Every finding on record at Seasons Hospice & Palliative Care of Oregon, LLC

Observed in Record Review. In 1 of 5 patient records reviewed, the organization failed to plan the patient's care. During record review for RRNHV 2, the aide care plan was not individualized as there had been orders for the aide to 'provide post mortem care' every visit. This was validated with the RN Director of Clinical Operations.

Observed in Record Review. In 1 of 4 patient records reviewed with aide services ordered, the Hospice Nurse Surveyor observed the aide did not follow the care plan and the agency did not follow the organizations process to communicate changes reported by the aide. Agency documented process is for the aide to notify the RN if there is changes with the patient and document their contact in the aide note. The RN then will review and make changes to POC if needed and document the conversation in a communication note. On RRNHV #1, it was noted on record review that the aide did not perform bed/chair transfer during the last visit and documented in the aide visit note that the RN was contacted, however, there was not case communication note from the RN in the record this communication had occurred. This was reviewed and discussed with the Hospice Director and Director of Quality.

Observed in Record Review. In 3 of 20 patient records reviewed, the organization failed to assess its patient's condition according to defined time frames. During record review for RRHV#3, RRNHV#2, and RRNHV#5, the Hospice Nurse Surveyor observed the initial social work evaluation was not completed within five days of the election of benefits. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 20 of 20 patient records reviewed, the organization failed to assess and reassess its patient's. During record review for RRNHV#2, the Hospice Nurse Surveyor observed the patient came onto service with a pleurex drain which the wife was managing, which was part of his hospice diagnosis End Stage Liver Disease. The organization failed to document assessment of the pleurex drain site. During record review, the Hospice Nurse Surveyor observed the need for therapy services was not assessed as part of the comprehensive assessment as evidenced by no utilization of the therapy contract for at least the last two years. This was discussed and reviewed with the Hospice team.

Observed in Record Review. In 17 of 17 patient records reviewed, the organization failed to assess and reassess. During record review for all records, the Hospice Nurse Surveyor observed the comprehensive assessments for all disciplines did not include progress towards goals. After conversation with the Director, it was noted that care plans have been a process improvement project. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 20 of 20 patient records reviewed, the organization failed to plan the patient's care. During record review for all records, the Hospice Nurse Surveyor observed there was no documentation in the medical record of time frames for meeting goals. For example in RRHV#1, the patient had a goal for patient/ cg to demonstrate proper wound care with no projected timeframe to meet that goal. In RRHV#2, the patient had a goal for patient will have decreased fear and anxiety regarding death with no projected goal date. And in RRHV#3, the patient had a goal for patient/ cg will verbalize understanding of when to use PRN medications with no projected date to achieve the goal. In RRHV#1, RRHV#3, RRHV#4, RRNHV#2,RRNHV#3, RRNHV#5, and RRNHV#8 the patient's had goals for the music therapist but the person that filled that role had left and there was no current music therapist. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 6 of 20 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions. In RRHV#3, the patient had a resolved goal for preventing falls but had many recent falls and the POC was not updated. She also had issues with sleep disturbance and it was not addressed on her POC. In RRNHV#2, the patient had ascites, confusion and new onset grief from losing his brother the week before survey, but these items were not on the POC. In RRNHV#5, the patient was had high risk for fall and had a recent fall, but falls were not addressed on his POC. In RRNHV#6, the patient had recent edema and SOB but it was not addressed on his POC. In RRNHV#7, the patient was at high risk of fall but it was not addressed on his POC. In RRNHV#10, the patient had a new rash, was at high risk for fall and has multiple aide/ nursing notes stating agitation and being combative but these were not on the POC. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 2 of 20 patient records reviewed, the organization failed to plan the patient's care. During record review for RRHV#4, the Hospice Nurse Surveyor observed the patient had both bilateral legs wrapped with ace wraps at the last nursing visit but there were no orders for that type of leg wrap. The orders received was for tubi-grips. During record review for RRNHV#2, the Hospice Nurse Surveyor observed the patient had a pleurex drain in place that the wife was managing but the management of the drain (i.e. how often to drain, how much can be drained) was not addressed on the POC. This was discussed and reviewed with the Hospice Team.

Observed in Patient Home. In 2 of 4 home visits conducted, the organization failed to implement infection prevention and control activities it had planned. During RRHV#3 and RRHV#4, the Hospice Nurse Surveyor observed the staff did not follow the organizational hand hygiene policy. During RRHV#3, the Chaplain did not perform hand hygiene before having direct contact with the patient. In RRHV#4, the RN placed tubi-grips on the patients legs and immediately placed gloves on to do equipment cleaning without performing hand hygiene. She also removed a thermometer sleeve from the thermometer to throw away and did not do hand hygiene right after. This was discussed and reviewed with the Hospice Team.

Observed in Tracer Activities. The organization failed to plan for scope and level of care. During tracer activities for Contract Review, the Hospice Nurse Surveyor observed the organization could not provide an active contract for the purposes of symptom management or to enable the patient to maintain activities of daily living related to physical therapy, occupational therapy and speech therapy needs. The contract in place was 7 years old with no outreach to the contracted company for contract oversite and no utilization of therapy services over at least the last 2 years. This was reviewed and discussed with the Hospice Team.

Observed in Record Review. In 13 of 13 patient records reviewed, the organization failed to plan the patient's care. During record review for RRHV#1, RRHV#2, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#6, RRNHV#7, RRNHV#8, RRNHV#9, and RRNHV#10, the Hospice Nurse Surveyor observed the aide care plan did not include all items needed. For example in RRHV#1 and RRHV#2, both patients were on oxygen but the aide care plan did not give instructions on what to do with the oxygen during the bath/ shower. During RRHV#2, the Hospice Nurse Surveyor observed the bath time and observed the patient remove her oxygen prior to getting in the shower. In RRNHV#2, the patient had bleeding precautions on the POC but this was not addressed on the aide POC. In RRNHV#7, the patient was a high fall risk but this was not addressed on their aide POC. During record review for RRHV#1, RRHV#2, RRHV#3, RRHV#4, RRNHV#2, RRNHV#3, RRNHV#6, RRNHV#7, RRNHV#8, RRNHV#9 and RRNHV#10, the aide care plan was not individualized. Both care plans stated to provide post mortem care every visit. In RRNHV#1, the nurse developed an aide plan of care but there were no orders for aide visits and no aide visits documented. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 5 of 5 patient records reviewed, the organization failed to provide care, treatment, or services in accordance with the orders. During record review for RRHV#1, RRHV#3, RRNHV#6, and RRNHV#10, the Hospice Nurse Surveyor observed the aide did not follow the care plan. For example RRHV#1 and RRHV#3, patient toileting was already completed. In RRHV#4, the patient refused oral care and nail care. In RRNHV#6, the patient refused bathing and oral care. In RRNHV#10, the patient refused skin care and perineal care. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 5 of 5 patient records reviewed, the organization failed to provide care, treatment, or services in accordance with the orders. During record review for RRHV#1, RRHV#3, RRNHV#6, and RRNHV#10, the Hospice Nurse Surveyor observed the aide did not follow the care plan and failed to include documentation that it was reported to the RN. This was discussed with the Director who stated their policies says they need to document communication in the record and they in fact did education on this a week prior to survey. For example RRHV#1 and RRHV#3, patient toileting was already completed but there was no communication to the RN. In RRHV#4, the patient refused oral care and nail care but there was no documentation of communication to the RN. In RRNHV#6, the patient refused bathing and oral care and there was no documentation of communication to the RN. In RRNHV#10, the patient refused skin care and perineal care and there was no documentation of communication to the RN. This was discussed and reviewed with the Hospice Team.

Observed in Tracer Activities. In 1 of 13 HR files reviewed, the organization failed to document supervision. During HR file review, the Hospice Nurse Surveyor observed HR#3 ( volunteer) did not have documentation of back to bedside supervisory visit as required by organizational policy. This was discussed and reviewed with the Hospice Team.

Observed in Tracer Activities. The organization failed to provide evidence that the governing body and leadership established processes to support patient care, treatment, or services through sustained compliance as evidenced by previous findings for 418.56, 418.76, 418.104, 418.100, 418.54, and 418.72. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 3 of 20 patient records reviewed, the organization failed to maintain a complete and accurate patient record. During record review for RRHV#1, the Hospice Nurse Surveyor observed the RN had checked a box for no oxygen in the home but later documented education was provided for the 2 Liters by NC that was ordered. During record review for RRNHV#1, the Hospice Nurse Surveyor observed the RN documented an aide supervisory visit but the patient did not have an aide visiting. During record review for RRHV#1, RRHV#2, and RRNHV#1, the Hospice Nurse Surveyor observed the use of abbreviations not included on the approved abbreviation list. For example in RRHV#2, the patient had abbreviations such as BP and Beg. Leadership assumed it meant benefit period and beginning but was unsure. In RRHV#2, the patient had notation for liq Ativan but liq was not included on the abbreviation list. And for RRNHV#2, the patient recertification note included abbreviations BP, CBP and Beg but the leadership were unsure what it meant. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 2 of 2 patient records reviewed, the organization failed to give information about the care the patient received to the service provider who will provide care moving forward. During record review for RRDC#1 and RRDC#2, the Hospice Nurse Surveyor observed no discharge summary was sent to the provider as required by organizational policy. This was discussed and reviewed with the Hospice Team.

Observed in Tracer Activities. In 1 of 13 HR files reviewed, the organization failed to obtain a background check on volunteer staff. During record review for HR#3 ( volunteer) the Hospice Nurse Surveyor observed no documentation of a background check at hire per company policy. This was discussed and reviewed with the Hospice Team.

Observed in Tracer Activities. The organization failed to comply with law and regulation. During license verification and review the Hospice Nurse Surveyor observed the Clia certificate was not updated with the person currently responsible. During conversation with the Hospice Team, it was noted the person who is listed on the CLIA certificate left 5 months previous to survey. The paperwork was submitted the day the surveyor discovered it. This was discussed and reviewed with the Hospice Team.