Every finding on record at Thc Hospice Care Acquisitions, LLC

Observed in Record Review. During HV# 3, RR# 5, and RR# 6's patient record review it was noted the organization had not ensured staff followed the organization's policy, Safety Program – EC75 that included completing a fall risk assessment on all patients at start of care and recertification; and the Fall Preventions Program that included completing a fall risk assessment whenever a fall occurs. For example: review of HV# 3's patient record revealed HV# 3 had sustained a fall with injuries approximately 18 days prior to the surveyor review of the record. Further review of the record revealed no documentation of a fall risk assessment. Further review of HV# 3's revealed three falls with injuries one days prior to the surveyor review of the record with a fall risk assessment completed. Review of RR# 5 and RR# 6 patient records revealed fall risk assessments at start of care with the risk for falls. Further review of RR# 5 and RR# 6's patient records revealed no documentation of a fall risk assessment at recertification as required per policy. This was reviewed, discussed, and validated with the Administrator/Branch Director. Observed in Record Review. In 4 of 9 active patient records reviewed, During HV# 1's patient record review it was noted the organization had not ensured staff completed wound measurements as required by policy, Wound Assessment Standard Operating Procedure Document number 213 that included at a minimum weekly measurements of all wounds and more often if significant changes are noted upon assessment. For example: review of HV# 1's patient record revealed HV# 1 was admitted approximately 17 days prior to the surveyor review of the record. Review of the RN start of care comprehensive assessment revealed wound # 1, a mid-back pressure ulcer stage IV that was not assessed at start of care due to the wound dressing had recently been changed. Further review of HV# 1's patient record revealed wound # 1 measured two days after the start of care. Further review of HV# 1's patient record revealed no additional wound measurements. This was reviewed, discussed, and validated with the Administrator/Branch Manager.

Observed in Record Review. In 2 of 9 active patient records reviewed, During RR# 1 and RR# 4's patient records review it was noted the organization had not ensured the plan of care included patient's goals, time frames, settings, and services required to meet those goals. For example: review of RR# 4's plan of care revealed no time frames for the goals. Review of RR# 1's plan of care revealed goals with the same time frame to include nursing, medical social worker, and chaplain to develop a care plan 31 days after start of care. In addition the goal patient will receive assistance with personal care and hygiene and other activities of daily living as needed with the time frame of 31 days after the start of care. This was reviewed, discussed, and validated by the Administrator/Branch Director.

Observed in Record Review. In 9 of 9 patient records reviewed with oxygen, During HV# 1, HV# 2, HV# 3, RR# 1, RR# 2, RR# 3, RR# 4, RR# 5, and RR# 6's patient records review it was noted the organization had not ensured the plan of care included all services, needed for the palliation and management of the terminal illness and related conditions including measurable outcomes anticipated from implementing and coordinating the plan of care; Medications and treatments necessary to meet the patient's needs; and medical supplies and appliances necessary to meet the patient's needs. For example: Review of HV# 1’s patient record revealed HV# 1 had a new skin tear wound #3. Further review of HV# 1’s patient record revealed wound care provided to include packing it with AG [silver foam dressing], approximately 17 days prior to the surveyor review of the record. However, review of HV# 1’s record revealed no wound care orders for wound #3. During HV# 2’s home observation it was noted HV# 2 required a Hoyer lift for transfers. However, review of HV# 2’s plan of care revealed no documentation of a Hoyer lift. Review of RR# 4's patient record revealed an order for continuous oxygen at 11 liters per minute (LPM)with no information on how the oxygen would be delivered/route. Review of HV# 1, RR# 2, RR# 3, and RR# 6's plans of care revealed oxygen order for 2-5 LPM PRN [as needed] with no information on how the oxygen would be delivered/route. Review of RR# 5’s patient record revealed oxygen at 2 LPM at night with no information on how the oxygen would be delivered/route. Review of Hv# 3’s patient record revealed oxygen at 2 LPM PRN with no information on how the oxygen would be delivered/route. Review of RR# 1's plan of care revealed oxygen order for 1-5 LPM PRN with no information on how the oxygen would be delivered/route. Further review of RR# 1's patient record revealed RR# 1 was on a pureed diet due to dysphagia and a diagnosis of long-term anticoagulation. However, review of RR# 1's plan of care revealed no aspiration precautions or bleeding precautions. This was reviewed, discussed, and validated by the Administrator/Branch Director.

Observed in Record Review. In 4 of 7 active patient records reviewed with Hospice Aide services, During HV# 1, HV# 2, RR# 3, and RR# 6's patient records review it was noted the organization had not ensured the hospice aide followed the plan of care. For example: review of RR# 3's patient record revealed an Aide Care Plan with the task of documentation of the last BM [bowel movement]. Review of RR# 3's hospice aide visit documentation revealed four/four visits with no documentation regarding the last BM. Review of HV# 2's patient record revealed an Aide Care Plan with the task of documentation of the last BM. Review of HV# 2's hospice aide visit documentation revealed seven/seven visits with no documentation regarding the last BM. Review of RR# 6’s patient record revealed an Aide Care Plan with the task of documentation of the last BM. Review of RR# 6’s aide visit documentation for current certification period with four/four visits with no documentation regarding the last BM. Review of HV# 1's patient record revealed HV# 1's start of care was approximately 17 days prior to the surveyor review of the record with documentation of five hospice aide visit notes. Review of HV# 1's Aide Care Plan revealed the task of shower. However, review of the hospice aide visits notes revealed three of the five visits with documentation of a bed bath and no documentation the RN was notified. During HV# 1's home observation HV# 1's spouse shared that HV# 1 had only received bed baths since start of care. This was reviewed, discussed, and validated with the Administrator/Branch Director.

Observed in Patient Home. In 2 of 2 home visits conducted with vital sign equipment, During HV# 2 and HV# 3's home observation it was noted the organization had not ensured staff followed the contact time (wet time) as specified by Sani-wipes IFU and alcohol wipes IFU. For example: during HV# 2's home observation the Registered Nurse was observed cleaning the pulse oximetry, thermometer, stethoscope, and B/P cuff with a Sani-wipe and immediately placed each item into the nurse bag without allowing the minimum of two-minute contact time prior to putting the equipment into the nurse bag. During HV# 3's home observation the RN was observed cleaning the thermometer and pulse oximetry with an alcohol pad and placed each item into the nurse bag without allowing at minimum 30 seconds of contact time. In addition, during HV# 3's home observation the RN placed the stethoscope and B/P cuff on top of the nurse bag after use and then left the home and went to the car where the Sani-wipes were located and wiped the Stethoscope with a Sani-wipe and placed it over the car door and then wiped the B/P cuff with a Sani-wipe and placed the B/P cuff immediately into the nurse bag without allowing the minimum two minutes of contact time to disinfect. Next the RN was observed wiping the Stethoscope with another Sani-wipe and placed it immediately into the bag without allowing the minimum two minutes of contact time to disinfect. This was discussed with the Administrator/Branch Director and validated. Observed in Patient Home. In 2 of 2 home visits conducted with nurse bags, During HV# 2 and HV# 3's home observations it was noted the organization had not ensured staff followed the organization's Infection Control and Prevention Plan with Branch Specific Risk Analysis Policy and Procedure 10, bag technique, that included the nurse bag should be closed during the visit when not being accessed and the nurse bag supplies included handwashing equipment such as antimicrobial soap, alcohol based waterless hand rub and paper towels. For example: during HV# 2 and HV# 3's home observation the nursing bags remained open during the home visits. In addition, during HV# 2’s home observation the Registered Nurse (RN) shared there was no soap or alcohol based waterless hand rub available in the bag and was observed leaving HV# 2’s room to go to the public restroom to complete hand hygiene. This was discussed with the Administrator/Branch Director and validated. Observed in Patient Home. In 3 of 3 home visits conducted, During HV# 1, HV# 2, and HV# 3's home observations it was noted the organization had not ensured staff performed hand hygiene at times required by organizational policies Hand Hygiene and Bag Technique. For example: during HV# 1's home observation the Home Health Aide (HHA) was observed removing gloves and putting on new gloves without performing hand hygiene. In addition, the HHA was observed using the same pair of gloves to clean a bowel movement then wash HV# 1's back and then apply lotion to HV# 1's back. During HV# 2 the Registered Nurse (RN) was observed removing gloves and putting on new gloves without performing hand hygiene multiple times to include applying skin barrier to the anal area and then removed the gloves and used the electric bed controls to adjust HV# 2 without performing hand hygiene after removing the gloves. In addition, during HV# 2's home observation the RN was observed entering the nurse bag on multiple times without performing hand hygiene prior to entering the nurse bag. During HV# 3's home observation the RN was observed entering the nurse bag multiple times without performing hand hygiene prior to entering the nurse bag. This was discussed with the Administrator/Branch Director and validated.

Observed in Record Review. In 5 of 7 active patient records reviewed with Hospice Aide services, During HV# 1, RR# 1, RR# 2, RR# 3, and RR# 5's patient records review it was noted the organization had not ensured the registered nurse (RN) prepared complete written patient care instructions for the hospice aide. For example: review of HV# 1's patient record review revealed two pressure ulcer wounds with dressings. Review of HV# 1's Aide Care Plan revealed the task of a shower. Further review of the Aide Care Plan revealed no documentation of wounds, dressings, or instructions on keeping the dressings dry. In addition, review of HV# 1's patient record revealed HV# 1 was at risk for falls. However, further review of the Aide Care Plan revealed no documentation of fall precautions. Review of RR# 1's patient record revealed RR# 1 was on a pureed diet due to dysphagia. Review of RR# 1's Aide Care Plan revealed the task of assist with feeding. Further review of the Aide Care Plan revealed no documentation of RR# 1's puree diet or aspiration precautions. Further review of RR# 1's patient record revealed documentation the hospice aide assisted RR# 1 with feeding during nine visits since start of care. Review of RR# 2 and RR# 5's patient records revealed RR# 2 and RR# 5 were at risk for fall. Review of the Aide Care Plans revealed no documentation of fall precautions. Review of RR# 3's patient record revealed a diagnosis for dysphagia and a pureed diet order. Further review of RR# 3's patient record revealed RR# 3 was at risk for falls. Review of the Aide Care Plan revealed no documentation of aspiration precautions or fall precautions. This was reviewed, discussed, and validated with the Administrator/Branch Director.