Every finding on record at Simple Hospice Services, Inc.

Observed in Record Review. In 2 of 6 patient records reviewed, the organization failed to ensure the plan of care includes all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRNHV#4 the patient was treated with antibiotics for a UTI since last survey yet the infection was not reflected on the care plan. In RRNHV#6 documentation from the RN noted the patient family reported shortness of breath, yet there was no care plan for Respiratory. These observations were reviewed with the Administrator.

Observed in Record Review. In 2 of 6 patient records reviewed, the hospice failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness. For example: on review of RRNHV#4 there were incomplete orders noted on the medication profile. The order for Thick-it was noted to instruct to use as directed and did not give specific instructions for the prescribed consistency. The order for Loperamide 2mg 1 tab was ordered every 2-4 hours but failed to specify the med was PRN diarrhea, or any further instruction on how to use. Further, an order for Glucerna was ordered 1 suspension per nasogastric 1 cap daily. Staff noted the patient did not have a nasogastric tube. In RRNHV#3 the order for Imodium was incomplete as it read Imodium 2mg 1 tab as needed without an further instructions as how often to give the medication. These observations were reviewed with the Administrator.

Observed in Record Review. In 2 of 2 patient records reviewed, the organization failed to assess and reassess its patients. During record review for RRBR#1 and RRHV#3, the Hospice Nurse Surveyor observed no documentation for the wounds the patients were receiving treatment for from a contracted agency. This was discussed and reviewed with the Administrator.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization failed to reassess patient related to medications being taken. During home visit for RRHV#3, the Hospice Nurse Surveyor observed the LVN doing a medication reconciliation. Multiple medications on the list were not being taken as ordered. The LVN did not update them on the list as she stated the family handles the meds. Patient has had bouts of diarrhea and so is no longer taking MiraLAX daily, Colace daily, or Dulcolax suppository daily. Two medications were not updated or removed. AN anti-fungal for a nail infection is no longer being used but is on the medication list and Omeprazole was listed as to be taken for 10 days (ordered 4 1/2 months earlier) but that order was not updated. This was discussed and reviewed with the Administrator.

Observed in Record Review. In 1 of 14 patient records reviewed, the organization failed to assess and reassess its patients no less than every 15 days. During record review for RRNHV#6, the Hospice Nurse Surveyor observed the RN was making visits but was not documenting a full comprehensive assessment for the 5 weeks leading up to the survey date. The short form nursing visit note was being utilized which only included pain/ vitals/ narrative and did not include a full physical assessment. This was discussed and reviewed with the Administrator. Observed in Record Review. In 14 of 14 patient records reviewed, the organization failed to assess and reassess its patients including documenting progress towards desired outcomes. During record review for all records, the Hospice Nurse Surveyor observed the organization was not documenting progress towards goals. This was discussed and reviewed with the Administrator.

Observed in Record Review. In 14 of 14 patient records reviewed, the organization failed to plan the patient's care. During record review for all records, the Hospice Nurse Surveyor observed all timeframes for all goals and all patients were listed for IDG dates. This was discussed and reviewed with the Administrator.

Observed in Record Review. In 6 of 14 patient records reviewed, the organization failed to plan the patient's care. During record review for RRHV#1, RRHV#2, RRNHV#1, RRNHV#4, the Hospice Nurse Surveyor observed all services needed for the palliation and management of the terminal illness and related conditions were not included on the Plan of Care. For example in RRHV#1 and RRHV#2, both patients were a high risk for fall but that was not addressed on the Plan of Care. For RRNHV#1, the Plan of Care did not include poor appetite or difficulty swallowing and the patient was given a goal for imminently dying 6 months earlier but it was not updated. For RRNHV#4, the SW documented she was working on coping strategies with the patient and family but it was not addressed on the Plan of Care. Also in RRHV#3, the LVN was educating on aspiration precautions but that was not addressed on the Plan of Care. Also for RRBR#1 and RRHV#3, the Hospice Nurse Surveyor observed wound care was provided by a contracted organization but the wound care being provided was not part of the Plan of Care. Also for RRHV#2, the Hospice Nurse Surveyor observed PRN orders for Morphine and Acetaminophen for pain with no indication when to take which medication. Also for RRHV#2, oxygen orders did not include route or frequency. This was discussed and reviewed with the Administrator.

Observed in Patient Home. In 1 of 3 home visits conducted, The organization failed to implement the infection prevention and control activities it had planned. During RRHV#3, the Hospice Nurse Surveyor noted that the organization did not implement the infection prevention and control activities it planned related to equipment cleaning and implementation of the bag technique policy. The RN was observed cleaning her equipment and then setting down on tope of used, uncleaned equipment. At the end of the visit, the RN was observed placing her uses, disposable barrier on top of her open cloth nursing bag. This was discussed and reviewed with the Administrator. Observed in Patient Home. In 1 of 3 home visits conducted, The organization failed to implement the infection prevention and control activities it had planned. During RRHV#3, the Hospice Nurse Surveyor noted that the organization did not implement the infection prevention and control activities it planned related to hand hygiene. The RN was observed to enter the clinical bag intermittently with gloves and without hand hygiene or changing gloves between each entry. This was discussed and reviewed with the Administrator.

Observed in Record Review. In 2 of 2 patient records reviewed, The organization failed to provide the planned scope and level of care. During record review for RRHV#3 and RRBR#1, the Hospice Nurse Surveyor observed wound care being provided by a contract organization but wound care is a core service. This was discussed and reviewed with the Administrator.

Observed in Record Review. In 2 of 2 patient records reviewed, the organization failed to plan the patient's care. During record review for RRBR#1 and RRBR#2, the Hospice Nurse Surveyor observed a post death assessment had been completed and letters had been mailed but no Bereavement Care Plan with individual interventions, timing and frequency was documented. This was discussed and reviewed with the Administrator.

Observed in Record Review. In 1 of 14 patient records reviewed, the organization failed to assess and reassess. During record review for RRNHV#2, the Hospice Nurse Surveyor observed the spiritual assessment was not completed. Per the notes the SC did not make a visit but the SW and RN did. The RN documented a mini spiritual assessment but left the boxes blank concerning pt/ family spiritual concern. This was discussed and reviewed with the Administrator.

Observed in Record Review. In 3 of 5 patient records reviewed, the organization failed to supervise staff effectively. During record review for RRHV#3, RRNHV#2, and RRNHV#5 the Hospice Nurse Surveyor observed that home health aide supervision was not completed no less frequently than every 14 days. For example in RRHV#3, the RN documented supervision on 7/27 and 8/24 but none in between. For RRNHV#2, there was no documentation of aide supervision for the months of July and August and up to this survey date. And in RRNHV#5, the home health aide began visits on 7/3 but the first supervision did not take place until 8/12. This was discussed and reviewed with the Administrator.

Observed in Tracer Activities. The organization failed to have policies and procedures in place to guide and support patient care, treatment, or services. During review of all tracers, the Hospice Nurse Surveyor observed the organization failed to implement policy related to documentation, forms and timely assessments. This was discussed and reviewed with the Administrator.

Observed in HR File Review. In 1 of 12 HR files reviewed, the organization failed to document competency. During HR file review the Hospice Nurse Surveyor observed HR#10 had no 90 day competency, as required by organizational policy. This was discussed and reviewed with the Administrator.

Observed in Record Review. In 2 of 14 patient records reviewed, the organization failed to document in the patient record in a timely manner. During record review for RRHV#2 and RRHV#3, the Hospice Nurse Surveyor observed documentation of visits in the clinical record were outside of the organization's policy of submitted same day. For example in RRHV#2, there was no documentation of aide visits for the last 6 weeks. And for RRHV#3, there was no documentation of aide visits for the week of August 27th. This was discussed and reviewed with the Administrator.

Observed in HR File Review. In 1 of 12 HR files reviewed, the organization failed to verify staff qualifications. During HR file review the Hospice Nurse Surveyor observed HR#10 had license verification on 5/11/23 but began employment on 3/1/23. This was discussed and reviewed with the Administrator.

Observed in Record Review. In 2 of 2 patient records reviewed, the organization failed to comply with law and regulation. During record review for RRHV#1 with 1/1 requested, the Hospice Nurse Surveyor observed the Hospice Addendum was requested at SOC but there was no documentation that it was provided. Also for RRHV#1, the patient had a copy of the NOMNOC in their home during the visit which was signed at SOC. During record review for RRDC#2, the Hospice Nurse Surveyor observed the patient was discharged for extended prognosis but no NOMNOC was documented. This was discussed and reviewed with the Administrator.