Every finding on record at Sunlit Hospice, Inc.

Observed in Patient Home. In 1 of 3 home visits conducted, the clinician failed to conduct a patient-specific comprehensive assessment and reassessment the identified the patient's need for hospice care and services. For example: during the home visit the RN was observed to conduct a patient assessment. The RN took the patient's vital signs, and examined the lower extremities. He asked about pain, last BM, and general how he was feeling, yet the RN failed to listen to lung, heart, and bowel sounds the fully assess the respiratory, cardiac, and gastrointestinal systems. After the visit was concluded and the RN and surveyor left the patient home, upon reviewing the visit the RN acknowledged the assessment did not include listening to lungs, heart and bowel sounds. He then returned to the patient home to complete the missing elements of the patient assessment. This Observation was reviewed with the DPCS and CEO Administrator.

Observed in Record Review. In 6 of 9 patient records reviewed, the organization failed to ensure the hospice develop an individualized written plan of care that reflect the patient and family goals based on the problems identified in the comprehensive assessments. On review of clinical records, the plan of care goals lacked being individualized, specific, measurable, and time bound. Most goals established time frames were specified to be for the next 2 weeks of hospice care, and the goal continued from IDG to IDG. All goals established were noted to be long term goals, yet there were no short term goals that led up to the long term goal. For example: On RRHV#2 example of goals were patient will have decreased dyspnea for the next two weeks, and ADL needs are met for the next two weeks of hospice care. These goals were established on admission and remain unchanged to date of survey one year after admission. In RRHV#3 example of goals that were not measurable were patient will be comfortable for the next two weeks of hospice care, and patient will have adequate food and fluids as tolerated or desired in two weeks of hospice care. In RRNHV#4 an example was patient will maintain physical mobility with limitation for the next two weeks. In RRNHV#5 example of goals were ADL needs are met for the next 2 weeks of hospice care and the patient's comfort will be promoted as skin integrity changes throughout disease and dying process. In RRNHV#6 a goal was signs and symptoms of depression will be managed with medication ordered and intervention rendered for the next 2 weeks of hospice care and patient needs will be met on a day to day basis as expressed through nonverbal cues for the next 2 weeks of hospice care. And in RRNHV#8 an example was insomnia will be managed after medication/intervention given for the next 2 weeks of hospice care. The goals for RRNHV#5, RRNHV#6, and RRNHV#8 were established on admission and remained unchanged to date of survey, all greater than one year of service. These observations were reviewed with the CEO and DPCS.

Observed in Record Review. In 2 of 9 patient records reviewed, for active 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,and RRHV#2, the patient was being seen monthly by the Medical Social Worker yet there was no psychosocial care plan to guide the care being provided. This observation was reviewed with the CEO.

Observed in Record Review. In 2 of 9 patient records reviewed, for active patients, the organization failed to ensure the plan of care include all drugs and treatment necessary to meet the needs of the patient. For example: on review of RRHV#2 the medication profile contained an order for thickener yet the order failed to specify directions on how to use to reach what desired consistency. In RRNHV#4 the medication profile order for Lorazepam specified 2mg/ml, 1ml as needed for acute seizure activity, however the order failed to specify a frequency for the PRN administration. These observations were reviewed with the CEO.

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. For example: on observation in RRHV#1 the LVN was observed to remove gloves after providing patient care and failed to sanitize hands prior to donning a new pair of gloves on several occasions as required by policy. This observation was reviewed with the CEO/RN.

Observed in Record Review. In 9 of 9 patient records reviewed, the organization failed to ensure the entries to the clinical record were appropriately authenticated in accordance with the organization's policy and currently accepted standards of practice. For example: on review of RRNHV#8 it was noted that multiple patient visit notes were not electronically signed and dated by the clinician that conducted the visit, but instead the entries were noted to say signed by an (RN name), RN to close note on behalf of staff assigned. Examples include September LVN visit, and September MSW visit note. In RRNHV#9 an example of note signed not by the assigned clinician was in September for the MSW. Further examples of notes signed by the RN on behalf of the assigned staff can be seen throughout all records reviewed. This observation was reviewed with the CEO/RN and RN Field Nurse.

Observed in Record Review. In 2 of 2 patient records reviewed, for live discharge, the organization failed to ensure staff operate and furnish services in compliance with all applicable Federal, State, and Local laws and regulations. For example: in RRDC#2 the patient was discharged for extended prognosis. There was a Notice of Medicare Non-Coverage signed on the record, however the patient signature was dated the day of discharge not at least 2 days prior as required. Further, in the section that listed the QIO and number to call for appeal, the organization had listed the DPCS name and the org phone number. There was also a signed revocation form on the record, when the documentation and discharge orders note the patient was discharged for extended prognosis. In RRDC#1, the patient revoked the hospice benefit and a signed revocation form was found on the record, but there was also a signed Notice of Medicare Non-Coverage noted on the record. The NOMNC also had the org information listed in the QIO contact section. These observations were reviewed with the CEO and DPCS.