Every finding on record at Ring of Salvation Hospice Care, Inc

Upon patient record review, 4 of 5 records (Patient #1, #3, #4, #5 ) 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: The medication profile included Miralax powder 17G- drink 1 G solution daily as needed for constipation. There was no evidence of an accurate dose or diluent. Corrected on site. Patient 3: The medication profile included Miralax Powder for sol 17G drink 1G soln as needed for constipation. There is no evidence of an accurate dose or diluent. Corrected on site. Patient 4: The medication profile included, Morphine sulfate 20mg/ml or concentrate 15ml 0.2ml under tongue every 2-4hours as needed. No evidence of accurate dose or reason for medication. Ondansetron 0.4mg 1 tab under tongue every 8 hours as needed. There was no evidence of a reason. Acetaminophen(Tylenol) 650mg suppository rectally Q 4 hours as needed. There was no evidence of a reason. Atropine sulfate sol 1% 5ml 2 drops under tongue every 3 hours as needed. There was no evidence of a reason. Patient 5: The medication profile included Amlodipine Besylate 10/mg 1 tab daily for hypertension. There was no evidence of a route.

Upon patient record review, 5 of 5 records (Patient #1, #2, #3, #4, #5) 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: Patient terminal diagnosis is End stage Heart failure, there is a problem list for the care plan for Cardiac and respiratory. There was no evidence of goals and interventions on the care plan for Cardiac/Respiratory. Corrected on site. An order written 1/25/2022 included O2 2LPM via nc as needed for SOB. There was no evidence of the O2 problems with goals and interventions. Corrected on site. Patient 2: An order written 1/26/2022 included O2 2LPM via nc as needed for SOB. There was no evidence of the O2 problems with goals and interventions. Correction on site. Patient 3: Terminal diagnosis on admission is Alzheimer's. There is no evidence of a care plan for neuro. Corrected on site. Patient 4: Terminal diagnosis on admission Chronic systolic Heart Failure. There was no evidence of a cardio/respiratory care plan. An order written 2/29/2022 included o2 2LPM via nc as needed for SOB. There was no evidence of the O2 problems with goals and interventions. Correction on site. Patient 5: Patient terminal diagnosis End Stage Renal Disease. Care plan states in active problem list Cardiac and respiratory problems. There was no evidence of a cardio/respiratory care plan for fluid overload.

Upon patient record review, 4 of 5 records (Patient #1, #3, #4, #5) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 1: An order written 1/25/2022 included Miralax powder 17G- drink 1 G solution daily as needed for constipation. There was no evidence of an accurate dose or diluent, nor is it on the care plan. Corrected on site. Patient 3: An order written 2/8/2022 included Miralax Powder for sol 17G drink 1G soln as needed for constipations as needed for constipation. There was no evidence of an accurate dose or diluent, nor is it on the care plan. corrected on site. Patient 4: order dated 12/29/2022 included, Morphine sulfate 20mg/ml or concentrate 15ml 0.2ml under tongue every 2-4hours as needed. No evidence of accurate dose or reason for medication. Ondansetron 0.4mg 1 tab under tongue every 8 hours as needed. There was no evidence of a reason. Acetaminophen(Tylenol) 650mg suppository rectally Q 4 hours as needed. There was no evidence of a reason. Atropine sulfate sol 1% 5ml 2 drops under tongue every 3 hours as needed. There was no evidence of a reason. Patient 5: An order dated 1/11/2022 includes Amlodipine Besylate 10/mg 1 tab daily for hypertension. There was no evidence of a route. An order written 1/11/2022 included o2 2LPM via nc as needed for SOB. There was no evidence of o2 information in the care plan.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #1, RN Home visit. RN place nursing bag on carpeted floor. She took all antiseptic wipes, and barrier towel used, placed in a plastic bag she had brought in her nursing bag, and placed this dirty bag back into her nursing bag. Per agency policy 6-013.1 Bag Technique, nursing bags are to be placed on clean dry surfaces able to disinfect, and any paper towel/newspaper have been used as protective barrier for bag placement will be discarded. There was no evidence of following acceptable standards. Patient #2, MSW home visit. MSW washed hands coming into home, did not wash hands on exiting home. Policy 6-006.1 Hand Hygiene includes washing hands after any patient contact, and hand washing competency includes washing hands prior to leaving patient residence. There was no evidence of following acceptable standards. Patient #3, RN Home visit. RN placed nursing bag on carpeted floor. She took all antiseptic wipes, and barrier towel used, placed in a dirty plastic bag she had placed dirty items in from first RN visit, and placed this dirty bag back into her nursing bag. Per agency policy 6-013, nursing bags are to be placed on clean dry surfaces able to disinfect, and any paper towel/newspaper have been used as protective barrier for bag placement will be discarded. There was no evidence of following acceptable standards.

Upon personnel record review, 1 of 12 records (Personnel # 5) did not have evidence that the hospice employees have received orientation on their specific job requirements. Personnel 5: Employee has dual role of SC/BC. There was evidence of orientation to the SC role. There was no evidence of a signed job description or orientation to the role of BC. Corrected on site.