Every finding on record at Sanctuary Hospice

Observed in Record Review. In 10 of 12 patient records reviewed, The hospice did not ensure the patient's care plan goals were measurable, realistic, and relevant. For example, the surveyor noted on HSHV1, HSHV2, HSHV3, HSRR4, HSRR5, HSRR6, HSRR7, HSRR8, HSRR9, and HSRR10, care plan goals included phrases such as: “Comfort will be maintained during anticipated aspiration pneumonia events related to ongoing overt signs of aspiration on a daily basis with persistent cough. Family is able to cope with changes with a healing road to peace. Optimal bowel elimination and comfort - prevention of constipation and diarrhea, Will minimize episodes of confusion and forgetfulness to the extent possible with reminders and coaching, Pt will have decreased anxiety related to respiratory changes. -Pt will have optimum level of oxygen > 88% within limitations of disease process, -Issues will be resolved to decrease stressors, Patient will feel comfortable expressing her thoughts/feelings -Patient will feel supported by hospice team, resulting in decreased feelings of isolation -Patient will have healthy coping skills, Minimize complications due impaired mobility within limitations of disease process. Comfort will be promoted as skin integrity changes throughout disease and dying process in the nursing home setting. Promote optimal rest status for Pt/Family/PCG. Sleep-Pt/pcg will verbalize/express understanding of medication /treatment orders and side effects until needs met. Resp--Early detection of upper respiratory infection. -Pt will have optimum level of oxygen until needs met-Family will demonstrate healthy coping as changes occur.” These goals do not contain specific information that can be accurately measured, to assist the staff in determining whether the patient is progressing towards achieving goals. These findings were reviewed, discussed and validated by the DPCS and Chief Clinical Officer.

Observed in Record Review. In 3 of 3 patient records reviewed, The hospice nurse did not ensure the aide care plan include details pertinent to patient care. For example, the surveyor noted on HSHV1, HSHV2 and HSHV3, the patient used oxygen as needed or continuously; however, the details for oxygen/use were not included on the aide care plan. Standards require a registered nurse who supervises the aide provide directions for care. These findings were reviewed, discussed, and confirmed with the DPCS, and Chief Clinical Officer.

Observed in Patient Home. In 1 of 1 home visits conducted, The HCO staff did not ensure the list of prescriptions that relate to the patient’s care, treatment, or services was accurate. For example, the surveyor noted on HSHV1 the medication list contained in the patient’s record did not match the patient’s home medication list for the following: Seroquel 25mg, 1 tab, oral, at bedtime for agitation and Haldol 0.5mg, 1 tab, oral, every 4 hours for agitation, were ordered on 06/18/23, but were added to the patient’s home medication list. (The patient’s daughter was apparently knowledgeable about both medication and verbalized never having given the patient the Haldol.) Additionally, Mirtazapine 15mg, ½ table, oral at bedtime was discontinued on 06/06/23 and Pantoprazole 20 mg, 1, oral, daily, was discontinued on 04/25/23. Both medications were still present on the patient’s home medication list. The organization’s medication management policy requires medications reconciliation take plan on admission and at any time there are changes to the patient’s medication list. These findings were reviewed, discussed, and confirmed with the DPCS, and Chief Clinical Officer.

Observed in Patient Home. In 1 of 1 home visits conducted, the list of prescription and nonprescription medications, herbal products, and home remedies that relate to the patient's care, treatment, or services was not accurate. For example, during HV#1 there were inaccuracies in the medication list that did not match the patient’s medications for the following: Dark Cherry Extract 1 capsule daily for gout was on the medication list, but the patient’s daughter said it was given as needed. Vitamin C 500 mg 1 tablet daily supplement was on the medication list, but the daughter said that she was giving 1,000 mg a day. Carboxymethylcellulose Sodium 0.5% Lubricant Eye Drops 1 drop twice daily was listed but the daughter said that the patient is using this only after monthly eye treatments. This was reviewed with the Administrator, Chief Clinical Officer, and Director of Patient Care services.