Every finding on record at St Joseph Hospice LLC

Based on observations and interview, 2 of 2 Certified Nurse Aides (CNA) did not ensure a safe environment during the provision of care for 1 of 1 patient. (CNA #1, CNA #2, and Patient # 1) The finding includes: Patient #1 Observations during a home visit on 4/26/2022 between 9:02 AM and 9:42 AM revealed CNA # 1 and CNA #2 performing a bed bath for Patient #1. The patient's hospital bed was in the high position during the bath. Observations showed CNA #1 and CNA #2 left the patient's bedside with the bed in the high position and the side rails were in the down position. On 4/26/2022 at 9:44 AM, CNA #1 and CNA #2 were asked if they were aware that they had left the patient's bed in a positron of potential danger, and both CNAs nodded their heads in agreement.

Based on observations, record reviews, and interview, the hospice did not have the documentation to show the hospice had a comprehensive updated medication profile for 1 of 2 patient records reviewed. (Patient #3) The finding includes: Patient #3 Observations during a home visit on 4/26/2022 between 10:40 AM and 11:17 AM revealed discrepancies existed between the hospice medication profile list and the actual medications the patient takes. Patient #3's caregiver reported the patient is Diabetic and uses a sliding scale insulin (Toujeo) pen. There was no documentation on the hospice's medication profile for insulin. The hospice medication profile listed Trazodone 150 mgs (milligrams) oral tablet take 1 tablet at bedtime, Zoloft 25 mg oral tablet take once only, but the patient's care giver reported these are as needed (PRN) medications. Lisdexamfetamine 70 mgs oral tablet daily is listed on hospice's medication profile for the patient, the patient's caregiver reported Lisdexamfetamine 70 mgs oral tablet daily had been discontinued. On 4/26/2022 at 11:17 AM, Registered Nurse #2 verified the findings.

Based on record reviews and interview, the hospice failed to ensure the patient's Plan of Care was updated with accurate target dates, services needed, and continuous assessments for 9 of 11 patient records reviewed. (Patient #1, #2, #3, #4, #6, #8, #9, #10 and #11) The findings include: Patient #1 On 4/26/2022 at 4:03 PM, review of Patient #1's chart revealed the patient's Start of Care (SOC) was dated 7/23/2020. Review of the patient's Plan of Care (POC) for the episode dated 3/15/2022 to 5/13/2022 revealed Goals: Patient/family will have final arrangements in place; Target Date 10/20/2020, Passage of stool without aids; Target date 3/14/2022 Patient/caregiver will be compliant with removal of safety hazards from patient's residence reducing the risk of falls/injury; Target date 3/14/2022. Patient #2 On 4/27/2022 at 8:09 AM, review of Patient #2's chart revealed the patient was admitted on 3/23/2018. Review of the patient's POC for the episode dated 3/2/2022 to 4/30/2022 revealed Goals: Patient's personal care needs will be met; Target date 12/31/2021, Patient will be pain free or verbalize an acceptable pain level with current pain management regimen; Target date 12/31/2021, Patient/caregiver verbalize/demonstrate proper skin care; Target date 12/31/2021. Patient #3 On 4/27/2022 at 10:04 AM, review of Patient #3's chart revealed the patient was admitted on 11/12/2021. Review of the patient's POC for the episode dated 2/10/2022 to 5/10/2022 revealed Goals: Patient/caregiver will demonstrate understanding of measures to prevent/alleviate constipation; Target date 2/9/2022 Patient will be pain free or verbalize an acceptable pain level with current pain management regimen; Target date 1/14/2022 Patient/caregiver will verbalize understanding/demonstrate adequate fluid intake; Target date 1/12/2022. Patient #4 On 4/25/2022 at 2:35 PM, review of Patient #4's chart revealed the patient was admitted on 11/30/2021 and expired 12/7/2021 at home. A Certified Nurse Assistant (CNA) visit was documented on 12/6/202. There was no documentation for a CNA assignment completed by the RN. The CNA note showed "All care was done." On 4/27/2022 at 11:05 AM, the Clinical Director and RN #2 revealed, "The RN didn't fill out an assignment sheet for the CNA. The aides know not to go out to see patients without an assignment." Patient #6 On 4/25/2022 at 12:35 PM review of Patient #6's chart revealed the patient was admitted on 7/15/2021 and expired 8/6/2021 at home. Documentation of a Stage II pressure ulcer and the patient's family using Silvadene cream was verified, but there were no wound measurements in the documentation and no wound care orders in the patient's POC. On 4/27/2022 at 11:55 AM, the Clinical Director and RN #2 verified the findings. Patient #8 On 4/26/2022 at 3:20 PM, review of Patient #8's chart revealed the patient was admitted on 7/14/2021. Review of the patient's POC for the episode dated 3/11/2022 to 5/9/2022 revealed Goals: Skin integrity will be maintained and problems managed as disease process will all; Target date 3/10/2022, Patient/caregiver verbalize understanding regarding signs/symptoms of urinary tract infection and what to report; Target date 3/10/2022 Patient #9 On 4/26/2022 at 1:52 PM, review of Patient #9's chart revealed the patient was admitted to services on 11/10/2020. Review of the patient's POC for the episode dated 3/5/2022 to 5/3/2022 revealed Goals: Patient will demonstrate understanding of appropriate use of meds(medications) for pain management; Target date 1/3/2022, Patient's skin remains free of breakdown; Target date 1/3/2022, Establish/maintain normal bowel habits; Target date 1/3/2022. Patient #10 On 4/26/2022 at 1:03 PM, review of Patient #10's chart showed the patient was admitted on 9/10/2021. Review of the patient's POC for the episode dated 3/9/2022 to 5/7/2022 revealed Goals: Pt/CG(Patient/Caregiver) can describe interventions to prevent skin breakdown; Target date 3/8/2022, Maintenance of respiratory baselines as evidenced by breathing at optimal level within disease parameters; Target date 3/8/2022, Patient/caregiver verbalize understanding of/demonstrate how to reduce risk and avoid urinary tract infection; Target date 3/8/2022. Patient #11 On 4/26/2022 at 12:08 PM, review of Patient #11's chart showed the patient was admitted on 11/18/2021. review of the patient's POC for the episode dated 2/6/2022 to 5/16/2022 revealed Goals: Anxiety reduced and within manageable level during dyspneic episodes; Target date 2/15/2022, Patient/Caregiver will verbalize understanding of pain management regimen; Target date 2/15/2022, Patient/CG will verbalize understanding of s/s(signs/symptoms) to report to RN/MD; Target date 2/15/2022. On 4/27/2022 at 12:00 PM, the Clinical Director and RN #2 verified all of the findings.

Based on observations, patient record reviews, and interview, the Interdisciplinary Team (IDT) to individualize failed to individualize the Plan of Care (POC) regarding Chaplin visits for 3 of 9 patients. (Patient #2, #9, and #10) The findings include: Patient #2 On 4/27/2022 at 8:09 AM, review of Patient #2's chart revealed the patient was admitted on 3/23/2018. Review of the visit orders revealed the Chaplin visit schedule was 4 Pro Re Nata (PRN) visits as needed with no scheduled visits. The schedule was not individualized for patient needs. On 4/27/2022 at 10:51 AM, the Clinical Director and Registered Nurse (RN) #2 revealed, "Should be seeing the patient on regularly scheduled visits." Patient #9 On 4/26/2022 at 1:52 PM, review of Patient #9's chart revealed the patient was admitted on 11/10/2020. Review of the visit orders showed the Chaplin visits were scheduled 4 PRN visits with no scheduled visits. The schedule was not individualized for patient needs. On 4/27/2022 at 12:13 PM, the Clinical Director and RN #2 revealed, "Should be seeing the patient on regularly scheduled visits." Patient #10 On 4/26/2022 at 1:03 PM, review of Patient #10's chart revealed the patient was admitted on 9/10/2021. Review of the visit schedules revealed the Chaplin visit schedule was 4 PRN visits with no scheduled visits. The schedule was not individualized for patient needs. On 4/27/2022 at 11:37 AM, the Clinical Director and RN #2 revealed, "Should be seeing the patient regularly on scheduled visits."

Based on observations and interview, the hospice staff failed to follow accepted principle of infection control during the provision of care by 1 of 2 Registered Nurses (RN #2). The findings include: Patient #3 Observations during a home visit with Patient #3 on 4/26/2022 between 10:40 AM and 11:17 AM revealed RN #2 wearing gloves in the provision of patient care touched his/her eye glasses and mask 6 times without removing the gloves and performing hand hygiene. RN #2 removed the eye glasses from his/her face and placed the eye glasses in his/her uniform pocket 3 times wearing gloves, removed the gloves, did not perform hand hygiene, and then sanitized the equipment, used in the provision of patient care, retracted the tape measure without sanitizing the tape measure, and and failed to sanitize the stethoscope placed around his/her neck prior to leaving the patient's home. On 4/26/2022 at 11:20 AM, RN #2 reported he/she was unaware of the infection control breaches.

Based on record reviews and interview, the hospice failed to ensure the Certified Nurse Assistant (CNA) assignment was individualized with clear instructions for 9 of 10 patient charts reviewed. (Patient #1, #2, #4, #6, #7, #8, #9, #10, and #11) The findings include: Patient #1 On 4/26/2022 at 4:03 PM, review of Patient #1 Start of Care (SOC) dated 7/23/2020 for the Plan of Care (POC) for episodes dated 3/15/2022 to 5/13/2022 revealed the CNA visit schedule for 5 visits every week for 8 weeks. Review of the CNA Care Plan revealed "Nail Care" without frequency for task, and "Shampoo weekly or per request of pt or family" without specific frequency. On 4/27/2022 at 11:22 AM, the Clinical Director and RN #2 revealed "Should be more specific" and verified the finding. Patient #2 On 4/27/2022 at 8:09 AM, review of Patient #2's chart revealed the patient was admitted on 3/23/2018. Review of the patient's POC for the episode dated 3/2/2022 to 4/30/2022 revealed the CNA visit schedule for 3 visits every week for 8 weeks. Review of the CNA Care Plan revealed "give SSE (soap suds enema) as directed by RN". On 4/27/2022 at 11:22 AM, the Clinical Director and RN #2 revealed, "Aides don't do enemas" and verified the finding. Patient #4 On 4/25/2022 at 2:35 PM, review of Patient #4's chart revealed the patient was admitted on 11/30/2021. Review of the patient's POC for the episode dated 11/30/2021 to 12/7/2021 revealed the CNA visit schedule for 2 visits every week for 7 weeks. Patient #4 expired on 12/7/2021, but was visited by a CNA on 12/6/2021 with a CNA note reporting "all care provided". There was no documented CNA assignment in the patient's chart. On 4/27/2022 at 11:05 AM, RN #2 revealed "I must have forgot to fill out an assignment sheet." Patient #6 On 4/25/2022 at 12:35 PM, review of Patient #6's chart revealed the patient was admitted on 7/15/2021 and expired 8/6/2021 at home. Review of the patient's POC for the episode dated 7/15/2021 to 10/22/2021 revealed the CNA visit schedule for 3 visits every week for 13 weeks. Review of the CNA Care Plan revealed "Incontinent Care" as the only intervention and no specific scheduling. On 4/27/2022 at 11:55 AM, the Clinical Director and RN #2 revealed "There should be more tasks." Patient #7 On 4/26/2022 at 2:32 PM, review of Patient #7's chart revealed the patient was admitted on 3/29/2022 with a CNA visit schedule for 2 visits a week for 13 weeks. Review of the CNA Care Plan revealed "Nail Care-per pt(patient) or Cg(caregiver) request, Foot Care per pt or Cg request, Shampoo weekly or per request of pt or Cg". Specific task frequencies were not included in the instructions. On 4/27/2022 at 12:08 PM, the Clinical Director and RN #2 revealed, "Should be more specific" and verified the finding. Patient #8 On 4/26/2022 at 3:20 PM, review of Patient #8's chart revealed the patient was admitted on 7/14/2021. Review of the patient's POC for the episode dated 3/11/2022 to 5/9/2022 revealed the CNA visit schedule for 5 visits a week for 9 weeks, and then for 3 visits a week starting 4/4/2022. Review of the CNA Care Plan revealed "Hospice CNA to Shampoo weekly" without a specified frequency. On 4/27/2022 at 11:27 AM, the Clinical Director and RN #2 revealed "should be more specific" and verified the finding. Patient #9 On 4/26/2022 at 1:52 PM, review of Patient #9's chart revealed the patient was admitted on 11/10/2020. Review of the patient's POC for the episode dated 3/5/2022 to 5/3/2022 revealed the CNA visit schedule for 2 visits each week for 9 weeks. Review of the CNA Care Plan showed 15 interventions and/or tasks without specified frequencies. On 4/27/2022 at 12:13 PM, the Clinical Director and RN #2 revealed "They need to add the frequencies" and verified the findings. Patient #10 On 4/26/2022 at 1:03 PM, review of Patient #10's chart revealed the patient was admitted on 9/10/2021. Review of the patient's POC for the episode dated 3/9/2022 to 5/7/2022 revealed the CNA visit schedule for 2 visits each week for 8 weeks, and for 3 visits for the week of 3/28/2022. Review of the CNA Care Plan showed 14 interventions and/or tasks without specified frequencies. On 4/27/2022 at 11:37 AM, the Clinical Director and RN #2 revealed, "They need to add the frequencies" and verified the findings. Patient #11 On 4/26/2022 at 12:08 PM, review of Patient #11's chart revealed the patient was admitted on 11/18/2021. Review of the patient's POC for the episode dated 2/6/2022 to 5/16/2022 revealed the CNA visit schedule for 2 visits each week for 10 weeks. Review of the CNA Care Plan showed 14 interventions and tasks without specified frequencies. On 4/27/2022 at 11:49 AM, the Clinical Director and RN #2 revealed "They need to add the frequencies" and verified the findings.