Every finding on record at Premium Hospice, Inc.

Observed in Record Review. In 3 of 3 patient records reviewed, During review of RR#1-3 it was noted SN goals on each POC were the same with each goal to be achieved within 14 days e.g.: Within 2 weeks and continuing throughout the benefit period, the patient’s pain will be maintained at an acceptable level as determined by the patient, as evidenced by effective use of prescribed pain regimen, and no signs of uncontrolled pain or distress. Patient will be able to maintain an effective breathing pattern, as evidenced by relaxed breathing at normal rate and depth and absence of dyspnea within 2 weeks and throughout the benefit period. This was discussed with the organization Administrator and DPCS.

Observed in Record Review. In 1 of 2 patient records reviewed, the organization failed to provide accurate assessment documentation. For example, in Bereavement #2 the home visit documentation note indicated the patient had pain and was medicated for pain but in additional documentation on the same home visit note, the Nurse marked no observable pain. This was validated by the Administrator and the Director of Patient Care Services.

Observed in Record Review. In 7 of 7 recertified patient records reviewed, the organization failed to follow the plan of care. For example, in RRHV#1, in benefit period 1, the Hospice Nurse indicated the goal as follows, patient will receive appropriate emotional support within 2 weeks and throughout the benefit period and continued the same goal in benefit period number two but there is no documentation in the Hospice Nurse's notes to support the goal having been worked towards and the Physician being contacted to notify the goal had not been accomplished. In RRHV#3 the goal states, pt/cg will demonstrate knowledge of safety measures within 2 weeks and throughout the benefit period as evidenced by the absence of accident fall or accident injury. There are similar findings in RRHV #1,2, and 3, RRNHV #4 and 7, and RRDC #1 and 2. This was validated and reviewed with the Director of Patient Care Services an the Administrator.

Observed in Record Review. In 7 of 7 recertified patient records reviewed, the organization failed to revise the plan of care based on the patient's progress towards goals. For example, in RRHV #3 the goal stated, pt/cg will demonstrate knowledge of safety measures within 2 weeks and throughout the benefit period as evidenced by the absence of accident fall or accident injury. The goal was not accomplished within the benefit period and was not revised to meet the needs of the patient. There were similar findings throughout multiple charts, RRHV#1, 2, and 3, RRNHV #4 and 7, and RRDC #1 and 2. This was validated and reviewed with the Administrator.

Observed in Record Review. In 7 of 7 recertified patient records reviewed, the organization failed to provide teaching of the interventions established in the plan of care. From example, in RRHV#3 the goal states, pt/cg will demonstrate knowledge of safety measures within 2 weeks and throughout the benefit period as evidenced by the absence of accident fall or accident injury. In the Hospice Nurse’s documentation on several notes there is no documentation to support safety teachings. In fact, safety teaching is marked as “no” on the Hospice Nurse notes. Another example, in RRHV#1, in benefit period 1, the Hospice Nurse indicated the goal as follows, patient will receive appropriate emotional support within 2 weeks and throughout the benefit period. There is no documentation in the notes to address the patient/caregiver receiving “appropriate emotional support”. There were similar records with the same issues, RRHV #1, 2, and 3, RRNHV #4 and 7, and RRDC # 1 and 2. This was validated and reviewed with the Administrator. Observed in Record Review. In 1 of 14 patient records reviewed, the Hospice Nurse failed to follow the order for blood glucose monitoring and sliding scale medication administration. For example, in RRNHV #1 the order states, SN to monitor blood glucose levels and facility to monitor on days the Hospice Nurse does not visit and administer medication per sliding scale. The Hospice Nurse did not monitor the blood glucose level as ordered and did not document if the facility monitored the blood glucose levels. This was validated by the Director of Patient Services.

Observed in Patient Home. In 1 of 3 home visits conducted, the Medical Social Worker (MSW) failed to notify the Hospice Nurse of the patients complaint of pain. For example, the patient stated, she had been having unresolved pain to her left lower leg and foot for months and has to take one Tramadol in the morning and one at bedtime and in addition, also has her Private Caregiver give two Tylenol at bedtime to help alleviate the pain to be able to sleep. During the visit the MSW did not acknowledge the patient's complaint of pain nor did the MSW report the pain to the Hospice Nurse. This was validated with the Director of Patient Care Services and the Administrator.

Observed in Patient Home. In 1 of 3 home visits conducted, the clinician failed to use an organization approved hand sanitizer as per policy 9-009.1. For example, in RRHV #1 the Hospice Nurse had a bottle of hand sanitizer which only contained 62% isopropyl alcohol and also stated, the hand sanitizer within the container was not the hand sanitizer originally in the bottle but the bottle was refilled with hand sanitizer of an unverifiable brand. The organization's Director of Patient Care Services could also not attest of the contents within the bottle and therefore, the bottle was not approved. The organization's policy states, organization approved, alcohol based hand rub which conforms to CDC guidelines. CDC guidelines state that 70% isopropyl alcohol. This was validated by the Director of Patient Care Services.

Observed in Patient Home. In 1 of 3 home visits conducted, the Certified Hospice Aide (CHA) failed to follow the plan of care. For example, the CHA ambulated the patient via walker, from the living room to the shower for care. The plan of care stated, the patient should remain in bed due to being bedbound and did not indicate an assistive device could be used to ambulate the patient. This was reviewed with the Administrator and the Direct of Patient Care Services.

Observed in Record Review. In 7 of 7 recertified patient records reviewed, there was no evidence that the governing body and leadership had established requirements to support patient care treatment and services as evidenced by failure to review and approve documents to ensure staff were following the plan of care and the Physician was being made aware of any plan of care deviations. This was reviewed with the Administrator and Director of Patient Services

Observed in Patient Home. It was found on HV#1 that the RN did not conduct medication reconciliation according to organization policy. The RN reviewed the MAR at the SNF but did not compare the SNF MAR with the current patient medication profile of the organization. This was verified with the DON who was also on the visit.

Observed in Infection Control System Tracer. In 2 of 3 home visits conducted, It was observed on HV#1 and HV#2 that the staff was not following the manufactures instructions for using the Lysol Wipes to clean equipment used on the patient. Instructions on the container stated that the solution should remain wet on the equipment for 4 minutes and allow to air dry. On both visits the equipment was wiped with the Lysol Wipe and immediately placed in the nursing bag. This was verified with the administrator and the DON.

Observed in Regulatory Review. It was found on HV#1 in a SNF the hospice plan of care was not found in the hospice record at the SNF. According to organization policy the current POC should be filed in the hospice chart in the SNF. This was verified with the DON.