Every finding on record at Tabitha, Inc.

Based on record review, policy and procedure review, the observation of the provision of cares, and staff interview, 4 of 4 staff (Staff D, E, F, and G) observed during the provision of cares to 4 of 4 patients (Patient 1, 2, 3, and 4) failed to perform appropriate hand hygiene, glove use, cleaning of multiple-patient equipment, and/or use of clean bag technique according to the agency policies and procedures to prevent the potential of cross contamination and home care acquired infections. The total sample size was 19. The census was 136. --- A. Review of the agency policy and procedure titled, Hand Hygiene, Policy No. 6-006.1, reviewed 11/24, revealed staff are to sanitize hands with soap and water or an alcohol-based hand rub, before having direct contact with patients, after contact with a patient's intact skin, when moving from contaminated body site to clean body site during patient care, after contact with inanimate objects in the immediate vicinity of the patient, and after removing gloves. B. Review of the agency policy and procedure titled, Bag Technique, Policy No. 6-013.1 revised 11/18, revealed: 1.Hand washing supplies are to be removed from the supply bag and left at the sink at the start of the visit. 2.Hand washing is to be completed prior to opening the supply bag, supplies are to be removed from the supply bag after hand washing, when the visit is completed, reusable equipment was to be cleaned using alcohol, soap and water, or other appropriate solution, hands washed, and supplies returned to the bag. 3.Laptop, tablet, or other documentation device are to be cleaned using alcohol, or sanitizing wipe prior to returning equipment to the supply bag at the end of the visit. 4.The policy does not provide instruction to staff for the sanitization of equipment such as cell phones that are not returned to a supply bag. C. Review of clinical records revealed: 1.Patient 1's Hospice IDG (Interdisciplinary Group) Comprehensive Assessment and Plan of Care Update, dated 11/5/24, included orders for Social Worker (SW) 2 times per month and 3 as needed visits to assist patient/family with coping, companionship, and support. 2.Patient 2's Hospice Recertification Plan of Care Update for the certification period of 10/7/24 thru 12/5/24, included orders for Home Health Aide (HHA) 2 times a week for 8 weeks, then 1 time a week for 1 week, for assistance with personal cares, hygiene, and activities of daily living (ADLs). 3.Patient 3's Hospice Certification and Plan of Care for the certification period of 9/25/24 thru 12/23/24, included orders Skilled Nurse (SN) 2 times per week for 13 weeks, then 1 time a week for 1 week, and 3 as needed visits for patient evaluations and assessments. 4.Patient 4's Hospice Certification and Plan of Care for the certification period of 10/2/24 through 12/30/24, included orders for SN 2 times per week for 13 weeks, then 1 time a week for 1 week, and 3 as needed visits for patient evaluations and assessments. D. The observation of the provision of SW services on 11/18/24 at 10:25 AM by Staff-D (SW) to Patient 1, revealed the SW failed to sanitize the cell phone used during the visit to assist the patient with speaking to a family member and prior to placing the cell phone in [gender] pocket after completing the visit with the patient. E. The observation of the provision of HHA services on 11/18/24 at 12:28 PM by Staff-E to Patient 2, revealed the HHA failed to have hand sanitizer available for use during the bed bath process until provided by the SN (Staff- GG) and failed to perform hand hygiene once hand sanitizer available for use: 1.After cleansing the patient's body (dirty task) and prior to applying clean gloves to apply lotion (clean task) on the patient on three occasions 2.After cleansing the patient's back and removing gloves and prior to leaving the room to obtain clean bed supplies. 3.After changing pillowcase soiled with wound drainage and prior to applying a clean pillowcase. F. The observation of the provision of SN services on 11/21/24 at 10:20 AM by Staff-F to Patient 3, revealed the SN failed to sanitize hands after completing assessment and storing used equipment in dirty supply bag and prior to enter clean supply bag to retrieve a devotional book, and failed to sanitize hands prior to returning the devotional book back to the clean supply bag. G. The observation of the provision of SN services on 11/21/24 at 1:20 PM by Staff-G to Patient 4, revealed the SN failed to sanitize hands after completing patient assessment and prior to entering bag to remove sanitizer wipes. H. During an interview on 11/21/24 at 3:30 PM, the Administrator and Director of Clinical Services (DCS)- B & DCS-C confirmed staff D, E, F, G failed to perform appropriate hand hygiene, glove use, cleaning of multiple-patient equipment, and/or use of clean bag technique during the provision of cares, according to the agency policies and procedures, to prevent the potential of cross contamination and home care acquired infections.

Based on record review, policy and procedure review, and staff interview, the agency failed to include the patient's progress towards all of the patient and agency identified goals in the revised/updated plan of care for 18 of 18 clinical records reviewed (Patient 1-18) and failed to have a process in place to ensure the progress was documented in the patient's revised/updated plan of care. The total sample size was 18. The census was 197. Findings are: A. Review of the agency policy and procedure titled, Interdisciplinary Group Plan of Care, revised 12/2021, revealed the interdisciplinary Group (IDG) was to assess, develop, and update the patient's plan of care at a minimum of every 15 calendar days. It did not have the requirement to include the patient's progress towards all the patient and agency identified goals in the revised/updated plan of care. B. Review of the policy and procedure titled Interdisciplinary Group Meeting, revised 11/2018 revealed the IDG meeting plan of care update form was to be used for updates and was to include progress towards targeted outcomes. It does not include updates on the progress towards all patient and agency identified goals in the Hospice Recertification Plan of Care Update form. C. Review of clinical records revealed: 1. Patient 1's Hospice Recertification Plan of Care Update and Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 10/2021 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification periods were 7/27/21 through 10/24/21 and 10/25/21 through 1/22/22. 2. Patient 2's Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 12/6/21 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification period was 12/6/21 through 3/5/22. 3. Patient 3's Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 11/20/21 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification period was 11/20/21 through 2/17/22. 4. Patient 4's Hospice Recertification Plan of Care Update and Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 10/2021 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification periods were 9/7/21 through 12/5/21 and 12/6/21 through 2/3/22. 5. Patient 5's Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 10/13/2021 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification periods 10/13/21 through 1/10/22. 6. Patient 6's Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 11/12/2021 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification period was 11/12/21 through 2/9/22. 7. Patient 7's Hospice Recertification Plan of Care Update and Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 10/2021 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification periods were 9/21/21 through 11/19/21 and 11/20/21 through 1/18/22. 8. Patient 8's Hospice Recertification Plan of Care Update and Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 10/2021 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification periods were 8/21/21 through 10/19/21, 10/20/21 through 12/18/21, and 12/19/21 through 2/16/22. 9. Patient 9's Hospice Recertification Plan of Care Update and Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 10/2021 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification periods were 9/21/21 through 12/20/21 and 12/21/21 through 3/19/22. 10. Patient 10's Hospice Recertification Plan of Care Update and Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 10/2021 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification periods were 9/21/21 through 11/19/21 and 11/20/21 through 1/18/22. 11. Patient 11's Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 10/14/2021 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification period was 10/14/21 through 1/11/22. 12. Patient 12's Hospice Recertification Plan of Care Update and Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 10/12/2021 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification periods were 10/12/21 through 12/10/21 and 12/11/21 through 2/8/22. 13. Patient 13's Hospice Recertification Plan of Care Update and Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 10/2021 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification periods were 8/11/21 through 11/8/21 and 11/9/21 through 2/6/22. 14. Patient 14's Hospice Recertification Plan of Care Update and Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 10/2021 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification periods were 8/18/21 through 10/16/21, 10/17/21 through 12/15/21, and 12/16/21 through 2/13/22. 15. Patient 15's Hospice Recertification Plan of Care Update and Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 10/2021 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification periods were 8/13/21 through 10/11/21, 10/12/21 through 12/10/21, and 12/11/21 through 2/8/22. 16. Patient 16's Hospice Recertification Plan of Care Update and Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 10/2021 through 12/29/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification periods were 8/25/21 through 10/23/21 and 10/24/21 through 12/22/21, and 12/23/21 through 2/20/22. 17. Patient 17's Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 11/10/2021 through 12/06/2021 (record review period), did not include the progress towards all patient and agency identified goals. The full certification periods were 11/10/21 through 2/7/22. 18. Patient 18's Hospice Recertification Plan of Care Update and Hospice IDG Comprehensive Assessment and Plan of Care Update Reports occurring during 11/2/2020 through 2/5/21 (record review period), did not include the progress towards all patient and agency identified goals. The full certification periods were 11/20/2020 through 1/1/2021 and 1/2/2021 through 2/5/2021. D. During an interview on 12/29/21 at 4:30 PM, the Administrator and the Director of Clinical Services confirmed the agency failed to include the patient's progress towards all of the patient and agency identified goals in the revised/updated plan of care for 18 of 18 clinical records reviewed (Patient 1-18) and failed to have a process in place to ensure the progress was documented in the patient's revised/updated plan of care for all patients of the agency.

Based on record review, policy and procedure review, observation of the provision of cares, and staff interview, the agency failed to ensure the Hospice Aide (HA) plan of care included all patient-specific care instructions to ensure hospice aide was able to effectively meet all patient care goals for 8 of 17 patients reviewed who received HA services (Patient- 2, 3, 4, 5, 6, 7, 12 and 13). The total sample size was 18. The census was 197. Findings are: A. Review of the agency policy and procedure titled Plan of Care, updated 11/2020, revealed there was no process in place for the development of the Hospice Aide (HA) plan of care, including patient-specific instructions and interventions. B. The observation of the provision of cares revealed: 1. On 12/21/21 at 1:30 PM, Patient 2 was observed to use a 4 wheeled walker for ambulation, have oxygen via nasal cannula at 5 liters per minute, and was wearing a soft neck brace. 2. On 12/22/21 at 11:00 AM, Patient 3 was observed to use a 4 wheeled walker, oxygen at 2 liters per minute, used a portable oxygen tank while ambulating and switched to an oxygen concentrator once at rest. 3. On 12/22/21 at 2:00 PM, Patient 4 was observed to report extreme fatigue, a fall in past week, and use of a 4 wheeled walker. It was also reported the patient's usual pulse rate is between 30 - 50 beats per minute (a low pulse rate which can cause dizziness, weakness, and fatigue). C. Review of Patient-2's clinical record revealed: 1. The Hospice Certification and Plan of Care for the certification period of 12/6/21- through 3/5/22 included: a). orders for HA services 1 time per week for 1 week, then 2 times a week for 12 weeks for assistance with personal care, hygiene, activities of daily living, and bathing, b). orders for wound care to an ulcer on the left buttock with ointment and dressing change, c). a diagnosis of dependence on supplemental oxygen. 2. The written Aide Care Plan Report (HA Plan of Care) failed to include interventions for the use of a 4-wheeled walker, soft neck brace, oxygen use, what to do for wound dressing protection and/or removal, reporting of changes in wound, and breathing patterns. D. Review of Patient-3's clinical record revealed: 1. The Hospice Certification and Plan of Care for the certification period of 11/20/21 through 2/17/22, included: a). orders for HA services 2 times per week for 12 week, then 1 time per week for 1 weeks, b). a diagnosis of dependence on supplemental oxygen. 2. A Client Coordination Note Report dated 11/20/21 revealed the patient owns a shower chair, uses oxygen as needed and has history of limited mobility of the left arm. 3. The Aide Care Plan Report did not include instruction to the HA for the use of oxygen, shower chair, or limitations of the left arm. E. Review of Patient- 4's clinical record reviewed: 1. The Hospice Recertification and Plan of Care Update for the certification periods 9/7/21 through 12/5/21 and 12/6/21 through 2/3/22 for the certification period of 11/10/21 through 1/8/22, included: a). orders for HA services 1 time per week for assistance with personal care, hygiene, activities of daily living. b). a diagnosis of a history of falls 2. The Aide Plan of Care Report did not include any of the instructions to the HA for the history of falls, assist level, use of walker, side effects to be aware of due to the patient's history of low pulse. The plan of care also listed all tasks only "as needed" basis versus specified frequencies. F. Review of Patient 5's clinical record revealed: 1. The Hospice Certification and Plan of Care for the certification period of 10/13/21 through 1/10/22, included: a). orders for HA 2 times a week for 12 weeks for assistance with personal cares, hygiene, and activities of daily living, b). a diagnosis of history of falls, c). wound dressing to left heel and left calf, d). has a suprapubic catheter (a catheter inserted through the abdominal wall into the bladder for drainage of urine). 2. The Aide Plan of Care Report did not include instructions to the HA regarding the type of durable medical equipment needed for ambulation (for instance a walker), the type of indwelling catheter, instructions related to the wound dressings to the left leg. The HA plan of care lists all tasks except for shower and nail care only on an "as needed" basis versus specified frequencies. G. Review of Patient 6's clinical record revealed: 1. The Hospice Certification and Plan of Care for the certification period of 11/12/21 through 2/9/22, included: a). orders for HA 2 times a week for 12 weeks, then 1 time per week for 1 week for assistance with personal cares, hygiene, and activities of daily living, b). diagnosis of history of falls and dependence on oxygen, c). the agency supplies durable medical equipment including tub/shower equipment, commode, wheelchair, and walker. 2. The Aide Plan of Care Report did not include instructions to the HA regarding the type of durable medical equipment needed for ambulation (for instance the walker), the type shower equipment to use, or how the patient manages their oxygen. H. Review of Patient 7's clinical record revealed: 1. The Hospice Recertification and Plan of Care Update for the certification periods of 9/21/21 through 11/19/21 and 11/20/21 through 1/18/22 included orders for HA 2 times per week for 1 week, then 3 times a week for 8 weeks; 2 times per week for 8 weeks respectively. 2. The Aide Plan of Care Report instructs the HA to transfer the patient from bed to chair to bed every visit but does not include the assist level or equipment needed to transfer the patient. I. Review of Patient 12's clinical record revealed: 1. The Hospice Recertification and Plan of Care Update for the certification periods of 10/12/21 through 12/11/21 and 12/12/21 through 2/8/22 included: a). orders for HA 1 time per week for 1 week, then 2 times per week; and 3 times per week for 8 weeks, then 2 times per week for 2 weeks respectively, b). the agency supplies include shower/tub equipment. 2. The Aide Plan of Care Report instructs the HA to transfer the patient from bed to chair to bed, and assist with toileting every visit but does not include the assist level or equipment needed to transfer the patient. The plan of care also instructs the HA to provide shower to patient 2 times per week but does not indicate the type of shower/tub equipment to utilize. J. Review of Patient 13's clinical record revealed: 1. The Hospice Certification and Plan of Care for the certification period of 8/11/21 through 11/8/21 and The Hospice Recertification and Plan of Care Update for the period of 11/9/21 through 2/6/21 included: a). orders for HA 2 times a week for 12 weeks and 1 time per week for 13 weeks, respectively for assistance with personal cares, hygiene, and activities of daily living, b). diagnoses of dependence on supplemental oxygen, presence of urinary device (flexible plastic tube inserted in the bladder to drain urine when a person cannot urinate) and presence of colostomy (opening for the colon, or large intestine, through the abdomen, usually with a bag attached to collect stool). 2. The Aide Plan of Care Report instructs the HA to transfer the patient from bed to chair to bed every visit but does not include the assist level or equipment needed to transfer the patient, and does not include the presence of a colostomy or urinary catheter or the patient's use of oxygen. K. During an interview on 12/29/21 at 4:30 PM, the Administrator and the Director of Clinical Services confirmed the Hospice Aide Plan of Care for Patient's 2, 3, 4, 5, 6, 7, 12, and 13 did not include all necessary patient-specific care instructions to ensure the hospice aide was able to effectively meet all patient care goals.