Every finding on record at Silverado Hospice of Houston Inc.

Observed in Record Review. In 1 of 14 patient records reviewed, it was noted that the organization did not ensure all requirements related to a comprehensive assessment were implemented. For example, during a review of the medical record for RRNHV#8, the physician's brief narrative statement on the certificate of terminal illness included the following information: “At the time of Hospice admission, she was noted to be unresponsive to voice and/or touch. Thus, she was comatose.” The Comprehensive Assessment completed by the Registered Nurse members of the interdisciplinary team did not include an assessment of the patient's Neurological system. This observation was reviewed with the Administrator.

Observed in Record Review. During a review of 3 of 14 patient records, it was noted that the organization did not ensure the comprehensive assessment update included all required information. For example, a review of the interdisciplinary group meeting notes for RRHV#2, revealed that the patient's progress towards goals was not documented by each member of the interdisciplinary team [Social Worker, Chaplain]. Example #2: A review of the interdisciplinary group meeting noted for RRHV#4, revealed that during the 2nd week of the 15th benefit period, the following information was not documented by each member of the interdisciplinary team [Skilled Nurse, Social Worker, Chaplain]: changes since the last updated assessment, response to care, treatment, and services, and progress towards goals. Example #3: A review of the interdisciplinary group meeting noted for RRNHV#1, revealed that during the 9th and 10th benefit periods, the following information was not documented by each member of the interdisciplinary team [Social Worker, Chaplain]: changes since the last updated assessment, response to care, treatment, and services, and progress towards goals. This observation was reviewed with the Administrator and the QAPI Manager.

Observed in Record Review. In 1 of 14 patient records reviewed, it was noted that the organization did not ensure that the plan of care goals included outcome measures for specific care activities. For example, during a review of the medical record for RRNHV#8, it was noted that the physician’s brief narrative statement on the certificate of terminal illness included the following information: “At the time of Hospice admission, she was noted to be unresponsive to voice and/or touch. Thus, she was comatose.” The Comprehensive Assessment completed by the Registered Nurse members of the interdisciplinary team documented the use of the PAINAD scale to assess pain. The plan of care included the following goal statement: “Patient will report a tolerable pain score of 4/10 or less in 14 days.” This observation was reviewed with the Administrator.

Observed in Record Review. In 1 of 14 patient records reviewed, it was noted that the organization did not ensure all services described in the plan of care were implemented. For example, during a review of the medical record for RRHV#3, it was noted that the plan of care described the frequency for Chaplain services delivery as one (1) visit every week. There was no documented evidence that a visit by the Chaplain member of the interdisciplinary team was completed during week 2 of hospice services. This observation was reviewed with the Administrator.

Observed in Individual Tracer. In 1 of 4 Individual Tracers, it was noted that the organization did not ensure its infection prevention and control activities to eliminate the risk of infection were implemented. For example, during home visit activity for RRHV#3, it was noted that after equipment cleaning was completed the clinician placed the equipment (stethoscope, blood pressure machine) directly into the nursing bag. The clinician used Sani-Cloth germicidal disposable wipes for equipment cleaning. The manufacturer instructions for use included the following information: Unfold a clean wipe and thoroughly wet surface. Allow surface to remain wet for two (2) minutes. Let air dry. This observation was reviewed with the Administrator and the QAPI Manager.

Observed in Record Review. In 1 of 13 patient records reviewed, the patient record included duplicate medication orders. In RR#3, Tylenol was ordered for pain, morphine was ordered for pain or shortness of breath and hydrocodone was ordered for pain without differentiation of when to use which of the three ordered products for pain. This was validated with the QAPI Director.

Observed in Record Review. In 1 of 13 patient records reviewed, the plan of care did not identify all treatments necessary to meet the patient's needs. In HV#2 a new wound was identified and Optifoam was applied to the wound. There were no wound care orders reflected in the plan of care until one month later at which time more extensive wound care was ordered. This was validated with the Director of Patient Care Services.

Observed in Patient Home. In 2 of 3 home visits conducted, the staff failed to perform hand hygiene consistent with CDC guidelines. In HV#2 the home health aide washed her hands but turned the faucet off with her bare hands. Likewise in HV#3 the RN failed to use the paper towel to turn off the faucet as required by CDC guidelines. This was validated with the DPCS.

Observed in Patient Home. In 1 of 2 home visits conducted, that involved aide services being observed, the Registered Nurse failed to provide the aide with written patient care instructions that were appropriate to the needs of the patient. In HV#1 recent IDG notes indicated that the patient was bedbound. The aide care plan assigned the aide to give the patient a shower. In interviewing the aide she stated that she had been doing bed baths for at least 2 months because the patient is bedbound. The aide care plan was not updated in accordance with the patient's decline in mobility. This was validated with the DPCS.

Observed in Patient Home. In 1 of 2 home visits conducted, in which aide services were observed the aide failed to follow the aide plan of care. In HV#1 the aide care plan required the aide to provide the patient with a shower. The aide reported that the patient was bedbound and she had been unable to shower her for at least two months. This was validated with the DPCS.

Observed in Patient Home. In 1 of 2 home visits conducted, in which aide services were provided the medical record failed to include documentation that the aide reported to the RN that she was unable to provide the care prescribed in the aide plan of care. In HV#1 the aide reported that while the aide assignment called for the patient to have a shower, the patient was bedbound and had therefore been receiving a bed bath for at least two months. There was no documentation in the record that this change in the patient's condition had been reported to the RN. This was validated with the QAPI director.

Observed in Patient Home. In 1 of 2 home visits conducted, in which aide services were observed, the documented aide supervision failed to assess the quality of services provided and that the services ordered by the IDG met the patient's needs. In HV#1 the nursing supervisory visits for at least two months failed to document that the aide was not following the plan of care which required the aide to provide the patient a shower. This was validated with the QAPI Director.