Every finding on record at Silver State Hospice, Inc

Observed in Individual Tracer. In 4 of 14 patient records reviewed, Confirmed by the Administrator. An initial bereavement assessment had not been completed to include identification of the family or caregivers focusing on the social, spiritual and cultural factors that may impact their ability to cope. Example : During review of HOSv#1, HOSrr#1, HOSrr#2 , HOSrr#3 the initial bereavement assessment had not been completed at the start of care.

Observed in Individual Tracer. In 1 of 14 patient records reviewed and confirmed by the Administrator. The plan of care had not been updated to include interventions and goals as identified in patient assessments. Example: During review of HOSrr#3 The RN notes 2-3 weeks after the Start of Care had documented that the patient had been agitated with screaming . The plan of care had not been updated to reflect the agitation as a problem with a measurable goal to resolve.

Observed in Individual Tracer. In 3 of 14 patient records reviewed, Confirmed by the Administrator. Medication orders had not been clear or complete. Example: During review of HOSrr#2 medication orders had not been complete. Example: During review of HOSrr#2 medication orders had included Lorazepam 0.5 mg prn for anxiety and Haloperidol 2mg po prn for anxiety. The orders had not indicated which to utilize first. Observed in Individual Tracer. In 3 of 14 patient records reviewed, Confirmed by the Administrator. The plan of care had not been updated to reflect the change in care. Example: During review of HOSrr#1 a catheter had been ordered , but had not been documented in the Hospice plan of care to include goals and interventions. During review of HOSrr#2 the patient had a diagnosis of Dysphagia with possible aspiration. The plan of care had not documented treatment or interventions based on the assessed needs or diagnosis. During review of HOSrr#3 RN notes had documented that the patient had been agitated with screaming. The plan of care had not been updated to reflect treatment or goals for the assessed needs.

Observed in Patient Home. In 1 of 3 Hospice visits observed and confirmed by the Administrator. Staff had not followed the organization policy or CDC guidelines . Example: During observation of HOSv#2 the CNA changed her gloves during care, however had not cleansed her hands between glove changes per organization policy and CDC guidelines.

Observed in Individual Tracer. In 2 of 2 patient records reviewed, for bereavement services and confirmed by the Administrator. The organization had not developed a bereavement plan of care that included the services offered and the frequency. Example: During review of HOSbr/rr #1 and HOS br/rr #2 the bereavement post death assessment and plan of care had been blank and not completed.

Observed in HR File Review. In1 of 1 Hospice CNA personnel file reviewed and confirmed by the Administrator. The supervisor had not observed the following areas of the hospice aide's performance of the tasks with a patient or pseudo-patient as part of a simulation: Example: The CNA had been hired within the last two months. During review of the competence file it had been noted that the required tasks to include personal care and safe transfers had not been observed with a patient or pseudo-patient.

Observed in Patient Home. In 1 of 3 Hospice visits observed and confirmed by the Administrator. The aide plan of care had not specified the care to be provided to the patient. Example: During observation of HOSv#2 the Patient had continuous oxygen ordered. The CNA removed the oxygen during care, however the plan of care had not provided instruction for the removal during care.

Observed in HR File Review. In 1 of 8 personnel files reviewed and confirmed by the Administrator. The organization had not maintained or documented the volunteer orientation provided to the volunteer.