Every finding on record at Sk Hospice Services, Inc.

Observed in Record Review. In 4 of 10 patient records reviewed, the hospice's interdisciplinary group, in consultation with the patient's attending physician, did not complete the comprehensive assessment within five (5) calendar days after the election of hospice care. In review of the record for HV#2, the initial spiritual care assessment was completed and documented over one (1) month after the patient's election of hospice. There was no documentation as to the reason for the delay of the assessment. In RR#1, the spiritual care and psychosocial initial assessments were not completed within 5 day of the election of hospice care. In RR#2 and RR#6, the spiritual care initial assessment was not completed within 5 days of patient's election of hospice. This was reveiwed and verified with the Compliance Officer.

Observed in Record Review. In 4 of 12 patient records reviewed, the organization did not assess/reassess its patient by ensuring the hospice interdisciplinary group (IDG) updated the comprehensive assessment in collaboration with the patient's attending physician as the patient's condition required, but at least every 15 days. In review of the record for HV#3, in 3 of 3 IDG Notes reviewed, there was no evidence/documentation that the Spiritual Care Counselor participated in the IDG meeting. In RR#6 and RR#7, there were multiple IDG Notes with no documentation/evidence that the Spiritual Care Counselor had participated in reviewing and updating the patient's assessment. In RR#2, 2 of 3 IDG Notes reveiwed had no documentation/evidence that the RN had participated in IDG process of updating/reviewing the comprehensive assessment. This was reviewed and verified with the Administrator/Director of Patient Care Services.

Observed in Record Review. In 1 of 12 patient records reviewed, the organization did not plan the patient's care by including all services needed for the palliation and management of the terminal illness and related conditions, including measurable outcomes anticipated from implementing and coordinating the plan of care. In RR#4, the patient's goals of care related to problems/interventions/status were not identified and documented until 34 days after the start of care. This was reveiwed and verified with the Compliance Officer.

Observed in Record Review. In 2 of 12 patient records reviewed, the hospice plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including medications and treatment necessary to need the patient's needs. In review of the record for HV#3 and RR#3, the hospice plan of care included Comfort Kit to be started under the direction of Hospice Licensed Staff. There were no detailed and complete orders documented in the plan of care for the specific individual medications included in the organization's comfort kit. This was reveiwed and verified with the Compliance Officer.

Observed in Record Review. In 1 of 14 patient records reviewed, the organization did not provide the patient with care, treatment, or services according to the patient's individualized plan of care. In review of the record for HV#2, the patient's plan of care included the order for Oxygen 2 liters per nasal cannula prn. The patient's caregiver confirmed to the skilled nurse and surveyor that there was no oxygen concentrator in the home. The organization's oxygen provider was contacted and the concentrator was delivered to the home same day. This was reveiwed and confirmed with the Compliance Coordinator.

Observed in Record Review. In 3 of 12 patient records reviewed, the organization did not accept the patient for care, treatment, or services based on its ability to meet the patient's needs by ensuring the medical director or hospice physician-designee reveiwed the clinical information for each patient and provided written certification that life expectancy was six (6) months or less if the illness ran its normal course. In RR#3, RR#7, RRDC#1, there was no evidence that objective data, such as the patient's history and physical or diagnostic results/findings, to support the terminal diagnosis was obtained and reveiwed by the Medical Director prior to admission and completion of the CTI. This was reviewed and verified with the Compliance Officer.

Observed in Patient Home. In 2 of 3 home visits conducted, the organization did not implement the infection prevention and control activities it had planned to minimize, reduce, or eliminate the risk of infection. In HV#1, the RN placed used care equipment (stethoscope, BP monitor, pulse oximeter) back into the field bag without cleaning. The nurse also stored and transported care equipment in an open bag with notebooks and other non-care items. In HV#2, the LVN placed the field bag directly on the floor and opened the bag to remove the care equipment used to perform the patient assessment. These practices were not according to the organization's bag technique policy and procedure. This was reveiwed and verified with the Compliance Officer.

Observed in Individual Tracer. In 1 of 1 patient records reviewed, RR1, during the record review the surveyor noted the organization failed to show evidence the hospice’s interdisciplinary group updated the comprehensive assessment in collaboration with the patient’s attending physician, if any, as frequently as the patient’s condition requires, but no less than every 15 days. For example, there was no RN visit for a comprehensive assessment conducted for 26 days following the patient's admission. This was not compliant with the organization's policy and validated by the Director of Nursing.

Observed in Individual Tracer. In 1 of 1 patient records reviewed, HV/RR1, during the home visit and record review, the surveyor noted the organization failed to show evidence it had revised the plans and goals for care, treatment, or services based on the patient’s needs. For example, the IDG note dated 2/17/23 indicated the patient had an occasional productive cough and an over the counter cough medication was ordered following the IDG meeting. However, there was no updated or revised problem associated with a change in respiratory condition. This was discussed and validated with the Director of Nursing,

Observed in Individual Tracer. In 1 of 1 home visits conducted, HV 1, during the home visit the surveyor noted the organization failed to demonstrate it used standard precautions to reduce the risk of infection. For example, the nurse used the family's soap and paper towels, failed to conduct hand hygiene prior to and following access to nursing bag; and prior to and after direct contact with patient. This was not compliant with the organization's Hand Hygiene policy and validated by the Director of Nursing. Observed in Individual Tracer. In 1 of 1 home visits conducted, HV1, during the home visit the surveyor noted the organization failed to implement infection prevention and control activities when cleaning and performing disinfection of medical supplies and devices. For example, the nurse cleaned the bag equipment with bleach wipes and failed to allow adequate wet time (minimum 1 minute) prior to returning the equipment to the nurse bag. This was not compliant with the organization's Nurse Bag Technique policy which stated equipment should be cleaned with alcohol. This was validated by the Director of Nursing. Observed in Individual Tracer. In 1 of 1 home visits conducted, HV1, during the home visit the surveyor noted the organization failed to implement its infection prevention and control activities to minimize, reduce, or eliminate the risk of infection. For example, the nurse placed the clinical bag directly on the kitchen table without a barrier. This was not compliant with the organization's Nurse Bag Technique policy and validated by the Director of Nursing.

Observed in Individual Tracer. In 1 of 1 patient records with hospice aide services, RR2, during the record review, the surveyor noted the organization had failed to show evidence it supervised the hospice aide during an on-site visit to the patient’s home no less frequently than every 14 days. For example, RR2, there were two instances in which there no aide supervisory visits documented for 42 days (1/11/23-2/22/23) and (7/12/22-8/22/22). This was not compliant with the organization supervision policy and validated by the Director of Nursing.

Observed in Individual Tracer. In 1 of 1 home visits conducted, HV1, during the home visit, the surveyor noted the organization did not show evidence the patient record contained all clinical documentation regarding patient care, treatment or services. For example, there were multiple medications from a previous hospice provider in the patient's home medication box, which were dated October 2022, three months prior to the current admission. There was no documentation of instruction regarding storage or destruction of inactive medications. These medications included Lorazepam 1mg po. for agitation/anxiety. This was not compliant with the organizations Medication Policy and validated by the Director of Nursing.