Every finding on record at Seasons Hospice & Palliative Care of Texas-San Antonio, LLC

Observed in Record Review. On 1 of 10 active patient records reviewed, the organization did not provide education and training to the patient based off of services identified on the Plan of care. On RRHV #1, patient was started on amoxicillin therapy and there was no documentation in the record to reflect that patient or caregivers had been educated on the new medication therapy. This finding was reviewed with agency leadership.

Observed in Record Review. In 10 of 10 active patient records reviewed, the Hospice surveyor noted the goals in patient records were not measurable and specific to the care needs of the patient. On records reviewed goals were not measurable and specific to the patient with timeframes and measures. Examples include: nursing plan of care will be established that meets needs of patient, oxygen levels will be monitored as appropriate, spiritual support as appropriate, pain will be controlled”, caregiver will verbalize mouth care with no timeframe to achieve goal. This finding was reviewed with agency leaders.

Observed in Record Review. In 3 of 10 active patient records reviewed, the organization did not individualize the plan of care to reflect the goals and outcomes anticipated. On RRHV #1, patient had started an antibiotic, and the plan of care had not been updated with goals or outcomes for the change in the care plan. On RRHV #3, patient had lost Social Security coverage and the MSW was working with the patient to resolve the matter including helping arrange appointments and calls to social security, but these needs were not reflected on the plan of care. On RRNHV #5, teaching goals from start of care 6 months ago had not been updated to reflect the current needs of patient. This finding was reviewed with agency leadership.

Observed in Record Review. In 6 of 10 active patient records reviewed, the medication record was not accurate and reflect duplication of therapy. Agency Medication Profile Policy states the organization will address duplicate therapy. On RRHV #1 it was noted that patient had multiple duplicate PRN therapy for constipation and pain management with no clear indication of when to use each duplicate therapy. For example, PRN constipation orders for Polyethylene Glycol, Bisacodyl and Lactulose with indication of constipation and no indication how to handle the duplication. In addition, PRN pain orders of Hydrocodone/Tylenol, Tylenol supp, and Morphine with indication of pain and no clear instruction how to handle the duplication in therapy. On RRHV #2 it was noted that patient had duplicate PRN medication orders for Morphine and acetaminophen and no indication on how to handle the duplicate therapy. On RRHV # 3, it was noted that patient had duplicate therapy of Benadryl and hydroxyzine PRN for Itching and duplicate pain therapy of Tylenol and Morphine both with no indication how to handle the duplicate therapy. On RRNHV #1 it was note patient had duplicate therapy for cough/congestion of Guaifenesin and Ipratropium neb with no indication how to handle the duplicate therapy. On RRNHV #4 and RRNHV #6 it was noted patient had duplicate pain therapy of Tylenol and Morphine with no indication how to handle the duplicate therapy. This finding was reviewed with agency leaders. Observed in Record Review. In 1 of 10 active patient records reviewed, the organization did not provide care, treatment or services according to the patient's individual plan of care. In RRHV #1, the surveyor noted that during the home visit, the nurse told the caregiver and patient to administer Lactulose 3 times per day when the plan of care stated Lactulose 2 times per day PRN constipation. On discussion with the nurse after the visit, the nurse stated that she will call the md in the car and get an order for the medication change versus her normal process of doing it in the home. This was reviewed and confirmed with Quality Consultant who was present for the visit.

Observed in Tracer Activities. During the review of the Volunteer Program, the Hospice nurse surveyor identified the that organization did not provide at least 5% of the total patient care hours for the last year. The agency lost all but one of their volunteers and their volunteer coordinator and a new coordinator was hired 6 months ago and working to recruit and train new volunteers. The organization has an active performance improvement plan and tracking the percent monthly and is currently at 2% of total hours. This was reviewed and validated with the agency leaders.

Observed in Record Review. In 1 of 10 active patient records reviewed, the medication profile was inaccurate. Agency Medication Profile policy states that the profile will be updated reflecting new changes, modifications and/or discontinued medications and this will be used to teach patient/caregivers during visits. During RRHV#1, it was noted the medication list in the facility was not accurate to reflect changes in medications. The list in the facility was updated 2 months ago and the patient has since had two medication changes (Amoxicillin and change in Lactulose dosing) that were not reflected in the medication list at the board and care facility. This was discussed with the agency leadership.

Observed in Individual Tracer. In 2 of 3 home visits conducted, the medication list in the patient's residence did not match the organization's list in the record. For example in HV1 medication list was not updated. The patient had been on Tamsulosin for years, Metoprolol changed from 100mg to 25mg prior to 9/4/21. These were not reflected on the agency's list. A second example in HV2 the medication list had not been updated. The patient had been started on Ascorbic Acid and Zinc 8/21. The patient was still on Aspirin and Atorvastatin even those these had been discontinued a while ago per the nurse.

Observed in Individual Tracer. In 13 of 13 patient records reviewed, the plans of care goals did not have time frames for achieving goals. This was verified by the Regional Clinical Director. In addition, HV1 and RR8 did not have a measurable goal for achieving pain control. Both were documented as acceptable level of pain without further clarification. This also was verified by the Regional Clinical Director.

Observed in Individual Tracer. In 3 of 13 patient records reviewed, the agency had not care planned all interventions to manage symptoms. During review of RR5 RR7, and RR8 of these three patients on oxygen there was no oxygen care planned or ordered. In addition, in RR7 the patient had a feeding tube, however, there was no care planning/orders for care, including site care and nutrition. This was verified by the Regional Clinical Director.

Observed in Individual Tracer. In 2 of 3 home visits conducted, the surveyor observed the staff not following accepted standards of practice and the agency's policy Hand Hygiene 4003. The policy stated that staff may not use bar soap. The nurse at HV1 used bar soap at the patient's kitchen sink to wash her hands. The nurse then went into the nursing bag to remove equipment. During HV3 the aide did not change gloves between the bath and applying lotion. The agency's policy Personal Protective Equipment 4005a stated NOTE: gloves must be changed between tasks and procedures on the same patient, after contact with material that may contain high concentration of micro-organism and after contact with infective material that may have high concentrations of bacteria or virus.

Observed in Individual Tracer. In 1 of 3 home visits conducted, the surveyor noted that the aide care plan had not been updated to reflect the current care. During HV3 the surveyor interviewed the aide and caregiver regarding assigned tasks. Both concurred that the aide had not been doing hair care and shaving, and often did not do oral care This was verified by the Regional Clinical Director.

Observed in Individual Tracer. In 3 of 13 patient records reviewed, the hospice discharge summary did not include the following: - A summary of the patient’s stay, including treatments, symptoms, and pain management - The patient’s current plan of care - The patient’s latest physician orders - Any other documentation that will assist in postdischarge continuity of care or that is requested by the attending physician or receiving physician. During record review of RR 10, RR 11, and RR 13 the agency did not have a discharge summary. This was verified by the Regional Clinical Director.

Observed in Leadership Session. The organization did not update their CLIA certificate with the current personnel responsible. The certificate reflected the medical director who left the organization 3/1/2020.