Every finding on record at Precor Hospice Inc.

Observed in Emergency Management Session. The organization’s staffing plan did not address the management of all staff and volunteers as follows: Reporting processes; Roles and responsibilities for essential functions; Integration of staffing agencies, volunteer staffing, or deployed medical assistance teams into assigned roles and responsibilities; Verifying the identity and licensures of volunteer practitioners (such as nurses, respiratory therapists, physical therapists). This was discussed with the DON and CNO.

Observed in Record Review. In 1 of 6 patient records reviewed, the plan of care did not include clear medication orders. In the chart for RRHV#1, the plan of care included Bisacodyl suppositories, Milk of Magnesia and MiraLAX all ordered prn for constipation without further clarity on when to give which medication. This was discussed with the DON.

Observed in Record Review. In 2 of 6 patient records reviewed, the plan of care was not updated with progress toward goals. In the chart for RRHV#3, the nutrition problem was identified in November 2024 with a goal of ALF staff and family will understand effects of terminal disease on nutrition and hydration. within 72 hours remained on the current plan of care at the time of the survey, approximately 5 months from the time of identification. The medication goal that the facility staff would verbalize use, side effects, and administration of medications within 24-48 hours of admission also remained on the current plan of care. In the chart for RRHV#1, the care plan had not been updated with progress toward goals. For example, Patient/caregiver will verbalize understanding of bowel protocol and need to report changes of bowel pattern was identified upon admission more than one year prior to survey, with a target time frame within 2 weeks. This goal remains on the current care plan. This was discussed with the DON.

Observed in Record Review. In 1 of 6 patient records reviewed, care was not provided in accordance with the plan of care. In the chart for RRHV#2, the aide did not provide a shower, oral care, shampoo, etc. at one visit, though the services were ordered at each visit on the aide plan of care. This was discussed with the DON.

Observed in Record Review. In 6 of 6 patient records reviewed, Observed in Record Review at Precor Hospice Inc. (2050 N 11th St. Suite 3, Beaumont, TX) site. In 6 of 6 patient records reviewed, The organization did not Implement interventions to reduce falls based on the patient’s assessed risk. During review of records 1-6 it was noted that fall prevention interventions were generic and not based on the specific findings from the fall risk assessment. For example the interventions simply stated initiate fall precautions. This was confirmed by the Director of Nursing.

Observed in Record Review. The written plan of care was not based on the patient’s goals and the time frames, settings, and services required to meet those goals. During review of patient record 3 it was noted that the time frame for pain to be managed was by time of death or discharge. This was confirmed by the Director of Nursing.

Observed in Record Review. In 6 of 6 patient records reviewed, The plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including the following: Interventions to manage pain and symptoms. During review of patient records 1-6 it was noted that the plan of care did not include all interventions according to problems found in the initial assessment. For example in records 1 and 2 there were no interventions for mental status for a patient that had dementia and confusion, in record 3 there were no cardiac interventions for a patient with a primary diagnosis of CHF with pitting edema, in record 5 there were no interventions for edema for a patient with end stage kidney disease, and in record 6 there were no respiratory interventions for a patient with dyspnea. This was confirmed with the Director of Nursing.

Observed in Individual Tracer. The organization did not use standard precautions, * including the use of personal protective equipment, to reduce the risk of infection. During home visit 2 it was observed that the nurse did not cleanse her hands before entering the nursing bag and before donning gloves per policy. This was confirmed by the Director of Nursing. Observed in Individual Tracer. The organization did not reduce the risk of infections associated with medical equipment, devices, and supplies. During home visit 2 the nurse was observed to clean equipment with Sani-Wipes and then placed the equipment directly back in to the nursing bag. Sani-Wipes have a manufacturer's guideline of a 2 minute dry time. This was confirmed by the Director of Nursing.