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

Observed in Regulatory Review. In 19 of 20 patient records reviewed, it was noted that the written plan of care was not individualized for each patient. For example, in 19 of 20 records the goals did not include time frames. For example, the goals were vague and not measureable such as: RRHV#1 Patient/caregiver experience positive positive interactions and build positive memories Insurance benefits clarified and secured and Patient exhibits reduction/relief of any cardiopulmonary symptoms.. RRHV#6 Provided wound care per orders. RRNHV#3 Pain is currently managed at a level acceptable to the patient. and Patient/caregiver experiences effective communication. RRNHV#12 Patient exhibits reduction /relief of any cardiopulmonary symptoms RRNHV#14 Patient/caregiver will verbalize/demonstrate understanding of applicable safety measures. Also, the frequency orders on the POCs were not individualized based on the patient's needs. For example, in records RRNHV#3, #6 and #8 the frequency order in the POC for the SN included 8 as needed visits. In record RRNHV#5 frequency order for the SN included 13 as needed visits. In record RRHV#1, the frequency order for the SN included 7 as needed visits. In record RRHV#2 the frequency order for the SN included 6 as needed visits. In record RRHV#6 the frequency order for the SN included 11 as needed visits. In record RRNHV#13 the frequency order in the POC for the SN included 9 as needed visits. In record RRHV#5 the frequency order in the POC for the SN included 26 as needed visits and the MSW included 13 as needed visits.This was discussed and confirmed with the DPCS and Executive Director present.

Observed in Record Review. In 2 of 3 patient records reviewed, for patient's who discharged from hospice. it was noted that there was no order on the plan of care for the discharge of the patients. For example, in record RRDC#1 the patient transferred to another hospice and in RRDC#2 the patient was discharged for extended prognosis, in both cases there was no order for discharge. This was confirmed with the DPCS present.

Observed in Record Review. In 1 of 20 patient records reviewed, it was noted that plan of care was incomplete. For example, in record RRHV#4 the oxygen order did not include the route the oxygen was to be used, for example nasal cannula or mask. This was confirmed with the DPCS present.

Observed in Record Review. In 9 of 20 patient records reviewed, it was noted that care was not provided according to the plan of care. For example, in RRHV#1, RRHV#2 and RRHV#6 there was no documentation for 1 HHA visit being completed in the past month and no missed visit notes. In record RRNHV#5 there was no documentation for 1 HHA visit in the past two months and no missed visit note. In record RRNHV#6 there was no documentation for 1 nurse visit in the past month and no missed visit note. In record RRNHV#7 there was no documentation for 2 aide visits in the past 5 weeks and no missed visit notes. In record RRNHV#12 there was no documentation for 4 HHA visits in the past month and no missed visit notes. In record RRNHV#3 there was no documentation for 2 music therapy visits in the past month and no missed visit notes. In RRHV#5 the POC order stated the patient was to use oxygen 4 liters per nasal cannula continuously due to the patient's cardiac and respiratory diagnosis'. However, during the home visit it was observed that the aide assisted the patient to remove the nasal cannula, place it on the patient's chair, walk with the patient greater than 10 feet to the bathroom, complete a shower, and walk back to the chair. This was confirmed with the DPCS present.

Observed in Record Review. In 6 of 14 patient records reviewed, that included aide services it was noted that the staff were not supervised effectively, For example, in records RRHV#1, RRHV#2, RRHV#6, RRNHV#5, RRNHV#7 and RRNHV#12 the supervisory note was completed however the supervision was not effective. There was no indication that the nurse completing the supervision was aware that aide visits that were ordered in the POC had not been documented during the 14 days that were assessed. The supervisory area Does the aide follow the Plan of Care? was marked yes in each record. This was discussed and confirmed with the DPCS and Executive Director.

Observed in Document Review. Upon review of the data provided by the organization representing volunteer productivity for those volunteers providing both administrative and direct patient care services, the hospice pharmacy surveyor noted that the 12 month productivity reported from October of 2023 to September of 2024 to be at 2% as a percentage of the paid clinical hours of hospice employees and contract staff. In addition. in no month in the last twelve months did the organization achieve the 5% minimum requirement with 4% being the highest level achieved which was in November of 2023. The organization was documenting the dollar amounts saved by these percentages and recruitment and retention efforts. This issue was validated with the national director of volunteer services and local volunteer management at the time of the survey.

Observed in Patient Home. In 1 of 2 home visits conducted, that included oxygen in the home, it was noted that the safe and effective use of medical equipment was not observed. For example, during visit RRHV#5 there were 4 oxygen E tanks lying on the floor and 2 E tanks free standing. That day's nurse visit did not include education related to the oxygen tanks proper storage. This was confirmed with the DPCS present.

Observed in HR File Review. In 3 of 13 HR files reviewed, the hospice pharmacy surveyor noted that criminal background checks were not found in these employees' HR files as required by organizational policy and for hospices electing the deemed status option. The files included a chaplain, a music therapist, and a volunteer. All of these individuals were hired in 2022 under a previous owner and the current organization leadership was not aware at the time of the survey that this required information had not transferred to the new owner with the employee files of these individuals. This omission was validated with the HR manager, the volunteer coordinator, and hospice leadership at the time of the survey.

Observed in Record Review. the hospice nurse surveyor noted that in HV#5 the patient assessment did not include an assessment or reassessment of the patient’s facial tumor that had grown over the course of his hospice stay. There were no initial measurements nor were there any recent measurements or documentation about its progress in the recent nursing notes or IDG notes. The physician face to face also did not include any assessment. Findings were verified by the Director of Patient Experience.

Observed in Record Review. In 1 of 20 patient records reviewed, The hospice nurse surveyor noted (DRR#4) that there was no evidence that the caregivers received education about how to perform wound care, as ordered and indicated in the plan of care. The skilled nurse was not visiting daily and therefore the caregiver would have to provide the wound care. This was confirmed with the Director of Clinical Operations.

Observed in Record Review. In 18 of 20 patient records reviewed, The hospice nurse surveyor noted (ARR#1) that the initial assessment indicated that the patient had an active urinary tract infection and was prescribed Cipro and that the patient had chronic diarrhea; however there were no goals on the plan of care to address these problems. Also, the surveyor noted that the goals that were listed did not include outcome measures or time frames for achieving outcomes. In (ARR#2), the assessment indicated that the patient was high risk for falls, and that there was a potential risk for open flames with oxygen use; however there were no goals or interventions to address the safety risks on the plan of care. In (ARR#3), the surveyor noted that the assessment and visit notes indicated that the patient was experiencing pain, agitation and had dysphagia and there were no goals, outcome expectations, interventions or time frames for those issues,in the plan of care. Also, the patient had an order for wound care; however there were no goals or interventions to address management of the wound. In (ARR#4) there were no outcome goals or expectations for managing the patient's dyspnea and recurrent respiratory infection and peripheral edema. The surveyor noted in (ARR#5), (ARR#6) and (ARR#7) that there were no goals or outcome expectations and time frames that addressed the actual symptoms the patients were experiencing. For example, in (ARR#5) the goal statement was pain will be managed at a level acceptable to the patient and did not specify what the level was or when it would be achieved.; and safe wound care without any expected outcomes for wound care. The surveyor noted in 13 of 15 records reviewed, that that the interdisciplinary care plans did not include any time frames or expected outcomes for symptom management. This was confirmed with the clinical director. Observed in Record Review. It was noted by the nurse surveyor that the goals for HV#1, HV#2, HV#3, HV#4, and HV#5 were not measurable. Additionally, 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, mobility, or safety, most did not have time frames for completion. Findings were verified by the Clinical Director.

Observed in Record Review. It was noted that for HV#1 the order for foley catheter changes was for a #14 catheter, monthly. There was no documentation in the patient's record that the foley had been changed monthly. For HV#4 and HV#5 the order for oxygen did not include the route of administration. Additionally for HV#5 there were no orders for care of the bleeding tumor on the patient's face. Findings were verified by the Clinical Director. Observed in Record Review. In 18 of 20 patient records reviewed, The hospice nurse surveyor noted, (ARR# 2) that the oxygen order was unclear and did not indicate the frequency for use, the order stated daily and did not indicate PRN or continuous. Also, in (ARR#3), the wound care orders were unclear wound cleanser, pat dry, apply Zinc and a dry dressing and didn't indicate where the wound was, who was doing the wound care or how often to provide the wound care. In (ARR#5), the care plan indicated safe wound care; however there were no wound care orders and the patient assessment indicated that the patient had three wounds. In (ARR#6) the oxygen orders were incomplete and did not include a route/method of delivery until it was updated on the next IDG (8 days), In (ARR#7), the surveyor noted that there were no oxygen orders and the assessment and CTI indicated that the patient was on Oxygen 4L continuously. In (ARR#8), the surveyor noted that the patient was receiving back to back medications through a saline lock; however there were no orders for saline flushes before, between and after medications, as per policy Intermittent Infusion Device flushing and locking. Also, the surveyor noted that the patient was receiving oxygen 2 LPM via nasal cannula; however there were no oxygen orders in either the hospice or inpatient unit record. In (DRR#3), the surveyor noted that the patient was transferred to the inpatient unit; however neither the orders or the plan of care were updated to include orders for wound care, a Foley Catheter (inserted by the hospice nurse) or oxygen noted to be delivered at 3LPM in the visit notes. In (DRR#4), the oxygen order was incomplete and did not include a route of delivery, and there were no wound care orders, although the care plan stated instruct wound care. Also, the Foley catheter order was incomplete and did not include a Foley size or balloon size or frequency for changing, and the Foley irrigation order did not specify an amount of saline to use for irrigation. In (DRR#6), the surveyor noted that the flush Foley order did not indicate a volume for flushing. Also, the oxygen order did not indicate a route. In (DRR#7), the surveyor noted that the wound care orders did not specify the site of the wound to be treated (the patient had three) or the frequency or who was to perform the wound care. This was confirmed with the clinical director.

Observed in Patient Home. HV#4 it was noted by the nurse surveyor that the hospice aide did not provide care per the hospice aide care plan. The aide stated she shampooed the patient’s hair twice a month and applied lotion to the patient’s body along with skin barrier to her body after each bath. None of these were included in the hospice aide careplan.

Observed in Patient Home. In 4 of 5 home visits conducted, it was observed by the Nurse Surveyor that the organization did not implement the infection prevention and control activities it had planned. HV#1 with the registered nurse. The nurse put his nursing bag in the floor. He then set up his barrier and removed his equipment, going in and out of his bag several times without performing hand hygiene. HV#2 with the skilled nurse. She set up her barrier and equipment then put gloves on without hand sanitizing. She then took the patient’s pulse oximetry reading and temperature then documented on her tablet with her gloves on, went back to the patient to take her blood pressure. The skilled nurse documented again on her table and proceeded to complete the patient’s head to toe assessment to include inspecting the patient’s sacrum all with the same gloves on. She then removed her gloves; did not hand sanitize and then cleaned her equipment. Findings were verified by the Executive Director who was present during HV#1 and HV#2. During HV#4 with the hospice aide, it was noted by the nurse surveyor that the hospice aide hand sanitized and donned gloves. She then set up the patient’s bath supplies, pans of water, clean clothes, and linens. She then began to remove the patient’s clothes and bath the patient with the same gloves on, not hand sanitizing or changing gloves per policy before beginning hands on patient care. During HV#5 with the social worker, it was noted by the nurse surveyor that the patient had a large tumor on the side of his face that had bled profusely after a fall earlier in the day and which was still oozing. The social worker climbed on the bed with the patient, placed her tablet on the bed (sheets had visible blood on them) and held the patient’s hand with her bare hand (his fingernails had blood around them). After talking to the patient for a while, she got up, picked up her tablet, put it on a chair in the living room and washed her hands in the patient’s sink. Findings for HV#5 were verified by the Director of Patient Experience who was present on the visit.

Observed in Document Review. for HV#4 the Aide Care Plan did not instruct when that the aide should notify the RN. Additionally, the patient was on oxygen and the care plan did not address whether or not the oxygen could be removed for the patient’s bed bath if she had it on at the time of her bath. Findings were verified by the Clinical Director.

Observed in Record Review. In 5 of 20 patient records reviewed, The hospice nurse surveyor noted (ARR#8) that there was no evidence that the nurses had been documenting that they were flushing the saline lock when medications were administered. In discussion with the inpatient unit director, the surveyor confirmed that practice is that the nurses flush the line before administering a medication, between two medications and after the final medication is given. The surveyor noted that the medication administration record did not include documentation of the flushes that were given.

Observed in Record Review. In 2 of 7 discharge records, The hospice nurse surveyor noted ( DRR#1) that the patient record indicated that the patient had revoked their hospice benefit to seek treatment at another provider; however there was no evidence in the record that a transfer summary of the care and treatment had been made available to the new provider. Also, (DRR#6), the surveyor noted that the patient transferred to the local Veteran's Administration hospital; however there was no indication that a transfer summary had been provided to the receiving organization. This was confirmed with the clinical director.