Every finding on record at Red Hearts Hospice, Inc.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization did not provide education to the facility staff as to safe and effective use of medications. For example, in RRHV #3, there were two medications, morphine sulfate and lorazepam both with paper labels on the bottle that got wet. The patient's name, dosage, instructions for use of the medications were missing from the labels. The organization's nurse and the facility nurse could not validate that education was provided as to safe use of the medications. There was also no documented evidence in the clinical record to support education was provided. This was validated and reviewed with the Administrator and the Director of Patient Care Services.

Observed in Record Review. In 9 of 9 patient records reviewed, the organization did not establish individualized and measurable goals for each patient. For example, in RRHV #1 there were more than 50% of the goals with the same target date. In RRHV #2 benefit period # 9 more than 50% of the goals had the same target dates. There were similar findings in RRHV #3, RRNHV #1 and 2, RRBR #1, 2, 3, and 4. This was validated and reviewed with the Director of Patient Care Services and the Administrator.

Observed in Record Review. In 8 of 9 patient records reviewed, the organization did not document the progress towards the plan of care goals. For example, in RRHV #1, 2, 3, in RRNHV #1 and 2, and in RRBR #1, 2, and 4 the patients had several benefit periods and in review of the clinical record there was no documented evidence that the plan of care goals were achieved or not achieved but the clinicians continued to roll the goals into the next benefit period. This was validated and reviewed with the Director of Patient Care Services and the Administrator. Observed in Record Review. In 7 of 9 patient records reviewed, the organization did not revise the timeframes for the plan of care goals. For example, in RRHV #1 in benefit period #4 the goal for bereavement bereaved will have knowledge of how to utilize bereavement services. The target date was for the previous benefit period. In RRHV #2 benefit period # 8 the infection/immunological goal stated, patient will be prevented from eye infection within certification period. The target date was in benefit #7. In RRBR #1 in benefit period #4 the goal stated, bereaved will have knowledge of how to utilize bereavement services with a target date from 5/2024 which was several benefit periods prior. There were similar findings in RRBR #2,RRBR #4, RRNHV #1, and RRNHV #2. This was validated and reviewed with the Director of Patient Care Services and the Administrator.

Observed in Record Review. In 4 of 9 patient records reviewed, the organization did not follow the bereavement plan of care Physician's orders. For example, in RRBR #1 the bereavement plan of care indicated a letter would be mailed within one month. The bereavement letter was sent 50 days after the anticipated time of the mailing. In RRBR #2 there is no documented evidence in the clinical record the mailings were sent as per the plan of care. In RRHV #1 benefit period #4 the skilled nurse had a missed visit. In RRHV #3 in benefit period 2 and 3 the Medical Social Worker missed one visit in each benefit period. There is no documented evidence the Physician was notified and there was no missed visit documentation in the clinical record.This was validated and reviewed with the Director of Patient Care Services and the Administrator.

Observed in Record Review. In 3 of 11 patient records reviewed, the organization failed to ensure that the patient and/or primary caregiver receive education and training provided by the hospice as appropriate to their responsibilities for the care and services identified in the plan of care. For example: in review of RR#6 the patient had a tracheostomy and required tracheostomy care and suctioning. There was no indication in the record that the caregiver was given specific education and training to include demonstration of proficiency for providing trach care and suctioning. In Review of RR# 5 and RR#6 the patient had a G-tube and was receiving tube feedings that required dressing changes and residual checks. There was no indication in the record that the primary caregiver was given specific instruction and training in providing the care for the G-tube and feedings. In review of RR#8 the patient was diabetic and the plan of care orders called for blood glucose monitoring and administration of insulin. There was no indication in the documentation that the primary caregiver was given education and training to include demonstration of proficiency in blood glucose monitoring and administering insulin. These observations were reviewed with the Director of Nursing.

Observed in Record Review. In 5 of 11 patient records reviewed, the organization failed to ensure that the written plan of care reflected the patient and family goals and interventions and include all services necessary for the palliation and management of the terminal illness and related conditions. For example: On review of RR#4 it was noted that the patient was being serviced by the Medical Social Worker and the Chaplain yet there were no care plans open to reflect psychosocial and spiritual goals and interventions. In review of HV#1 the patient had multiple long term chronic wounds up to stage 4. The goals for the skin integrity stated altered skin will heal without any complications within 7 days. These goals lacked being specific, and achievable in the time period specified. Further in HV#1 the patient had a foley catheter yet there was no goals and interventions for the urinary system. In RR#6 there were goals that lacked being specific, and measurable, such as optimal elimination and comfort within the certification period and keep patient free of discomfort related to skin infection within 2 weeks. In review of RR# 8 the patient was placed on and died on continuous care for uncontrolled seizures however there were no goals and interventions to address continuous care, seizures, and imminent death noted on the patient's plan of care. In HV#2 the spiritual care was noted to have an extensive amount of goals that were not individualized to reflect the patient's specific needs. These observations were reviewed with the Director of Nursing, and Administrator.

Observed in Record Review. In 1 of 11 patient records reviewed, the organization failed to ensure that the care and services were provided in accordance with the plan of care. For example: in RR#5 the patient had peg tube for feeding. The plan of care ordered that residuals be checked each shift and feeding held if residuals exceeded an ordered parameter. There was no documentation of residuals being checked noted in the nursing visit documentation. This observation was reviewed with the Director of Nursing.

Observed in Data Session. Upon review of the data management program and QAPI summaries it was noted that the organization was not comparing internal data over time to compare levels of performance, patterns, trends and variations. Each quarter the QAPI summary contained data solely for the quarter reporting and did not compare data over time. This observation was reviewed with the Director of Nursing.

Observed in Record Review. In 1 of 11 patient records reviewed, the organization failed to ensure that the hospice aide assignment prepared by the registered nurse included written patient care instructions to include all necessary tasks. For example: Upon review of HV#1 the patient had a foley catheter but the aide assignment lacked assigning the task of foley care. Further the patient had wounds with dressings yet there was no specific instructions on how the was to handle the dressings while providing care. These observations were reviewed with the Director of Nursing and Administrator.

Observed in HR File Review. In 1 of 7 HR files reviewed, the organization failed to ensure that documentation of an initial orientation for each employee addressed the employee's specific job duties. For example upon review of the HR file for the MSW there was no documentation of orientation to the organizations policy and procedures and specific job duties. Further, it was noted the forms: acknowledges & understanding of policies and orientation procedures, staff orientation and training on HIPPA program, information for injury prevention, employee handbook acknowledgement receipt, and other state specific forms in the HR file were all unsigned by the MSW and the organization representative. This observation was reviewed with the Director of Nursing.

Observed in Competency Session. In 1 of 7 HR files reviewed, the organization failed to ensure that the staff competency was initially assessed and documented as part of orientation. For example: in review of the MSW HR file it was noted that the initial competency was completed and dated for the tasks, however the competency assessment skills checklist was incomplete and not signed or dated by the employee, the supervisor, or the preceptor. This observation was reviewed with the Director of Nursing.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization failed to ensure that the medical director reviewed the clinical information and provided a written certification that included all of the required elements. For example: on review of HV#1 and HV#3 the physician narrative for the current benefit period contained a certification statement that lacked consideration of current subjective and objective medical findings. This observation was reviewed with the Director of Nursing and the Director of Nursing Designee.

Observed in Record Review. In 2 of 11 patient records reviewed, that were receiving bereavement services, the organization failed to ensure that the patient record contained all information to reflect the patient's care, treatment, or services. For example: In review of RR #9 the bereavement coordinator documented a call to assess the post death bereavement risk assessment however the documentation of the bereavement risk assessment was left blank. In RR#5 the initial bereavement risk assessment was initiated yet the documentation of the risk assessment was incomplete. This observation was reviewed with the Director of Nursing, and Administrator.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization failed to ensure that the patient record contained information that reflected the care, treatment, and services. For example: in HV#3 and RR#8 the patient/caregiver elected to receive the Patient Notification of Non-Covered Items however there was no documentation in the patient record that the patient/caregiver ever received the completed notification form from the hospice. Example 2: in review of RR#8 the patient was diabetic with orders for blood glucose monitoring. Nursing documentation noted the blood glucose level however there was no documentation of how the blood glucose was obtained. These observations were reviewed with the Director of Nursing.