was to be performed to Patient #11's hand.  Wound care was provided at each skilled nurse visit two times a week. Wound resolved on 3/31/2025. Patient #14:Record review of Patient #14's clinical record revealed an Initial Plan of Care dated. 12/2/20204. The Plan of Care indicated that Patient #14 was admitted to the agency's services on 12/2/2025. The Plan of Care listed Hemiparesis Late Onset of Cerebrovascular Accident (weakness or partial loss of the ability to move or feel on one side of the body after a stroke) at the terminal diagnosis. Registered Nurse C conducted a skilled nurse visit on 1/24/2025. Registered Nurse C documented that a new order was initiated for the wound to Patient #14's sacrum (lower back). Registered Nurse C cleaned the wound to the lower back with Dakin's Solution (antiseptic solution used to clean and treat infected wounds), patted dry, applied triple antibiotic ointment, covered with classic Hydrofera Blue (antibiotic wound dressing), and secured with a dressing. Registered Nurse C wrote a physician order on 1/24/2025. The physician order read to clean the wound to the sacrum, with Dakin's Solution, pat dry, apply triple antibiotic ointment, cover with classic Hydrofera Blue secure with a dressing. The order did not include the frequency that the wound care treatment was to be performed to Patient #14's lower back. Patient #14's record contained Plans of Care dated 1/30/2025, 2/13/20205, 2/27/2025, and 3/27/2025. The Plans of Care did not include the frequency the wound care treatment was to be performed to Patient #14's lower back.  Patient #14's wound measured 3 x 3 x 3 centimeters on 1/24/2025. Patient #14's wound measured 2 x 2 x 3 centimeters on 3/24/2025. Wound care was provided at each skilled nurse visit two times a week. The wound had decreased in size. On 4/10/2025 at 3:10 p.m. a home visit was conducted. Patient #14's family member informed the surveyor that the nurse comes as scheduled, twice a week, on Mondays and Thursdays to perform wound care. Patient #14's family member informed the surveyor that the hospice nurse had taught Patient #14's family member how to perform the wound care should it be needed in between nurse visits.  During an interview on 4/9/2025 at 1:33 p.m. with the Administrator, Alternate Administrator/Supervising Nurse, and the Director of Operations, the surveyors discussed that the plans of care did not include the frequency that wound care treatment was to be performed. The surveyor asked what the agency's expectations for wound care orders written by staff were. The Alternate Administrator/Supervising Nurse Informed the surveyor that the frequency was to be included in the order for wound care. The surveyor asked how this could affect the agency's patients. The Alternate Administrator/Supervising Nurse stated, "No one would know what we're doing, how often we would do it, or who would be doing it (wound care)." During an interview on 4/10/2025 at 12:13 p.m. with Registered Nurse D, the surveyor discussed that the plan of care did not include the frequency that wound care was to be performed. The surveyor discussed that the wound care orders did not include the frequency that the wound care was to be performed. Registered Nurse D stated, "It's possible that I did not put in the frequency." Registered Nurse D informed the surveyor that Registered Nurse D documented it in the clinical note. The surveyor asked was the frequency of wound care treatments supposed to be included in the plan of care. Registered Nurse D stated, "Yes." During an interview on 4/10/2025 at 12:33 p.m. with Registered Nurse C, the surveyor discussed that the plan of care did not include the frequency that wound care was to be performed. The surveyor asked what was to be included in the plan of care for wound care treatments. Registered Nurse C stated, "The treatment that we are doing according to the physician orders. The frequency of the wound care should be in the order." Review of the agency's policy titled "Hospice Policy and Procedure Manual Plan of Care" and dated 01/31/2015 read in part; "Policy The hospice interdisciplinary group (IDG) must prepare a written plan of care for each patient. The written plan of care must specify the hospice care and services necessary to meet the patient and family-specific needs, as identified in the comprehensive assessment and as related to the terminal illness and related conditions. Procedure...D. The written plan of care, with a focus on palliative care will include the following...h. Drugs and treatment necessary to meet the needs of the patient..."

Based on record review and interview, the agency failed to provide infection control education to employees, contracted providers, patients, and family members and other caregivers in that the agency failed to provide, according to its policy, bloodborne pathogen training to employees within one year of the employees previous bloodborne pathogen training for 4 (Chaplain E, Registered Nurse C, Supervising Nurse, and Social Worker F) of 4 personnel records reviewed where staff had been employed greater than 12 months and had patient contact.  The failure placed the patients, staff, family members, and other caregivers at risk for exposure to infections and communicable diseases. --- Record review of the agency's policy titled. "Exposure Control Plan" dated 4/9/2024 read in part; Purpose To establish Agency programs that includes policies and procedures for the protection of both patients and staff from exposure to bloodborne pathogens, airborne pathogens, and hazardous material...Definitions A. Bloodborne Pathogens means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and humans immunodeficiency virus (HIV)...Policy A. The Agency is committed to providing a safe and healthful work environment for the entire staff. In accordance with federal and state laws and regulations, Agency will design, implement, and evaluate annually an Exposure Control Plan which will include...3. Ensuring that educational needs, exposure follow-up procedure, counseling and documentation needs will be followed as outlined in the Bloodborne Pathogen Program per Occupational Safety and Health Administration (OSHA), 29 CFR Part 1910.1030 relating to Bloodborne Pathogens, Airborne Pathogen Program, and Hazardous Material Program. 4. Compliance of the agency, employee and contractors with health and safety code Chapter 85, Subchapter 1, in the prevention of the transmission of the human immunodeficiency virus and hepatitis B virus...Airborne/Bloodborne Pathogen Program A. The purpose of the Airborne/Bloodborne Pathogen Program is to define Agency and staff responsibilities, educate Agency staff on all aspects of airborne and blood pathogens, and define available testing for Agency staff, as well as ensure the protection of Agency staff and patients. B. Agency responsibilities...5. To provide training and information related to airborne and bloodborne pathogens for all staff upon hire and annually thereafter including TB (Tuberculosis), HBV, and HIV..." Reviewed on 4/11/2025, The Occupational Safety and Health Administration related to bloodborne pathogens at 29 Code of Federal Regulations (dated 5/14/2019) read in part..."1910.1030(g)(2) Information and Training. 1910.1030(g)(2)(i) The employer shall train each employee with occupational exposure in accordance with the requirements of this section. Such training must be provided at no cost to the employee and during working hours. The employer shall institute a training program and ensure employee participation in the program. 1910.1030(g)(2)(ii) Training shall be provided as follows: 1910.1030(g)(2)(ii)(A) At the time of initial assignment to tasks where occupational exposure may take place; 1910.1030(g)(2)(ii)(B) At least annually thereafter...1910.1030(g)(2)(iv) Annual training for all employees shall be provided within one year of their previous training..."Chaplain E:Record review of Chaplain E's personnel record contained a job application dated 8/21/2023. The personnel record indicated that Chaplain E received orientation to the agency on 8/21/2023 and received Bloodborne Pathogen training on 8/21/2023. At the time of the survey, Chaplain E was a current employee.  Registered Nurse C:Record review of Registered Nurse C's personnel record contained a job application dated 8/21/2023. The personnel record indicated that Registered Nurse C received orientation to the agency on 8/21/2023 and received Bloodborne Pathogen training on 8/21/2023. Supervising Nurse:Record review of the Supervising Nurse's personnel record contained a job application dated 8/3/2023. The personnel record indicated that the Supervising Nurse received orientation to the agency on 8/7/2023 and received Bloodborne Pathogen training on 8/7/2023.  Social Worker F:Record review of Social Worker F's personnel record contained a job application dated 8/21/2023. The personnel record indicated that Social Worker F received orientation to the agency on 8/21/2023 and received Bloodborne Pathogen training on 8/21/2023.  The agency was unable to produce evidence that Chaplain E, Registered Nurse C, the Supervising Nurse, and Social Worker F had bloodborne pathogen training within one year of their previous training. During an interview on 4/11/2025 at 2:13 p.m. with the Director of Operations, the Director of Operations informed the surveyor that the annual Inservice, which included bloodborne pathogen training, had not been done for 2024. The Director of Operations informed the surveyor that Human Resources would be responsible for the annual Inservice. The previous Human Resources personnel left in January 2025. The Director of Operations stated, "We don't know why it (annual Inservice) wasn't done."  During an interview on 4/11/2025 at 3:42 p.m. with the Administrator, Alternate Administrator/Supervising Nurse, and the Director of Operations, the surveyor discussed that the agency staff did not have their Bloodborne Pathogen training within a year of the staff's previous training. The Administrator, Alternate Administrator/Supervising Nurse, and the Director of Operations did not dispute the finding that the agency's staff did not have their Bloodborne Pathogen training within one year of their previous training. The agency staff did not state how it could affect the agency's patients.

It is required that the hospice and its staff operate and provide care and services in compliance with local, state, and federal law and regulation. This standard was not met as evidenced by review of personnel records, policy, and interview. 11 of 11 (100%) personnel records reviewed revealed Office of Inspector General (OIG) exclusion list was not completed per agency policy. Agency policy Background Checks HR.23, states, in part, all employees and volunteers who have direct access to patients will have an OIG exclusion list checked monthly. Review of personnel records did not include documentation of the OIG exclusion list being checked monthly {Personnel Records #73713; #79201; #57744; #67396; #33619; #13898; #24602; #94143; #43214; #81894; #49243}. During an interview with the Alternate Administrator on 3/15/2022 the Alternate Administrator confirmed this finding and said he did not know the policy stated the OIG exclusion list was to be checked monthly.