Every finding on record at R.C. Hospice Care, Inc.

Observed in Individual Tracer. In 10 of 14 patient records reviewed, Confirmed by the COO. The written plan of care had not documented individualized measurable goals. Example: During review of HOSv#2 the patient goals had not been measurable. Goal #1 had documented that the patient will be supported with resources and emotional support. All goals had a target date of end of certification. Goals documented had been interventions provided. Example: The Patient /CG will demonstrate to the nurse how to give Ativan for nausea. During review of HOS rr#6 The plan of care had not documented the problem, intervention or goal for treatment provided in SN notes. The SN note had documented that the decubitus ulcer had been treated per orders.

Observed in Individual Tracer. In 1 of 14 hospice records reviewed and confirmed by the COO. The updated plan of care had not contained the scope and frequency for the volunteer services being utilized for respite services. Example: During review of HOSrr#2 a MSW note identified a need for a volunteer for respite services, but had not updated the plan of care .

Observed in Individual Tracer. In 2 of 14 patient records reviewed, PRN medication orders had not been accurate for treatment of a similar symptom. This had been confirmed by the COO. Example: During review of HOSv#1 and HOSv#3 Medication had been ordered for duplicate therapy, but had not indicated which to utilize first such as Morphine 20mg 1 tab every 1 hour prn for pain . Tylenol 350mg 1 tab prn for pain. HOSv#3 had documented Oxycodone 5mg 1 tab po prn for pain and Morphine 20mg 1 tab prn for pain. Observed in Individual Tracer. In 3 of 14 patient records reviewed, Confirmed by the COO. The patient plan of care had not included the treatments necessary to meet the patient needs. Example: During review of HOSv#3 the SN note had documented that a foley catheter had been initiated per physician order . The SN note had been providing a straight catheterization weekly. The plan of care had not been updated to document the intervention provided. During observation of HHv#2 and confirmed by the COO. The patient had a pickwick for urinary drainage and incontinence per a physician order. The plan of care had not been updated to include incontinence and the intervention for the placement and care of the pickwick drainage system . During review of HOS rr#6 The plan of care had not documented the problem or intervention . The SN note had documented that the decubitus ulcer had been treated per physician orders. The plan had not been updated to document the problem and intervention to be provided .

Observed in Individual Tracer. In 2 of 10 patient records reviewed, that had been current active patients. The Hospice aide plan of care had not been updated to reflect the care being proved. Example: During observation of HOSv#1 . Care had not been provided as identified in the POC . The HHA had provided a bed bath, however the plan of care had documented that a shower be provided. The HHA note had documented that a shower had been provided per plan of care, but a bed bath had been provided. The COO had stated and confirmed that the plan of care had not been updated as the patient physically declined.

Observed in Individual Tracer. In 2 of 3 patient records reviewed, receiving personal care by the Home health Aide and confirmed by the COO. Example: During observation of HOSv#1 and HOSv#3 . Care had not been provided as identified in the POC . The HHA had provided a bed bath, however the plan of care had documented that a shower be provided. The HHA note had documented that a shower had been provided per plan of care, but a bed bath had been provided.

Observed in Individual Tracer. In 1 of 14 Hospice patient records review and confirmed by the COO. During patient record review of HOSrr#2 there had not been documentation by the volunteer for service provided.

Observed in Patient Home. In 3 of 3 home visits conducted, Confirmed by the COO. The organization had not provided the patient and family procedures to follow during an emergency or education with equipment. During observation of HOSv#1 , HOSv#2 and HOSv#3 there had not been an individual Emergency plan completed in the home. The individual plan remained blank and had not been completed. During observation of HOSv#1 the family had stated that they had not received education on the use or care of the oxygen concentrator and e tank.

Observed in Leadership Session. During review of Hospice contracts to include Respite services, Medications and DME services and discussion with the Administrator. It had been confirmed that the Hospice had not evaluated its contracted services annually as identified in the Hospice policy. This had been confirmed by the COO.