Every finding on record at Royz, Inc.

Observed in Record Review. In 14 of 14 patient records reviewed, the Hospice Surveyor had been unable to validate that a Volunteer had been offered to the patient/family. In all records reviewed, the documentation that patient/family need for volunteer services had been evaluated and offered. In discussion with the HCO Leadership, the process for documentation had not been standardized so the information was not readily retrievable.

Observed in Record Review. In 2 of 14 patient records reviewed, the Hospice Surveyor had been unable to validate the care was provided as ordered as the documentation had not been clear. For example, RRNHV #12 and RR #13, the Hospice Aide (HA) had orders to provide either a shower or a bed bath; however, the HA had documented that she had provided both a bed bath and a shower. This was validated with the VP of Clinical Operations.

Observed in Record Review. In 14 of 14 patient records reviewed, the Hospice Surveyor noted patient plan of care (POC) goals had been generic, not specific to the patient, nor measurable. Examples include: for Pain: Patient/Caregiver verbalize pain is controlled within their desired comfort level at each visit (identify acceptable comfort), For constipation: Pt will have BM at least every 3 days (even in a record that stated the patient normally had a BM every 5 days). For Falls: Patient practices safe mobility and transfer techniques and Pt will experience a decrease # of falls ( in a record where a patient had no recorded falls). This was observed in all patient records. This was validated with the VP of Clinical Operations.

Observed in Record Review. In 8 of 14 patient records reviewed, the Hospice Surveyor noted the patient plan of care (POC) had not contained all treatments related to the patient specific care needs. For example, RRHV #1, the patient had alternate issues with diahhrea and constipation, yet this had not been included on the POC. RRNHV #5, the patient had been having problems with nausea, but the poc had been missing nausea and GI. RRNHV #9, the patient had issues with urinary tract infections and constipation; however, POC had been missing genitourinary and gastrointestinal interventions. In RRNHV #10, the POC had been missing pressure injury and uti prevention; RRNHV #11, GU/UTI prevention had been missing from the POC. also on this patient, Trach care had been on the poc for 4 weeks, but the patient had not had a trach. In RRNHV #12, RRNHV #13, and RRNHV #14, the patients had been bed bound but the POC had not addressed Pressure Injury Prevention and skin care. This was validated with the VP of Clinical Operations. Observed in Record Review. In 8 of 14 patient records reviewed, the Hospice Surveyor noted medication or care orders that had been incomplete. For example, RRHV #4, the patient had Benadryl ordered as needed for itching, however, there had not been a specific site of application noted. In RRNHV #6, the patient had both Morphine Sulfate by mouth solution 4 hrs sl as needed for pain and Norco 5-325 1 tab every 6 hours as needed for pain, without clear indications for as needed use. RRNHV #8 the patient had 2 constipation medications without clear indications for use. RRNHV #10 the patient had Diclofenac cream and Namyc powder ordered to apply to affected area, and Morphine and Ativan both ordered as needed for shortness of breath. In RRNHV #11, the patient had Morphine, oxycodone, Norco and Acetaminophen ordered as needed for pain. RRNHV #12 the patient had both a Lidocaine patch and diclofenac cream ordered to apply to the affected area, and Norco and Morphine both ordered as needed for pain. RRNHV #13 the wound care orders had not contained who was to complete the care and RRNHV #14 diclofenac cream ordered to apply to the affected area. This was validated with the VP of Clinical Operations.

Observed in Patient Home. In 3 of 4 home visits conducted, the Hospice Surveyor observed the clinician providing care had not disinfected equipment utilized during patient care with the HCO specified cleansing agent of alcohol wipes. In RRHV #1 and RRHV #2, the clinician had used Clorox wipes to clean the equipment, and RRHV #3, the clinician disinfected the equipment with wipes from an unlabeled baggie. This was validated with the DPCS present during the visits.

Observed in Tracer Activities. The Hospice Surveyor had been unable to validate active recruitment activities as there had been no supporting documentation. This was validated with the Volunteer Coordinator and Leadership present during a review of the Volunteer program.

Observed in Patient Home. In 1 of 4 home visits conducted, the Hospice Surveyor noted the medication list in the electronic medical record (EMR) had not contained all the medications the patient was being administered, or did not reflect the accurate dosing. In RRHV #1 the patient had Catapres that the patient had been taking two times per day for a long time; however the patient EMR profile reflected one time per day dosing. The same patient also had Dulcolax tablets that she had been taking as needed for constipation. This was validated with the DPCS present during the visit.

Observed in Record Review. In 1 of 4 patient records reviewed, the organization failed to ensure that the plan of care included all drugs and treatments necessary to meet the needs of the patient. For example: upon review of the record for HV#1, it was noted in the SN documentation that the patient caregiver was applying triple antibiotic ointment to the patient's ear and covering with a bandage. There were no orders noted in the record for this treatment nor was it included in the plan of care. This observation was reviewed with the Administrator and the DPCS.

Observed in Patient Home. In 1 of 2 home visits conducted, the organization failed to implement the infection prevention and control activities it had planned. For example: during the home observation for HV#2 the RN was noted to not follow the organization's policy for bag technique. Upon arrival to the patient home the RN was noted to set the bag down on the floor initially and then moved the bag to a chair that was stacked with clothing and other items without using a barrier as called for in the policy. During the visit the RN was observed removing equipment form the bag, placing the equipment on a dirty surface of the chair stacked with clothing and items, and returning the equipment after use to the bag without sanitizing. The organization policy directs the equipment be sanitized with alcohol wipes prior to returning to the bag. This observation was reviewed with the Administrator and the DPCS.

Observed in Patient Home. In 2 of 4 patient records reviewed, the organization failed to ensure that the RN responsible for the Aide written patient care instructions was complete. For example: During the home observation for HV#1 the patient was wearing O2 per nasal cannula during the visit and respirations appeared labored at times. Prior to the patient's bath the aide removed the O2 stating the patient preferred to bathe without his O2, however there were no written instructions on the Aide Assignment on how to handle the patient's O2 during the visit. In HV#2 the patient was receiving Aide services and had a dressing to the buttocks, yet there were no written instruction for the Aide on how to handle the dressing during the patient bath. These observations were reviewed with the Administrator and the DPCS.

Observed in Patient Home. In 1 of 2 home visits conducted, the organization failed to ensure that the patient record contained information that accurately reflected the patient's care treatment and services as related to the medication profile. For example: during the home observation for HV#2, there were multiple discrepancies noted when the RN conducted the in home medication reconciliation. There was a second type eye drops with the patient meds that the caregiver stated the patient had been taking long term, yet was not listed on the medication profile. Further, the medication profile showed the patient taking Rivaroxaban, Robitussin DM, Acetaminophen suppositories, and Bisac-evac suppository. The caregiver stated that the patient had not taken the Rivaroxaban, and Robitussin for quite some time, and that she did not recall having the suppositories. This observation was reviewed with the Administrator and the DPCS.