Every finding on record at The Visiting Nurse Association of Texas

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as hand hygiene. This standard was not met as evidenced by document review, interview, and observation. In 2 of 6 (33%) home visit observations conducted, the agency did not ensure the staff followed the hospice policy for the use of standard precautions to prevent the spread of infection. Agency Policy Hand Hygiene Policy, stated in part; "All Hospice staff providing patient care will perform hand hygiene in accordance with Centers for Disease Control and Prevention (CDC) recommendations." "E. With hands held upright, staff will dry and wrists thoroughly with a clean paper towel. They will use a paper towel to turn off the faucet." " "II. Hand Hygiene with an alcohol-Based Hand Rub...1. Prior to initial entry into the supply bag;4. After touching a patient or the patient's immediate environment." HOME VISIT 5: During the home visit (Clinical Record 5) on 01/28/2025 to observe the Registered Nurse (RN) (Personnel Record 5), the RN was observed to wash her hands with soap and water for 20 seconds and then touch the handles of the faucet to turn the water off with her right hand without using a paper towel to turn off the faucet. HOME VISIT 6: During Home Visit 6 (Clinical Record 6) on 01/28/2025 to observe the Registered Nurse (RN) (Personnel Record 6), the Registered Nurse assessed the patient and reached into the nursing bag to place the blood pressure cuff back into the bag. The RN did not perform hand hygiene after touching the patient. In an interview with the Hospice Administrator on 01/28/2025, it was confirmed that the agency policy for hand hygiene was not followed during home visit 5 and home visit 6.

It is required that the hospice designates a Registered Nurse member of the IDG to ensure the implementation of the interdisciplinary plan of care. Hospice care and services provided to patients and families follow the individualized plan of care established by the hospice IDG in collaboration with the attending physician (if any). This standard was not met as evidenced by joint clinical record review and interview. 2 of 20 (10%) clinical records revealed the agency failed to follow the written individualized plan of care established by the interdisciplinary group. Record # 94977 was reviewed and identified the patient elected hospice on 12/3/21. The chaplain visit frequency of 1-2 times per month X 4 months was ordered on 12/3/21. Routine chaplain visits were completed on 1/3/22, 1/18/22, and 1/31/22. During an interview, the administrator stated the monthly visit frequency is based on a calendar month. There was no documentation explaining the reason the ordered frequency was not followed. During an interview on 2/17/22, the administrator stated that she spoke with the chaplain, he started seeing the patient every other week and did not change the visit frequency order. Record #83362 was reviewed and identified the patient elected hospice on 1/23/22. The MSW visit frequency order of 1 X month was ordered on 1/23/22. There was no evidence that a visit was made from 1/23/22-1/31/22. There was no documentation explaining the missed visit. During an interview on 2/18/22, the Director of Nursing (employee #86598) stated that she reviewed the medical record and was unable to find a visit or a missed visit documented. She agreed there should have been a visit made during that time frame or the visit frequency order should have started on 2/1/2022.

It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments and includes all services necessary for the palliation and management of the terminal illness, including medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review, observation, and interview. 2 of 20 (10%) clinical records reviewed revealed that the agency failed to ensure the written plan of care included the specific interventions implemented for the safety of the patients. Record #75677 was reviewed and identified that the patient elected hospice care on 4/12/21. During the home visit on 2/14/22, the patient was observed to be in a low bed that with a mattress that contained bolsters, and there was a fall matt on the floor next to the bed. Care plan, effective on 2/14/22, revealed a goal that stated "Pt/CG (patient/caregiver) will demonstrate actions to reduce fall risks" and one that state "Pt/CG will verbalize understanding of safety risk and need for correction". There were three interventions: "Assess home safety risks and instruct the caregiver in ways to correct/remove", Instruct pt/CG regarding environmental factors that increase risk of falls", and "assess history of previous falls and identify risks for falls". Plan of care section titled "DME (durable medical equipment)/Supplies" states "(agency name) welcome bag". Interview with the administrator occurred on 2/16/22, she acknowledged that these items were not present on the plan care, and they should have been. Record #65783 was reviewed and identified that the patient elected hospice care on 5/4/21. Clinical note, dated 2/13/2022, stated “the facility called to report patient had a witnessed fall, with no apparent injuries.” Safety/Fall risk care plan, effective 5/4/21, has one goal written which stated: "patient/caregiver will verbalize understanding of safety risk and need for correction". There was one intervention (effective 5/4/21) which stated: Obtain DME (durable medical equipment) as indicated to reduce risk of falls. It was documented within the adverse events section of the medical record that the patient has had a total of 12 falls since 5/16/21 with no documented changes made to the care plan interventions. Under the DME section it showed the patient had the following items: hospital bed, oxygen concentrator, overbed table, and wheelchair. In an interview on 2/17/22, the administrator reported that upon her review of the medical record she found documentation indicating collaboration with facility staff regarding possible alarms, taking patient out to the nurse’s station, and ordering a fall matt (ordered and delivered on 9/21/21). She agreed that these interventions should have been included in the care plan.