Every finding on record at Sincerity Hospice Services, Inc.

Observed in Record Review. In 1 of 3 patient records reviewed, The organization failed to ensure the patient record was complete, promptly, and accurately documented. For example: on review of the record for RRHV#1 the documentation noted a stage 2 wound to the patient buttocks, with measurements with length and width but no depth. However, on discussion during home observation, the patient's wound, which was resolved, was not an open wound and was described by the RN and the Caregiver as a redness or stage 1. This observation was reviewed with the RN DPCS.

Observed in Record Review. In 3 of 3 patient records reviewed, for active patient records, the organization failed to develop an individualized plan of care for each patient that reflect the patient and family goals. For example: on review of RRHV#1 and RRHV#2 the goals established were noted to not be individualized and time bound as all goals had the same target dates all mostly noted to be set for the next IDG meeting date or the end of the certification period. On review of RRHV#3 all goals established were not individualized as the goals were noted to all have target dates of the end of the benefit period. This observation was reviewed with the Administrator and DPCS.

Observed in Record Review. In 2 of 3 patient records reviewed, for active patient records, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRHV#1 the patient was being seen by the social worker each certification period yet there was no psychosocial care plan to direct the care. In RRHV#2 the patient had a foley catheter, yet there was no genitourinary care plan open to guide the care. Further, the patient was being seen by the chaplain and MSW yet no psychosocial or spiritual care plans were established. These observations were reviewed with the Administrator.

Observed in Record Review. In 3 of 3 patient records reviewed, for active patient records, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. For example: On review of RRHV#2 the patient had a foley catheter yet the order for the catheter was incomplete. The order read may change FC as needed yet did not specify the size and type of catheter, nor the reason for as needed changes as required. The order for catheter flush noted may flush FC with NS as needed for sediment yet the order did not specify who was to flush the catheter. Example 2: on review of RRHV#1, RRHV#2, and RRHV#3 the plan of care order for oxygen noted oxygen 2-5 LPM via NC PRN for shortness of breath yet there were no specific instructions to guide the patient when to use which liter flow. These observations were reviewed with the Administrator and RN DPCS.

Observed in Record Review. In 1 of 3 patient records reviewed, the RN who is responsible for supervision of the hospice aide, failed to ensure written patient care instructions were prepared to guide care. For example: on review of RRHV#2 the patient had a indwelling foley catheter, yet the presence or care of the catheter was not addressed on the hospice aide plan of care. This observation was reviewed with the Administrator.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization failed to ensure the patient record contained all information to reflect the patient's care, treatment and services. For example: on home observation for RRHV#2 the medication reconciliation process was observed and it was noted that the lorazepam in the home was liquid yet the physician order on the medication profile was for 0.5 mg tablets. The medication profile included Trazadone for PRN use yet the caregiver noted she was not familiar with the medication, that they had not given the patient trazodone, and did not have any in the home. Additionally, the caregiver noted she had been giving the patient over the counter allergy medication daily and had been doing this for quite some time yet the medication was not on the medication profile. These observations were reviewed with the RN DPCS.

Observed in Record Review. In 1 of 2 patient records reviewed, for live discharges, the organization failed to document that the attending physician was notified of the availability of the discharge summary. On review of RRDC#1 and RRDC#2 there was no documentation that the attending physician or the receiving clinicians for the patient had been notified that a discharge summary was available. These observations were reviewed with the Administrator.

Observed in Competency Session. In 1 of 4 contracts reviewed, On review of the SNF contract, the hospice failed to ensure the SNF contract had a provision stating that the hospice will report all mistreatment, neglect, or verbal, mental, sexual, and physical abuse to the SNF, NF, or ICF/IID administrator within 24 hours of the hospice becoming aware of the alleged violation, including injuries of unknown source, and misappropriation of patient property by anyone unrelated to the hospice. This observation was reviewed with the Administrator.

Observed in Competency Session. In 1 of 4 patient records reviewed, the organization failed to ensure the hospice contracts require that all contracted entities obtain criminal background checks on contracted employees who have direct patient contact or access to patient records. On review of the contract for therapy there was no noted stipulation specifically for background checks on all contracted employees with direct patient contact of access to patient records. This observation was reviewed with the Administrator.

Observed in Emergency Management Session. During the Emergency Management Session and review of the Emergency Management Plan, the surveyor noted that the emergency plan did not define the patient population served and did not address the extent to which additional populations may be cared for during an emergency. This was confirmed with the Administrator present.

Observed in Emergency Management Session. During the Emergency Management Session and review of the Emergency Management Plan, the surveyor noted that the organization's plan did not describe how it would inform state and local officials of any on-duty staff they were unable to contact. This was confirmed with the Administrator present.

Observed in Record Review. In 5 of 5 patient records reviewed, the surveyor noted that the plan of care was not individualized. For example, in record HV#1 9 of 10 goals did not include time frames for achieving the goals and 1 of 10 goals the time frame to achieve was 6 weeks prior and had not been resolved or addressed in any way. Also in HV#1 on the admission assessment and recertification assessment it was noted that the patient was a high fall risk and there were no goals related to this risk, In record HV#2 8 of 10 goals did not include time frames for achieving the goals and 2 of 10 goals the time frame to achieve was 6 weeks prior and had not been resolved or addressed in any way. Also in HV#2 on the admission assessment and recertification assessment it was noted that the patient was a high fall risk and there were no goals related to this risk. HV#3 and RR#1's goals did not include time frames. RR#1 the patient had a foley catheter placed, but there was no goal related to the catheter. RR#2 record include 6 goals and they all had the same time frame, 3 months after admission. This was confirmed with the Administrator present.

Observed in Record Review. In 5 of 5 patient records reviewed, the surveyor noted that the frequency of services included PRN/as needed visits that did not include a reason to perform the PRN visit. For example, HV#1, 2, and RR#1 included orders for skilled nurse, spiritual counselor and social worker 1 PRN with no further direction. RR#2 included orders for skilled nurse 3 PRN with no further direction. Also, during record review HV#1 it was noted that the PRN/as needed medications Tylenol oral and rectal were both indicated for mild pain or fever with no further direction such as which to first, Lorazepam 0.5mg and 1mg were both indicated for anxiety with no further direction of which dose to use when, and Tramadol was indicated to use for pain with no further direction with 3 other PRN medications for pain. HV#2 and 3 and RR#1and 2 it was noted that the PRN/as needed medications Tylenol oral and rectal were both indicated for mild pain or fever with no further direction such as which to first.

Observed in Patient Home. In 3 of 3 home visits conducted, the surveyor noted that the organization had not followed standard practice to prevent transmission of infections. For example, during HV#1 and #2 the nurse did not follow contact time (wet time) as specified by the disinfectant manufacturer’s IFUs for the wipes the nurse stated were Clorox. During HV#3 the hospice aide used individually packaged Wet Ones to disinfect the equipment. Wet Ones are a Hand wipe and not recommended for any other use. This was confirmed with the Administrator who assisted in investigating the product. Observed in Patient Home. In 2 of 3 home visits conducted, the surveyor noted that the nurse did not follow accepted standards of practice to prevent the transmission of infections. For example, during HV#1 and HV#2 the nurse failed to perform hand hygiene consistent with policy. The nurse donned gloves and then performed all care, including direct contact with patient and patient environment and accessing the nursing bag, with no change in gloves as required by organization policy.

Observed in Record Review. During record review RR#1 the surveyor noted that the organization had not notified the physician of the availability of a discharge summary. This was confirmed with the Administrator present.

Observed in Record Review. In 5 of 5 patient records reviewed, the surveyor noted that there was no education provided for the patient's individualized disaster/emergency management plan. This was confirmed with the Administrator present.

Observed in Patient Home. During home visit HV#1 the surveyor noted that the hospice had not maintained a safe physical environment. For example, the oxygen concentrator and 2 e-tanks were stored in a closet with the door closed and 1 of 2 e-tanks was freestanding. The nurse did not take any action to correct these issues.

Observed in HR File Review. During HR file review the surveyor noted that the hospice had not conducted a criminal background check on the volunteer. The Administrator present stated that she was aware it should have been completed and was going to correct the error today.