Every finding on record at Quality Hospice Care, Inc.

Observed in Record Review. In 1 of 14 patient records reviewed, the organization did not respect the patient's right to elect and revoke hospice care in accordance with Medicare hospice regulations. In RRDC#1, it was noted that while the organization had a clear revocation process, the patient's completed and signed revocation statement was not documented/found. This was reveiwed with the Administrator/Director of Patient Care Services.

Observed in Record Review. In 3 of 10 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 interventions to manage the patient's symptoms. In RRHV#1, the patient with Parkinson's Disease also had a documented diagnosis of dysphagia. The hospice plan of care did not address the dysphagia. In RRHV#2, per the certificate of terminal illness, the patient's primary hospice diagnosis was cerebral infarction with additional diagnoses of dysphagia and seizure disorder. It was noted the dysphagia was not included in the plan of care. In RRNHV#3, the patient had a documented diagnosis of dysphagia (per the Certificate of Terminal Illness and RN initial assessment) and was on a mechanical soft diet and thinned liquids. Dysphagia was not included in the hospice plan of care. This was reviewed and verified with the Administrator/Director of Patient Care Services.

Observed in Patient Home. In 2 of 3 home visits conducted, the organization did not implement infection prevention and control activities when cleaning and performing disinfection of medical equipment, devices, and supplies. In RRHV#1. the RN used Clorox wipes to clean care equipment (blood pressure monitor/cuff, stethoscope), In RRHV#2, the RN used Lysol wipes to clean care equipment during the visit. Staff did not follow manufacturer's guidelines and organizational policy and procedure for cleaning the blood pressure monitor/care equipment. Policy and guidelines indicated care equipment was to be cleaned with alcohol or soap and water. This was reviewed and verified with the Administrator/Director of Patient Care Services.

Observed in Record Review. In 1 of 10 patient records reviewed, the patient record did not contain accurate information that reflected the patient's care, treatment, or services, including a list of medications with dose, strength, frequency, and route. In RRNHV#7, the patient's current medication profile indicated Dulcolax Suppository 10 mg one (1) suppository rectally once a day as needed for constipation if Lactulose ineffective. It was noted the patient's plan of care did not include Lactulose (discontinued one month prior). This was reviewed and verified with the Administrator/Director of Patient Care Services.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization did not provide education and training based on each patient's/caregiver's needs and abilities, including information on the storage, handling, and access to medical gases and supplies. In RRHV#2, two oxygen e-tanks were stored in the patient's room. One tank was secured in a portable stand, the other tank was sitting upright unsecured. Although the RN educated the facility caregiver on care of the patient, education related to the oxygen tank risk and safe storage/handling was not provided. The oxygen tank was placed on the floor on its side by the Administrator/Director of Patient Care Services prior to the end of the visit. This was reviewed and verified with the RN and Administrator/Director of Patient Care Services.