Every finding on record at Sacred Heart Hospice, LLC

Observed in Record Review. In 1 of 14 patient records reviewed, for active patients, it was noted by the nurse surveyor that for RRNHV#1 the RN did not visit the hospice patient no less than 15 days to conduct an assessment. The patient had a missed RN visit which resulted in 16 days between RN assessments. Finding was verified by the Director of Clinical Services.

Observed in Record Review. In 14 of 14 patient records reviewed, for all active records, the nurse surveyor noted that the goals were not measurable or individualized. For example, RRHV#2, “Patient will continue to maintain edema or show decreased edema in 2 weeks and while on hospice services.” There were no short-term goals at start of care to address issues of immediate needs such as understanding medication management, symptom management, pain management, or safety. Finding was verified with the Director of Clinical Services, the Regional Director of Operations, and the QAPI Director.

Observed in Record Review. In 5 of 14 patient records reviewed, for active patients it was noted by the nurse surveyor that orders were not clear or complete. For RRHV#1, RRHV#3, and RRNHV#6 the oxygen orders were for Oxygen 2 to 4 liters per minute binasal cannula as needed. Orders did not include parameters for titration or where the liter flow was to start. For RRNHV#1, the oxygen dosage orders were for 3.5 liters oxygen per minute continuously but it did not indicate the route, the instructions were 2-4 liters per minute via nasal canula continuously. Additionally, RRHV#3, the patient had two medications for pain (Acetaminophen and Hydrocodone APAP), but the orders did not indicate when to take which pain medication. RRNHV#1 the patient had four medications ordered for inhalation therapy, only two of the medication orders indicated that they were to be administered via the nebulizer. For RRNHV#4, the patient had two pain medications, Acetaminophen 325mg, 2 tabs every four hours for pain and Oxycodone HCl 5mg tab ordered both for pain with no indication of when to take which one. Findings were discussed with the Director of Clinical Services and the Regional Director of Operations. it was noted by the nurse surveyor that orders were not clear or complete. For RRHV#1, RRHV#3, and RRNHV#6 the oxygen orders were for Oxygen 2 to 4 liters per minute binasal cannula as needed. Orders did not include parameters for titration or where the liter flow was to start. For RRNHV#1, the oxygen dosage orders were for 3.5 liters oxygen per minute continuously but it did not indicate the route, the instructions were 2-4 liters per minute via nasal canula continuously. Additionally, RRHV#3, the patient had two medications for pain (Acetaminophen and Hydrocodone APAP), but the orders did not indicate when to take which pain medication. RRNHV#1 the patient had four medications ordered for inhalation therapy, only two of the medication orders indicated that they were to be administered via the nebulizer. For RRNHV#4, the patient had two pain medications, Acetaminophen 325mg, 2 tabs every four hours for pain and Oxycodone HCl 5mg tab ordered both for pain with no indication of when to take which one. Findings were discussed with the Director of Clinical Services and the Regional Director of Operations.

Observed in Patient Home. In 1 of 2 home visits conducted, for patients with oxygen, it was noted by the surveyor that needed equipment was not available. For RRHV#3, the patient had and oxygen concentrator and was on continuous oxygen but did not have a backup oxygen tank in her group home for emergency use. Finding was verified by the Director of Clinical Services who was present on the home visit. A back up oxygen tank was immediately ordered before we left the home.

Observed in Patient Home. In 1 of 4 home visits conducted, it was noted by the nurse surveyor that the staff failed to follow acceptable practice and agency policy when performing patient care. During RRHV#4, the registered nurse, hand sanitized, then set up his barriers, nursing bag and equipment, then gloved without hand sanitizing. He doffed and donned gloves during the visit another time without hand sanitizing and went in and out of his bag several times with his dirty gloves on to get alcohol wipes to clean his equipment. The patient had an abscess on his rectum that was draining with visible soiled linens and pillows all around the patient’s bedroom. Findings were discussed with the nurse on site and then later with the Clinical Director who had been present on the visit.

Observed in Record Review. In 4 of 13 patient records reviewed, for patients with a hospice aide, it was noted by the nurse surveyor that the hospice aide care plan did not contain all the necessary or current information. The organization’s EMR used a “task list” to assign duties to the hospice to provide care to the patient. For RRHV#1, RRHV#3, and RRNHV#1 the patient had continuous oxygen yet the “task list” did not include any mention of the oxygen or what the aide should do with it during the patient’s shower. For RRNHV#4, the patient had a feeding tube and wounds with no instruction as to what the aide should do. Additionally, there were no instructions as to when the hospice aide should notify the nurse Findings were discussed with the Director of Clinical Services and

Observed in Record Review. In 1 of 13 patient records reviewed, for active patients, it was noted by the nurse surveyor that hospice aide supervisory visits were not documented no less frequently than every fourteen days. For RRHV#2, and RRHV#3, hospice aide supervisory visits have not been documented for the last three months. For RRNHV#1, hospice aide supervisory visits have not been documented since the patient’s admission almost two months ago. Findings were verified with the Director of Clinical Services.

Observed in Patient Home. In 1 of 2 home visits conducted, it was noted by the nurse surveyor that for RRHV#2 six backup E-tanks were stored in the patient’s unventilated closed closet in the hallway between the bedroom and the bathroom. Finding was verified by the Clinical Director present on the visit and the closet door was opened and instruction was provided to the caregivers/family.

Observed in Individual Tracer. In 2 of 3 home visits conducted, and review of patient hospice record. Medication reconciliation had not been completed to identify all medications the patient had been taking. Example: During HOSv#3 the surveyor had noticed a bottle of Tylenol at the patient bedside and the HHA had found a Tylenol in patient bed. During review of the patient record , Tylenol had not been identified or documented within the record.

Observed in Individual Tracer. In 5 of 13 patient records reviewed, Patient goals within the plan of care had not been measurable. Example: During review of HOSrr#4 the goal had documented that the wound will show improvement in next two weeks. During review of HOSrr#5 the goal had documented that the caregivers to give pureed food/fruits and ensure.

Observed in Individual Tracer. In 3 of 13 patient records reviewed, The patient plan of care had not been updated to reflect changes identified during assessments. Example: During review of HOSrr#4 the patient assessment had identified that the patient had been having anxiety and Celexa had been ordered, however the plan of care had not been updated to document anxiety as a problem, nor developed a goal .

Observed in HR File Review. In 1 of 7 Personnel files reviewed a competence assessment had not been completed during orientation or annually per agency policy. Example: The Alternate Medical Director competence had been incomplete and blank when reviewed.

Observed in Individual Tracer. In 3 of 13 patient records reviewed, and confirmed by the quality manager. Medication profiles had not been updated to reflect the medication the patient had been taking. Example: During HOSv#2 visit, the patient had stated she had been taking a probiotic that had not been documented on the medication profile. During review of HOSv#3, the HHA had found a Tylenol in the patient bed and the surveyor had identified a Tylenol bottle at the patient's bedside. During review of the patient record Tylenol had not been documented in the medication profile. During record review of HOSrr#4 a note in June had identified that melatonin had been initiated for the patient, but the medication profile had not been updated.