Every finding on record at Ruth's Home Hospice, LLC

Based on review of the policy "The Plan of Care," clinical record reviews, and staff interview, it was determined the hospice failed to develop a plan of care that included all services necessary for the palliation and management of the terminal illness and related conditions and failed to reveal physician order for wound treatments provided for one patient (P) (P3) of 19 sampled patients. --- Findings include: Review of the policy titled, The Plan of Care," Policy No. 9-017, revised May 2023 reveals the following: Policy The care provided to the patient must be in accordance with the plan of care. Procedure 10. Any change in the patients condition must result in a change in the plan of care prior to implementation of the new service. 12. The written plan of care will contain, but will not be limited to the following: T. Physician-directed instruction to patient and family/caregiver Review of Wound Flow Sheet reveals wounds on right leg and right thumb with wound assessments dated 5/14/2024, 5/21/2024, 5/28/2024, 6/4/2024, 6/11/2024 and 6/18/2024. Review of the Skilled Nursing Visit note," dated 5/7/2024 reveals skin tear to dorsal right hand. Nursing documentation reveals patient applied Betadine (a brand name antiseptic solution) to the wound. Review of the Skilled Nursing Visit note dated 5/14/2024 reveals skin tear to right posterior outer hand/ thumb. Nursing documentation reveals wound cleansing/ dressing change was provided per care plan. The note further reveals that wound to the patients right shin had lost a large portion of scab and had triple antibiotic on it. Nurse instructed patient to paint with iodine (an antiseptic). Review of the Skilled Nursing Visit note dated 5/21/2024 reveals wound to right posterior outer hand/ thumb was cleansed with normal saline (a mixture of sodium chloride and water used to clean wounds) and painted with iodine. The nursing documentation further states the deepest part of the wound to the right lower extremity continues to form a scab with epithelization (final stage of wound healing and is pink/white in color) noted. Further review of the clinical record failed to reveal physician orders for wound treatment. On 7/16/2024 at approximately 2:00 pm, an interview with the Director of Clinical Services (DCS) confirmed the clinical record lacked physician orders for wound care. The DCS further stated the agency did not have a wound care policy. On 7/17/2024 at approximately 10:00 am, a ";Wound Care Policy for Guiding Light Hospice" policy was provided, but the DCS stated the governing body had not yet approved it.