Every finding on record at Salute Hospice, Inc.

Observed in Record Review. In 11 of 11 patient records reviewed, it was noted the organization failed to ensure that the written plan of care was based on measurable patient-centered goals with defined time frames. For example, in the record for RRHV#1, RRHV#2, RRHV#3, RRHV#4, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5, RRNHV#6, RRNHV#7. For example, each goal had conflicting target dates, for instance, a goal was simultaneously set for completion within 14 days and by the end of the episode. To mention some of the example goals as follows: Patient will have 6-8 hours of uninterrupted sleep with the use of medication by next 14 days and by end of episode; develop a safe and comfortable environment for patient, caregiver and hospice staff within the next 14 days; patient's caregiver/family/ will identify and express feelings sadness, guilt, fear freely and effectively by next 14 days. This finding was discussed and validated by the hospice management team.

Observed in Record Review. In 4 of 4 patient records with hospice aide services,, it was noted that the supervising nurse failed to assess hospice aide's ability to demonstrate ability to demonstrate initial and continued satisfactory performance to include 1 of the 5 required supervision elements for hospice aide oversight. For example, in review of record RRHV#1, the documentation in the supervisory note did not show if the aide was creating a successful interpersonal relationship with the patient and family. This finding was discussed and validated by the hospice management team.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization failed to maintain complete and accurate patient's record. For example, in RRHV#3, during medication reconciliation the hospice nurse (LVN) identified that two medications, Protonix 40 mg 1 tablet PO daily and Zofran 4 mg 1 tablet PO every 8 hours as needed for nausea, were missing from the most recently updated medicated list reconciled by the RN 14 days ago. The caregiver confirmed that the patient has been taking both medications consistently for a while. This finding was discussed with the hospice management team.

Observed in Proficiency Testing. In 4 of 11 patient records reviewed, the surveyor found that documentation of initial spiritual, pre-bereavement and post-bereavement assessments was incomplete. In the records of HV#1, HV#2, RR#7, and RR#8 sections of the assessment were left blank. This was reviewed with the CEO/Administrator, Co-owner, DPCS and other staff.

Observed in Record Review. In 11 of 11 patient records reviewed, it was noted that the initial spiritual care comprehensive assessment was not done in person. Rather, patients and families were assessed via telephone. All other disciplines documented that their assessments were conducted face-to-face. This was reviewed with the CEO/Administrator, Co-owner, DPCS and other staff. Observed in Record Review. In 7 of 11 patient records reviewed, it was noted that the initial social work comprehensive assessment was not completed within five days of the election of the hospice benefit. This was found in the records of RR#2, RR#3, RR#4, RR#5, RR#6, RR#7, RR#8. This was reviewed with the CEO/Administrator, Co-owner, DPCS and other staff.

Observed in Patient Home. In 1 of 2 home visits conducted, an effective medication reconciliation was not completed. During HV#2 the RN failed to use the current medication list to compare against the patient’s actual medications in order to accurately reconcile both. This was reviewed with the CEO/Administrator, Co-owner, DPCS and other staff.

Observed in Record Review. In 7 of 11 patient records reviewed, an RN did not visit patients every 15 days to update comprehensive assessments. Rather, an LVN was assigned to complete the assessments in the records of HV#1, HV#3, RR#2, RR#3, RR#4, RR#5, and RR#6. This was reviewed with the CEO/Administrator, Co-owner, DPCS and other staff.

Observed in Record Review. In 11 of 11 patient records reviewed, the surveyor found that patients who were prescribed opioids for pain management did not have bowel regimes initiated. This was reviewed with the CEO/Administrator, Co-owner, DPCS and other staff. Observed in Record Review. In 11 of 11 patient records reviewed, it was found that most goals had targeted completion dates that coincided with the last day of benefit period. This was reviewed with the CEO/Administrator, Co-owner, DPCS and other staff.

Observed in Record Review. In 11 of 11 patient records reviewed, it was noted that orders were incomplete. In every record there were orders for prn visits without documented rationale for these visits. This was reviewed with the CEO/Administrator, Co-owner, DPCS and other staff.

Observed in Record Review. In 9 of 11 patient records reviewed, the interdisciplinary group did not review and revise plans of care as frequently as patients’ conditions required, but no less than every 15 days. The same documentation was repeated by every discipline in most notes. In addition, no nursing updates were available because an RN had not completed comprehensive reassessments prior to the meetings. This was reviewed with the CEO/Administrator, Co-owner, DPCS and other staff.

Observed in Patient Home. In 1 of 2 home visits conducted, the hospice did not provide care as ordered. For example, during HV#2 the surveyor noted that at the start of care eight weeks prior, oxygen was ordered at 2 liters per minute per nasal cannula for shortness of breath, however there was no concentrator or tank in the home on the date this visit was made. According to the patient and family, these items were not delivered by the DME company. This was confirmed by the CEO/Administrator and Co-owner.

Observed in Patient Home. In 2 of 3 home visits conducted, hospice staff failed to perform hand hygiene according to policy 9-009 entitled Hand Hygiene. During HV#1 the RN performed hand hygiene several times. During one of those times, he applied hand sanitizer gel but did not continue to rub his hands until dry. Rather, he waved his hands in the air to accelerate drying, however this did not comply with the policy. And at HV #2 the RN did initiate hand hygiene using CDC guidelines, however he dried his hands and turned the faucet off with a hand towel hanging in the bathroom instead of using a disposable towel. This was reviewed with the CEO/Administrator, Co-owner and DPCS.

Observed in Tracer Activities. The Governing Body did not ensure that the following Conditions of Participation were met as determined through observations, documentation, and staff interviews: - §418.100, §418.54, §418.56. This was reviewed with the CEO/Administrator, Co-owner, DPCS and other staff.

Observed in Patient Home. In 1 of 3 home visits conducted, patient records did not contain information that reflected care, treatment, or services. During HV #2 it was noted that the current medication list was inaccurate. For example, Carvedilol 6.25 mgs 1 tablet po daily for high blood pressure was entered on the first medication list eight weeks ago, but the patient stated that she had not taken this drug for at least three months. A&D ointment and Calmoseptine also entered on the medication list eight weeks ago, but neither had been delivered as of this survey date. This was reviewed with the CEO/Administrator, Co-owner, DPCS and other staff.