Every finding on record at Stella Hospice, Inc.

Observed in Individual Tracer. In 13 of 14 patient records reviewed, The surveyor noted in (RRHV#1) that there was no evidence in the record that the patient was assessed for allergies. There was no evidence that allergies were assessed in (RR#2-10) or (DRR#1 and# 2) and (BRR#1). This was confirmed with the alternate administrator. Observed in Individual Tracer. In 4 of 10 patient records reviewed, During (RRHV#1), the surveyor noted that the assessment indicated that the patient was experiencing anxiety. The assessment did not indicate the severity of the anxiety, also there was no assessment of the diabetes and the patient's management and ability to perform blood glucose monitoring. In (RRHV#2), the assessment indicated that the patient was experiencing anxiety ; however, there was no assessment of the severity of symptoms. Also, the patient was ordered three anticoagulant medications and was identified as a bleeding risk; however, there was no assessment of the reasons for the medications or the patients bleeding risk. Also, there was no assessment of the patient's diabetes with three prescribed medications, In (RRHV#3), there was no assessment of the patient's diabetes and a blood glucose monitoring. The nurse indicated that the caregiver administers medications and performs the blood glucose monitoring; however, there was no evidence in the medical record that the caregiver's ability was assessed. In (RRAR#10), there was no assessment of the severity of the patient's anxiety. This was confirmed to be required by policy with the alternate administrator.

Observed in Individual Tracer. In 2 of 12 patient records reviewed, The surveyor noted (RRHV#2) that the initial bereavement risk assessment was not perform on the primary bereaved, the patient's spouse who lived in the home. It was completed with a friend instead. There was no evidence in the record that the spouse refused. Also, in (RRHV#3) the surveyor noted that the patient demographics indicated that the patient was married; however, the bereavement assessment was completed with a friend and there was no indication that the spouse refused or was unavailable. This was confirmed with alternate administrator.

Observed in Record Review. In 2 of 10 patient records reviewed, In (RRAR#4) , the surveyor noted that the plan of care had not been revised or updated since the patient was admitted in May. All that changed for the existing goals was a movement of the target date to the end of the next episode. For example, the goal stated pain decreased to SIT within 48 hours which remained as the goal for three episodes. Also, in (RRAR#8), there were no goals or interventions created when the patient was admitted in September, and the plan had not been revised to date. This was confirmed with the alternate administrator.

Observed in Record Review. In 4 of 10 patient records reviewed, The surveyor noted in (RRHV#1) that there were no measurable outcomes anticipated from implementing and coordinating the plan of care.. For example, the goal for dyspnea read dyspnea will be alleviated with rest and oxygen administration within next IDG . Also, in (RRHV#2), the goals did not include measures for reduce the episodes of anxiety and depression throughout certification period. In (RRHV#3) the goal for blood sugar management to prevent hospitalization did not include measurable outcomes or times for achieving outcomes expected. IN (RRAR#8) the surveyor noted that there were no outcome measures, goals or interventions in the plan of care. This was confirmed with the alternate administrator.

Observed in Record Review. In 3 of 3 home visits conducted, The surveyor noted ((RRHV#1) noted that the patient had a comfort kit in the home; however, there was no evidence in the record that the patient was educated on how to use the medications. In (RRHV#2) there was no evidence in the record that the patient was educated about the use of anticoagulants and risk for bleeding. Also, there was no evidence that the caregiver was assessed for ability to manage medications or blood glucose monitoring. In (RRHV#3), the surveyor noted that the patient has 20 medications as well as a comfort kit ordered. The nurse indicted the caregiver was administering the medications and performing routine blood glucose monitoring; however, there was no evidence in the record that either the patient or the caregiver were educated or evaluated for use of medications and devices. This was confirmed with the alternate administrator. Observed in Individual Tracer. In 1 of 10 patient records reviewed, During RRHV#1, the surveyor noted that there was no documentation in the record to confirm that the patient and caregivers comprehension and compliance with oxygen safety and use was assessed. The section of the form utilized in the patient record, to confirm what was taught was incomplete and did not include information about the use and dosing of oxygen. The dose was ordered as O2 2-5 lpm as needed; the patient's concentrator was set at 4LPM and was not in use at the time of the visit. There was no further information in the record about how the patient was utilizing the oxygen or her level of comprehension about how to dose it, as require by policy H-20044.4. This was confirmed with the alternate administrator.

Observed in Individual Tracer. In 1 of 10 patient records reviewed, During (RRHV#1), the surveyor noted that the assessment indicated that the patient was experiencing anxiety. During the visit the surveyor noted that the patient was expressing concerns about anxiety and the nurse educated the patient about the use of Lorazepam. The record did not include a plan or goals for managing the patient's anxiety since the patient was admitted one month ago. This was confirmed with the alternate administrator.

Observed in Record Review. In 1 of 10 patient records reviewed, In (RRAR#9), the surveyor noted that the most recent interdisciplinary team notes indicated that the patient continued to experience pain at 6/10, anxiety and dyspnea; however, the plan of care was not revised since September and no additional interventions were added to manage the symptoms. There were no additional pain medications or medications for anxiety and the plan of care did not address her use of oxygen at 5LPM as either continuous or intermittent use with COPD. This was confirmed with the alternate administrator. Observed in Record Review. In (RRHV#1), the surveyor noted that since a care plan to manage anxiety was not created, there were no interventions except medications included on the plan of care for the management of anxiety. This was confirmed with the alternate administrator.

Observed in Record Review. In 10 of 10 patient records reviewed, The surveyor noted in (RRHV#1-3) and (RRAR#4-10) that the plan of care did not include any diet orders. IN (RRAR#9) there was an order for Ensure supplements only. This was confirmed with the alternate administrator. Observed in Individual Tracer. In 2 of 10 patient records reviewed, During RRHV#1, the surveyor noted that the oxygen was set at 4lpm and that the patient stated she raises it to 5 lpm. The order was unclear and read O2 2-5lpm as needed for dyspnea and did not include titrating guidance, as required by policy.. In (RRAR#4), the order for Pepcid AC did not include a frequency or indication for use; the order was written as directed .This was confirmed with the alternate administrator.

Observed in Record Review. In 2 of 5 recertification records, In (RRAR#4) , the surveyor noted that the plan of care had not been revised or updated since the patient was admitted in May. All that changed for the existing goals was a movement of the target date to the end of the next episode. For example, the goal stated pain decreased to SIT within 48 hours which remained as the goal for three episodes. Also, in (RRAR#8), there were no goals or interventions created when the patient was admitted in September, and the plan had not been revised to date. This was confirmed with the alternate administrator.

Observed in Record Review. In 1 of 10 patient records reviewed, In (RRAR#4) , the surveyor noted that the plan of care included orders for spiritual counseling once a month and as needed. The surveyor noted that no visits were conducted for month three through ten and there was no indication that the patient declined the services. This was confirmed with the alternate administrator.

Observed in Tracer Activities. In 13 of 14 patient records reviewed, There was no evidence that the governing body and leadership had established requirements to support patient care treatment and services as evidenced by Condition level findings at 418.100, 418.56 and 418.104.

Observed in HR File Review. In 1 of 9 HR files reviewed, The surveyor noted that the competency for (HR#1MD) was not completed when hired or since. This was confirmed with the alternate administrator.

Observed in Record Review. In 10 of 10 patient records reviewed, The surveyor noted in (RRHV#1, RRHV#2, RRHV#3 and RRAR#4-10) that there was no information in the records about the patients' allergies and there was no evidence that the patients were assessed for allergies. This was confirmed with the alternate administrator.

Observed in Document Review. In 1 of 3 contracts reviewed, The surveyor noted that there was no evidence that the DME contracts was evaluated. This was confirmed with the alternate administrator.

Observed in Document Review. In 2 of 3 contracts reviewed, The surveyor noted that the Pharmacy contract and DME contract did not include language that described the manner in which contracted services will be coordinated, supervised, and evaluated by the hospice. Also, there was no stipulation that the outside agency will complete criminal background checks on contracted employees who provide direct patient care or have access to patient records. This was confirmed with the alternate administrator.

Observed in Patient Home. In 2 of 3 home visits conducted, the hospice nurse surveyor observed the nurse did not follow the organization's bag technique policy. During HV#2 and HV#3, the nurse cleaned her equipment and set it back onto the barrier she had used after patient care, in the same spot, rather than returning it to her nursing bag. She failed to clean it a second time before putting it away. This was discussed and verified with the DPCS Designee.