Every finding on record at Pruitthealth Hospice, Inc.

Based on record reviews and interview, the hospice failed to ensure the patient's comprehensive assessment (wound measurements) was updated for one two patients with wound care needs. (Patient #1 ) The findings are: On 2/23 2022 at 2:55 PM, review of Patient #1's chart revealed the Skilled Nurse (SN) did not document an update to the patient's comprehensive assessment regarding wound care measurements for nursing visits on 1/18/2022, 2/8/2022, and 2/10/2022. The finding was verified by Administrator #1 at 12:09 PM on 2/25/2022.

Based on record reviews and interview, the Skilled Nurse (SN) failed to develop and implement an Aide assignment sheet for the Aide for one of eleven patient charts with ordered Aide services. (Patient #7) The findings are: Patient #7 On 2/23/2022 at 7:55 PM, review of Patient #7's chart revealed there was no Aide assignment sheet developed by the SN. The orders for the Aide frequency was 1 x (time) week x 1, then 4 x week x 1 , then 5 x week. The Aide visited the patient on 12/23/2021, 12/27/2021, 12/28/2021, and 12/29/2021 without an Aide assignment developed by the SN. The patient expired on 12/29/2021. The finding was verified by Administrator #2 at 10:31 AM on 2/25/2022.

Based on record reviews and interview, 6 of 13 patient charts reviewed had no measurable outcomes in the patient's Plan Of Care (POC). (Patient #3, #,8, #9, #10, #11, and #12 ) The findings are: Patient #3 On 2/22/2022 at 3:59 PM, review of Patient #3's chart revealed the Plan Of Care (POC) had a goal without measurable outcomes: Verbalize/demonstrate appropriate and safe wound care and wound will be managed without infection and pain will be controlled. The finding was verified by Administrator #1 at 12:16 PM on 2/25/2022. Patient #8 On 2/23/2022 at 4:03 PM, review of Patient #8's chart revealed the patient's POC had a goal without a measurable outcome not measurable: Understand measures to cope with depression. The finding was verified by Administrator #1 at 12:16 PM on 2/25/2022. Patient #9 On 2/23/2022 at 5:23 PM, review of Patient #9's chart revealed the patient's POC had goals without a measurable outcome: POC will be established, pain will be manageable, Medical Social Worker POC, Chaplain POC, Assistance with personal care, Volunteer POC, changes in neurological status, and verbalize/demonstrate skin breakdown. The findings were verified by Administrator #1 at 11:30 AM on 2/25/2022. Patient #10 On 2/23/2022 at 5:59 PM, review of Patient #10's chart revealed the patient's POC had goals without a measurable outcome: POC will be established, appropriate pain management, reduction or relief in cardiopulmonary symptoms, and neurological status. The findings were verified by Administrator #1 at 11:36 AM on 2/25/2022. Patient #11 On 2/23/2022 at 6:31 PM, review of Patient #11's chart revealed the patient's POC had goals without measurable outcomes: POC will be established, appropriate pain management, reduction or relief in cardiopulmonary symptoms, and independence in care of tracheostomy. The finding was verified by Administrator #1 at 11:52 AM on 2/25/2022. Patient #12 On 2/23/2022 at 6:40 PM, review of Patient #12's chart revealed the patient's POC had goals without measurable outcomes: POC will be established, appropriate pain management, reduction or relief in cardiopulmonary symptoms, and understanding of infection control. The findings were verified by Administrator #1 at 12:01 PM on 2/25/2022.

Based on record reviews and interview, the Interdisciplinary Group (IDG) failed to ensure Aide services were delivered per the patient's Plan Of Care (POC) frequency order for one of eleven patient's with Aide services. (Patient #8) The findings are: Patient #8 On 2/23/2022 at 4:03 PM, review of Patient #8's chart revealed the Aide frequency order was 2 x(times) week x 1, then 7 x week x 10, then 1 x week x 1 effective 9/26/2021. The chart data showed the Aide did not make the first visit until 10/4/2022. The finding was verified by Administrator #2 at 10:50 AM on 2/25/2022

Based on observations and interview, the Skilled Nurse (SN) failed to follow accepted infection control prevention to prevent potential cross transmission of infectious agents in the home setting for 1 of 2 SN visits. The findings are: On 2/23/2022 from 11:59 AM to 12:45 PM, observations of SN #2 during a home visit revealed the SN did not perform hand hygiene after the removal of soiled gloves. The finding was verified by SN #2 at 12:45 PM on 2/23/2022.

Based on record reviews and interview, the Skilled Nurse (SN) failed to provide specific instructions for the Aide on the Aide assignment sheet for three of eleven patient charts with Aide services. (Patient #5, #6, and #8) The findings are: Patient #8 On 2/23/2022 at 4:03 PM, review of Patient #8's chart revealed the Aide assignment sheet had no frequency for the tasks assigned. The finding was verified by Administrator #2 at 10:50 AM on 12/25/2022. Patient #5 On 2/23/2022 at 7:05 PM, review of Patient #5's chart revealed the Aide assignment sheet had no frequency for the tasks assigned. The finding was verified by Administrator #2 at 10:06 AM on 12/25/2022. Patient #6 On 2/23/2022 at 7:33 PM, review of Patient #6's chart revealed the Aide assignment sheet had no frequency for the tasks assigned. The finding was verified by Administrator #2 at 10:20 AM on 12/25/2022.

Based on record review and interview, the hospice's Administrator failed to function as the sole supervisor of the hospice responsible for the primary site as well as all multiple locations. (Parent, Multiple Location #1 and #2). The findings are: On 2/25/2022 at 9:46 AM, review of the hospice data and personnel files revealed the hospice had an Administrator for the parent office and an Administrator for each of the two multiple location offices for a total of three Administrators. The supervision of the parent and multiple location offices as well as the operations functions are performed by the designated Administrator for the primary site and two multiple locations. The finding was verified by Administrator #1 at 11:11 AM on 2/25/2022 and Administrator #2 at 10:006 AM on 2/25/2022.

Based on record reviews and interview, the hospice failed to provide an organizational chart that was updated to include the current organizational lines in the hospice. The findings are: On 2/24/2022 at 3:24 PM, review of the hospice organizational chart #1 revealed the Parent office with the Multiple Location Offices (#1 and #2) directly reported to the Parent Office. Each of the Multiple Location Offices and the Parent Offices function independently of each other. Each office has an Administrator supervising staff and administrative functions. Each office has Nurses, Aides, Director of Nurses, Volunteer Coordinator, Medical Social Worker, Chaplains, Personnel Office Manager, and Medical Director. Organizational Chart #2 showed the two multiple locations that each had its own Administrator responsible for direct supervision of a Volunteer Coordinator, Social Worker, Director of Health Services (Director of Nursing), and Chaplain. Organizational Chart #2 revealed the Bereavement Coordinator is listed under the supervision of each the Administrator, but Bereavement Coordinator is an employee in the hospice's corporate office, and whose job description is listed under the Corporate Division. Administrator #1 at the primary practice verified the finding at 11:31 AM on 2/24/2022.

Based on record reviews and interview, the hospice had three Medical Directors. The hospice failed to appoint only one of the physicians as the Medical Director (Physician #1, #2, and #3) The findings are: On 2/25/2022 at 9:06 AM, review of the contracts with Physician #1, Physician #2, and Physician #3 revealed all three physicians had contracts for the hospice's Medical Director. The finding was verified by Administrator #1 at 11:11 AM on 2/25/2022, who stated, "Each of the three locations have their own Medical Director and an Associate Medical Director."