Every finding on record at Prespective Hospice, Inc.

Observed in Record Review. In 2 of 2 patient records reviewed, for bereavement records, the organization failed to conduct and document a patient specific comprehensive assessment that identifies the patient's need for hospice care and services. For example: on review of the closed bereavement records and interview with the bereavement coordinator, it was noted that the hospice failed to conduct a post-death bereavement risk assessment as required by organization policy. This observation was reviewed with the Bereavement Coordinator, QA LVN, and Administrator Designee.

Observed in Record Review. In 8 of 10 patient records reviewed, the organization failed to ensure the update to the comprehensive assessment is based on changes that have taken place since the initial assessment and includes information about the patient's progress toward desired outcomes and a reassessment of the patient's response to care. On the review of the IDG meeting documentation and plan of care there was a pattern of lack of update to the plan of care and comprehensive assessment. The IDG documentation lacked summaries from the core discipline members to update the comprehensive assessment and care plans were not updated to reflect changes based on the updated comprehensive assessment. For example: In review of HSRRHV#3 there was a goal stating patient's wife will verbalize understanding of routine pain management and breakthrough pain medication within 7 days. The goal was established in April and remains open on the care plan to date. Another example reads Lung sounds will be clear upon completion of Mucinex in 14 days, yet the goal was established in March and remains open even though Mucinex had been discontinued. There were current care plans open for wound care and fungal rash yet both issues had been resolved per the documentation. In HSRRNHV#5 a goal established in June stated patient will show decreased cough episodes with tussin DM medication treatment within 14 days yet the care plan has not been updated to reflect progress. In HSRRNHV#6 current goal established in 2022 stated patient/family will verbalize understanding of patient's diagnosis, and will be less fearful of patient's decline without any update to show progress to the goal. Similar examples of lack of updates to the comprehensive assessment and plan of care can be seen in HSRRHV#1, HSRRNHV#7, HSRRNHV#8, HSRRNHV#9, and HSRRNHV#10. These observations were reviewed with the QA LVN and Administrator Designee.

Observed in Record Review. In 2 of 10 patient records reviewed, for active records, the organization failed to ensure each patient and the primary caregiver receive education and training as appropriate to their responsibilities for the care and services identified in the plan of care. For example: on review of HSRRNHV#4 the patient had orders for wound care that stated caregiver to provide wound care in absence of the hospice staff, yet there was no documentation noted in the record that education was provided to the patient/caregiver on how to perform ordered dressing change, nor documentation of the caregivers proficiency at performing the task assigned. In HSRRNHV#5 the patient had orders for wound care and a foley catheter, yet there was no documentation that education was provided on wound care, or foley care to the patient/caregiver, nor the caregiver's response to the teaching provided. These observations were reviewed with the QA LVN.

Observed in Record Review. In 9 of 10 patient records reviewed, the organization failed to ensure the plan of care is based on the patient's goals and the time frames, settings, and services required to meet the goals, and that goals were specific, measurable, achievable, realistic, and time bound. For example: on review of HSRRNHV#4 an example of an established goal was patient will maintain adequate nutrition, and a goal that read like an intervention in patient will be educated on adequate coping skills. In HSRRHV#3 a goal read patient will have regular bowel movements. In HSRRHV#2 a goals read patient will maintain adequate nutrition and patient will have some relief from high ammonia levels. In HSRRNHV#9 a goal read patient will achieve adequate rest with proper sleep pattern. Similar findings of goals that lacked being specific, measurable, achievable, realistic, and time bound can be seen in HSRRHV#1, HSRRNHV#5, HSRRNHV#7, HSRRNHV#8, HSRRNHV#9 and HSRRNHV#10. These observations were reviewed with the QA LVN, and Administrator Designee.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization failed to ensure the staff implement the infection prevention and control activities it has planned. For example: on home observation of HSRRHV#3 the aide was observed to clean equipment with Clorox wipes and immediately store in the bag, not allowing for wet and dry time per manufacturers guidelines. The organization's policy is for cleaning equipment with alcohol. This observation was reviewed with the QA LVN.

Observed in Tracer Activities. During the interview with the bereavement coordinator it was noted that the organization failed to develop a bereavement plan of care that specifies the type of bereavement services to be offered and the frequency of service delivery. The bereavement coordinator described a process of sending a sympathy card, phone call, and various mailings for the bereaved. These were tracked on a spreadsheet and entered into the EMR, however there was no bereavement plan of care developed that specified the kind of bereavement services to be offered and the frequency of the services to be provided. This observation was reviewed with the Bereavement Coordinator, QA LVN, and Administrator Designee.

Observed in HR File Review. During the HR file review for the Medical Director and Medical Director Designee it was noted that the contract specified that the MD would be available 8:30am - 5:00pm and 8:00am - 4:00pm Monday through Friday for on-call after hours consultation, assistance, and decision regarding patient care, therefore not providing physician services on a 24-hour 7 day a week basis as required. This observation was reviewed with the QA LVN and Administrator Designee.

Observed in Record Review. In 8 of 8 patient records reviewed, the organization failed to ensure that patient record contain information that reflects the patient's care, treatment, and services. For example: on review of all clinical records where Aide services were provided the aide documentation failed to address all tasks assigned as the aide note had no place to document completion of each task. The aide provided a narrative of the visit but the documentation lacked addressing every task assigned. This observation was reviewed with the QA LVN.

Observed in Patient Home. In 1 of 2 home visits conducted, that medication reconciliation was conducted the organization failed to ensure the patient record contain information that reflects the patient's care, treatment, or services. On the home observation for HSRRHV#2 during the medication reconciliation the medication profile noted Atorvastatin 10mg daily, however the medication being given in the patient home was for 40mg daily. This observation was reviewed with the LVN and the QA LVN.

Observed in Competency Session. In 3 of 4 contracts reviewed, the organization failed to ensure the written agreement with an outside agency providing contracted services for the hospice included all required elements. For example: on review of the Pharmacy, SNF, and Therapy contracts it was noted that the contracts lacked a stipulation that the contracted entity must obtain criminal background checks on contracted employees who have direct patient contact or access to patient records. This observation was reviewed with the QA LVN and Administrator Designee.