Every finding on record at Silver State Hospice Care

Upon patient record review, 5 of 14 (Patient #2, #3, #4, #6, #7) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #2: The medication profile included oxygen 2-5lpm PRN without evidence of a route. COS Patient #3: The medication profile included hydrocortisone topical cream without evidence of a specific area for application. COS Patient #4: The medication profile included oxygen 2lpm PRN without evidence of a route. COS Patient #6: The medication profile included triple antibiotic ointment without evidence of a specific area for application. COS Patient #7: The medication profile included ammonium lactate lotion, Risamine ointment, and triamcinolone acetonide-dimethicone cream without evidence of specific areas for application. COS

Upon patient record review, 7 of 14 (Patient #1, #2, #3, #5, #6, #7, #10) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #1: The patient admitted 01/12/2023 however, the bereavement assessment was completed 06/26/2023. Patient #2: There was no evidence of a bereavement assessment completed. Patient #3: There was no evidence of a bereavement assessment completed. Patient #5: The patient admitted 06/24/2022 however, the bereavement assessment was completed 07/11/2023. Patient #6: There was no evidence of a bereavement assessment completed. Patient #7: There was no evidence of a bereavement assessment completed. Patient #10: There was no evidence of a bereavement assessment completed.

Upon patient record review, 1 of 14 (Patient #8) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #8: The social worker noted on admission that patient stated "I would like to meet with you sometime in the next month to talk about advance directives and getting a phone" however, the plan of care did not contain evidence of problems/interventions/goals to assist with these needs. COS

Upon patient record review, 5 of 14 (Patient #2, #3, #4, #6, #7) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #2: The order for oxygen 2-5lpm PRN did not contain evidence of a route. COS Patient #3: The order for hydrocortisone topical cream did not contain evidence of a specific area for application. COS Patient #4: The order for oxygen 2lpm PRN did not contain evidence of a route. COS Patient #6: The order for triple antibiotic ointment did not contain evidence of a specific area for application. COS Patient #7: The orders for ammonium lactate lotion, Risamine ointment, and triamcinolone acetonide-dimethicone cream did not contain evidence of specific areas for application. COS

Upon patient record review, 4 of 14 (Patient #3, #7, #9, #10) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs Patient #3: The nurse noted patient has a walker and hospital bed and the medication profile indicates patient using oxygen and albuterol inhalation however, there was no evidence of hospital bed, walker, nebulizer, and oxygen on the plan of care. COS Patient #7: The medication profile indicated patient using albuterol inhalation however, there was no evidence of nebulizer on the plan of care. COS Patient #9: The nurse noted patient using hospital bed however, there was no evidence of a hospital bed on the plan of care. COS Patient #10: The medication profile indicated patient using albuterol inhalation however, there was no evidence of nebulizer on the plan of care. COS

Upon client record review, 2 of 14 (Patient #5, #7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #5: The spiritual care visit frequency ordered 04/02/2023 1M2 and 05/20 1M2 and there was a coordination note 05/01/2023 "patient requests for SC for the month of May" however, there was no evidence of a visit for the month of May. COS Patient #7: The social work and spiritual care visit frequency ordered 03/09 1M3 and 05/18 was 1M2 each however, there was no evidence of a visit for the month of May for either discipline. COS

Upon observation, there was no evidence the hospice documents what QAPI projects are being conducted, the reasons for conducting these projects, and the measurable progress achieved on these projects. The agency QAPI activities included falls, safety, and infection tracking however, there was no evidence of measurable progress achieved on these projects since 2020.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Upon home visits, observed STNA remove gloves after completing care and discarding trash from Patient visit #1 and obtain clean linens for Patient visit #2 prior to sanitizing hands.

Upon observation, there was no evidence a copy is provided of the hospice written policies and procedures on the management and disposal of controlled drugs to the patient or patient representative and family. After reviewing admission packet and speaking with agency it was confirmed patients were not receiving a copy of the agency policy. COS

Upon client record review, 10 of 14 (Patient #1, #2, #3, #4, #5, #6, #7, #8, #9, #10) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed. Patients #1-#10: There was no evidence the agency provided and discussed the written policies and procedures for managing controlled drugs.

Upon inpatient contract review, 1 of 3 (Sage Creek) did not have evidence that the inpatient provider has established patient care policies consistent with those of the hospice and agrees to abide by the palliative care protocols and plan of care established by the hospice for its patients. COS

Upon inpatient contract review, 1 of 3 (Sage Creek) did not have evidence that the hospice retains a description of the training and the names of those giving the training are documented. COS

Upon personnel record review, 3 of 14 (Personnel #12, 13, 14) did not have evidence the hospice obtained a criminal background check on all contracted individuals who have direct patient care and access to patient records. Personnel #12-#14: There was no evidence of criminal background or sex offender checks.