Every finding on record at Reliance Hospice, Inc

Observed in Record Review. In 1 of 14 patient records reviewed, During RR7 it was noted documentation of an order for wound care to be performed every 3 days was an error. In discussion with the clinical leadership, it was determined the orders and treatment by the SN were documented in the wrong patient record.

Observed in Record Review. In 11 of 14 patient records reviewed, The stated patient/family goals did not contain specific information that can be accurately measured to assist organizational staff in determining whether the patient is progressing towards achieving their goals. During RR1 it was noted goals that were not measurable without time frames to assess if accomplished as follows: Complete final arrangements, Family will have mortuary plan in place, Pain will remain comfortable, have pain managed to a tolerable level during care. During RR2 it was noted goals without measurable time frame to assess if goals achieved as follows: Pain will remain comfortable, have pain managed to a tolerable level, during care, Pt will maintain improved ventilation/oxygenation of tissues within limits of disease process. RR3 had the following goals without time frames to assess if goal achieved: Adjust to changing cardiac/circulatory function and for pt to remain as comfortable as possible, PCG will demonstrate techniques in maintaining skin/mucous membrane integrity, Pt will accept to adjust diet to changing needs to prevent aspiration, Pt/Family/PCG will have mortuary plan in place, Pt will maintain improved ventilation/oxygenation of tissues within limits of disease process. RR4 goals lacked measurable time frames to assess if achieved as follows: Fall prevention, Pain will remain comfortable, have pain managed to a tolerable level, during care. Pt will demonstrate understanding of principles of pain control, including med/tx side effects and use of BTP medication, Pt will maintain improved ventilation/oxygenation of tissues within limits of disease process, Facilitate a spiritual environment to begin the bereavement process, Healing road to peace, To promote spirituality, needs will be met on a day to day basis as communicated to PCG as disease progression continues. During RR5 it was noted the following goal was not measurable to assess if achieved: Pt/Family/PCG will express feelings of grief and loss. During RR6 it was noted the following goals were not measurable to assess if achieved: Adjust to changing cardiac/circulatory function and Prevent discomfort due to increasing edema., Pt will have adequate food and fluids to maintain comfort as exhibited by expressed verbal and non-verbal communication, Pt/Family/PCG will express feelings of grief and loss. During RR7 it was noted the following goals were not measurable to assess if achieved: PCG will prevent or minimize neurological complications.by continuing to meet pts needs, Pt will adjust to changing nutritional need., Pt/Family/PCG will have mortuary plan in place. During RR8 it was noted the following goals were not measurable to assess if achieved: Pt will maintain improved ventilation/oxygenation of tissues within limits of disease process, Family and pt. to express feelings and emotions. Pain will remain comfortable, have pain managed to a tolerable level, PCG will adjust to changing nutritional needs as the pt continues to decline in condition, Patient will achieve regular bowel function without s/s of complications. During RR10 it was noted the following goals were not measurable to assess if achieved: Patient will achieve regular bowel function without s/s of complications, Pain will remain comfortable, have pain managed to a tolerable level, during care. During RRHV1 it was noted the following goals were not measurable to assess if achieved; Reduce discomfort caused by nausea, Patient will achieve regular bowel function without s/s of complications, Patient will verbalize an understanding of how to manage and prevent worsening of loss of ROM to right arm, Pt will adjust to changing nutritional needs, Pain will remain comfortable, have pain managed to a tolerable level, during care, Pt will maintain improved ventilation/oxygenation of tissues within limits of disease process, Pt/ Family/PCG will freely verbalize spiritual needs and concerns. Healing road to peace. During RRHV#4 it was noted the following goals wee not measurable to assess if achieved: Adjust to changing cardiac/circulatory function, Prevent discomfort due to increasing edema to bilateral lower extremities, PCG will demonstrate techniques in maintaining skin/mucous membrane integrity, PCG will prevent or minimize neurological complications of anxiety and agitation, PCG will prevent or minimize neurological complications, Pt will adjust to changing nutritional needs. This was discussed with the organization leadership.

Observed in Record Review. In 5 of 14 patient records reviewed, During RR1 it was noted the POC included assessment of the patient's pain status however it lacked of interventions identified to achieve the goal of pain relieve. During RR4 it was noted since the beginning of September 2025 the following problems were not added to the POC to provide palliative interventions: shortness of breath, abdominal ascites, urinary incontinence, vaginal bleeding, and open area on the patient's gluteal fold. The middle of October the problem of nausea and vomiting was added to the POC however the incidence of nausea and vomiting was documented since the beginning of September. During RR5 it was noted the inital RN assessment documented the patient lost 10 lbs recently with a BMI of 19.1 however the POC lacked interventions related to the nutritional deficit noted. In addition a skin integrity deficit was noted on the POC however there were no interventions documented to accomplish the goals. The RN documented at the IDG meeting the beginning of October 2025 that the patient was more forgetful and confused however the mental/neuro deficit was not added to the POC. During RR6 it was noted the patient was transported to the ED due to a fall. The organization was not notified of the fall and transport until 5 day later however the POC was not updated to reflect the recent fall. The RN at the initial evaluation noted the patient was alert and confused with increased confusion noted at IDG the middle of October 2025 however the POC lacked interventions related to the confusion/mental status. During RR10 it was noted a bowel deficit noted on the POC however there was lack of interventions to accomplish the goal. During RRHV4 it was noted lack of interventions on the POC for a urinary/UTI deficit.This was discussed with the organization leadership.

Observed in Record Review. In 1 of 14 patient records reviewed, During RR2 it was noted an order for wound care to the left forearm lacked the frequency of the dressing change and who would perform the wound care. This was discussed with the organization leadership. Observed in Record Review. In 1 of 14 patient records reviewed, During RR7 it was noted an order for tramadol for pain and acetaminophen for pain. There was lack of direction on levels of pain to indicate which medication to administer. This was discussed with the organization leadership.

Observed in Record Review. In 2 of 14 patient records reviewed, During RR3 and RR9 it was noted an order on the aide assignment forms that included oxygen 4L/min via NC continuous. There was lack of direction to the aide if the 02 can be removed during personal care or to remain in place during care. This was discussed with the organization leadership.

Observed in Record Review. In 1 of 14 patient records reviewed, During RR2 it was noted lack of documentation of the wound care procedure performed by the SN at the end of September. The documentation by the SN stated Wound care provided per physician orders, using sterile technique. This was discussed with the organization leadership.

Observed in Record Review. In 3 of 19 patient records reviewed, the initial bereavement assessment was not conducted. In RR#7, the Medical Social Worker (MSW) documented that the spouse, who was not present at the initial psychosocial visit, as the bereaved, but did not complete a bereavement assessment at the subsequent family meeting. In RR#10, the MSW referred to the POA as a friend, and documented the patient as estranged from her family who were listed on the Advanced Directive, but she did not complete a bereavement assessment on either the POA, or family members listed. In Bereavement Record#1, the MSW did not complete an initial bereavement assessment during the initial psychosocial assessment visit. This was reviewed and validated with the President, Administrator, and Director of Patient Care Services.

Observed in Record Review. In 2 of 4 active patient records reviewed with foley catheters, physician orders were not obtained prior to removal or routine catheter changes. During HV#2, the spouse shared that the patient's catheter was removed by the on-call nurse the night prior due to discomfort. During the record review for HV#2, it was identified that there was no physician order obtained to remove the catheter or not insert a new catheter. Identified in RR#9, the foley catheter placed three days after the admission date, was changed ten times over the course of twelve months with no physician order for routine catheter changes. This was reviewed and validated by the Director of Patient Care Services.

Observed in Patient Home. In 1 of 2 home visits conducted in which reusable equipment was utilized, standard precautions were not used to reduce the risk of infection related to disinfection of equipment. According to organizational policy No. 602 Bag Technique, blood pressure cuffs should be cleaned according to manufacturer instructions. During HV#1, the clinician was observed cleaning her blood pressure cuff with a Sani-cloth wipe; however, manufacturer guidelines indicated cleaning with a “dry cloth” only. During the same visit, the clinician was observed cleaning her vital sign equipment with a Sani-cloth wipe and placing the equipment back into the nurse bag without observing the manufacturer's guidelines of a 2-minute wet time. This was discussed with the President, Administrator, and Director of Patient Care Services following the visit. Observed in Patient Home. In 1 of 3 home visits conducted, standard precautions were not used to reduce the risk of infection in accordance to organizational policy #603, Bloodborne Pathogens Exposure Control Plan: wash hands before and after contact with a patient, and policy #602 Bag Technique: Hands will be decontaminated prior to returning clean equipment to bag. During HV#1, the Registered Nurse was observed wearing the same pair of gloves throughout the visit while performing the following tasks: entering the nurse bag, obtaining vital signs, assessing the patient, documenting on her computer, and cleaning the reusable equipment prior to returning to the bag. This was discussed with the President, Administrator, and Director of Patient Care Services following the visit.

Observed in Record Review. In 2 of 10 patient records reviewed with aide services, complete written patient care instructions were not prepared by the Registered Nurse. Upon review of the record for HV#2, it was noted the patient had a foley catheter inserted due to urinary retention and the update to the aide plan of care was not completed until 17 days after the catheter insertion. Upon review of RR#8, the patient had a foley catheter inserted due to urinary retention and the update to the aide plan of care was not completed until 77 days later. This was reviewed and validated with the President and Director of Patient Care Services.

Observed in Patient Home. In 2 of 3 home visits conducted, the patients’ home medication lists were not accurate. During HV#2 and upon interview with the spouse, the patient was given morphine from the “comfort kit” the prior evening during an on-call visit. The medications in the kit were not included on the medication list in the home and included the following: acetaminophen, bisacodyl, Haldol, hyoscyamine, lorazepam, and morphine. During HV#3 and upon interview with the daughter, a “comfort kit” was provided; however, the medications included in the kit were not listed on the patient’s medication list in the home. This was discussed with the organizational leadership: President, Administrator, and Director of Patient Services who acknowledged the process of not including the medications for symptom management, “comfort kit” until at which time medications are initiated. This was validated by the President.