Every finding on record at Quad Care Hospice Incorporated

Upon patient record review, 1 of 9 (Patient #1) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #1: There is evidence in the record of an order for Oxygen 2-4l/min via NC as needed. Oxygen is not on the medication record. (corrected on site)

Upon patient record review, 3 of 9 (Patient #1,2,3) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #1: There is evidence in the record Plavix 75 mg daily. The plan of care did not include problem/goal/intervention for risk of bleeding.(corrected on site) Patient #2: There is evidence the spiritual assessment identified "expression of spiritual distress, anxiety/depression". Spiritual distress was not addressed in the plan of care by the chaplain or nurse.(corrected on site) Patient #3: There is evidence of an order for Foley catheter on admission. The plan of care did not include problems/goals/interventions for foley catheter care and maintenance.(corrected on site)

Upon patient record review, 1 of 9 (Patient #1) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #1: There is evidence in the record on 8/13/24 the Braden Scale score was (13) Moderate. On 11/5/24, the Braden score was (10) high risk. The plan of care was not updated for potential for skin breakdown.(corrected on site)

Observed in Record Review. In 5 of 5 patient records reviewed, it was noted that the patient goals in the plan of care were not individualized. For example, HV#1and HV#2 in each record 11 of 11 goals on the POC stated through next review as a time frame. HV#3 12 of 12 goals on the POC stated through next review as a time frame. RR#1 3 of 6 goals on the POC stated through next review as a time frame and 2 of 6 had no time frame identified. RR#2 9 of 12 goals on the POC stated through next review as a time frame and 2 of 12 had no time frame identified.

Observed in Individual Tracer. In 3 of 3 home visits conducted, the surveyor noted that the hospice had not followed manufacturer's instruction for use of product to prevent the transmission of infections. For example, during HV #1, 2, and 3 the RN used Sanizide spray to disinfect her equipment after use and stated that she was aware of a 5 minute time. She sprayed the equipment and allowed it to remain on the barrier for 5 minutes prior to returning to her bag. She did not reapply the product during this time to maintain the 5 minute wet time as written on the product label directions. Also, during HV#2 and 3 the RN used a tape measure for arm circumference and allowed the retractable tape to retract after use and placed it on the dirty area without disinfecting the tape first.