Every finding on record at Thalia Hospice Care Inc

Upon patient record review, 1 of 5 (Patient #3) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #3: There was no evidence of an initial bereavement assessment in the record.

Upon patient record review, 2 of 5 (Patients #2, 3) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #2: The staff reported patient has 2 healed areas on her bottom on each "cheek" and an open area on the coccyx. The RN initial assessment states there are no skin issues other than healed areas. There is a POC for skin breakdown prevention, but no evidence of a wound POC with interventions and goals. The RN noted patient had seizures on initial assessment. There are no goals or interventions for seizures. The patient is on an anticoagulant. There are no interventions or goals for bleeding precautions. The diet needs and aspiration are listed in a GI pathway but no evidence of a specific nutrition pathway with interventions and goals and diet documented. Patient #3: The patient is on diabetic medications which are listed as covered by hospice. There are no interventions or goals for Diabetes on the POC. The patient is on Xarelto for history of DVT and PE. There are no interventions or goals related to bleeding precautions or use of anticoagulants on the POC.

Upon patient record review, 2 of 5 (Patient #2, 3) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient #2: The plan of care does not list all DME for the patient including low air loss mattress, fall mat, rolling shower chair, or over the bed table. The plan of care does not specify that the wheel chair is a high back reclining wheelchair, which leads to specific needs in relation to safety. It also does not include wound care supplies or thickener. Patient #3: This patient is on diabetic medications provided by hospice. Her diabetic supplies are not included on the plan of care.

Upon home visit observation, 1 of 5 (Patient #1), there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #1: During the home visit with RN, RN did not use proper infection control standards of practice and bag technique. She took her equipment out of her bag and placed it on the patient's kitchen table. She then took a barrier out of her bag and set it down and moved the equipment to the barrier. After the equipment was used, she did not clean the equipment prior to placing it back in her bag.

Upon personnel record review, 1 of 12 (Personnel #10) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel#10: Upon review of personnel record, this aide had not had a skills competency for feeding or assisting with feeding a patient or on modified diets and feeding a patient with aspiration precautions. The only competency on the checklist related to food was "adequate nutrition and fluid intake". The hospice aide had been performing this task with Patient #2.

Upon patient record review, 1 of 5 (Patient #2) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #2: The aide POC states that patient is "complete bedrest" but also states "wheelchair" This patient is total care of 6/6 ADLS. The aide cannot determine whether patient should be on complete bedrest or in wheelchair. The aide POC also did not include aspirations precautions, bleeding precautions for anticoagulation use, or seizure precautions as RN assessment states seizures in neuro portion of assessment. The aide POC also did not include shower chair for shower, or fall mat for fall precautions.

Upon patient record review 1 of 5 (Patient #2) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #2: This patient was reviewed by surveyor during joint home visit and observed the aide feeding the patient who is on a modified diet of pureed with nectar thickened liquids . This patient is end stage Alzheimer's disease with dysphagia and aspiration precautions. This task was not on the aide POC. The aide stated that they had called the RN "to add it to the POC"

Upon patient record review, 1 of 5 (Patient #5) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patient #5: There was no evidence of a discharge summary was sent to the MD.

Upon patient record review, 1 of 5 (Patient #5) did not have evidence that the discharge summary includes all required information. Patient #5: There was no evidence of a discharge summary in the record.

Upon personnel record review, 1 of 12 (Personnel # 8) did not have evidence the hospice obtained a criminal background check on all contracted individuals who have direct patient care and access to patient records. Under Nevada state regulations NRS 449, you must conduct a fingerprint-based criminal history background check on each employee and each independent contractor if you are the administrator of, or you are licensed to operate, any of the following: • Agency to provide personal care services in the home • Agency to provide nursing in the home • Facility for intermediate care • Facility for skilled nursing • Residential facility for groups • Homes for individual residential care Personnel 8: did not have fingerprint criminal history background checks completed.

Upon personnel record review, 8 of 12 (Personnel #1,2,3,4,9,10,11,12) did not have evidence of criminal background checks being obtained in accordance with state requirements. In the absence of state requirements, criminal background checks are obtained within three months of the date of employment for all states that the individual has lived or worked in the past 3 years. Under Nevada state regulations NRS 449, you must conduct a fingerprint-based criminal history background check on each employee and each independent contractor if you are the administrator of, or you are licensed to operate, any of the following: • Agency to provide personal care services in the home • Agency to provide nursing in the home • Facility for intermediate care • Facility for skilled nursing • Residential facility for groups • Homes for individual residential care Personnel 1, 2, 3, 4, 9, 10, 11, 12: did not have fingerprint criminal history background checks completed.