Every finding on record at Tides Hospice, LLC

Observed in Individual Tracer. The surveyor noted (RRHV#3) that there was no plan of care to manage seizures. The surveyor noted that the certification statement indicated that the patient had recently experienced seizures and was started on Keppra. although Keppra was included as an ordered medication, there was no plan of care for managing seizure activity.. In (RRAR#1), the surveyor noted that the patient was started on Cephalexin for a skin tear/wound infection; however, the care plan did not include management of the infection . In (RRAR#2), the plan of care did not include goals or interventions for managing the patient's urinary tract infection. In (RRAR#5) the patient's husband was performing dipstick urine testing and antibiotics were ordered; however management of the patient's recurrent urinary tract infection was not addressed on the care plan, although two rounds of antibiotics were ordered. This was confirmed with the clinical director.

Observed in Record Review. The surveyor noted (RRNHV#7) that the patient assessment indicated that the patient's pain level was 5/10. The plan of care included a goal for no pain; however the target date for achievement was at the end of the 90 day certification period and there was no short term goal to reduce the pain level. This was confirmed with the clinical director.

Observed in Individual Tracer. In 7 of 14 patient records reviewed, The surveyor noted (RRHV#1) that there were three medications ordered for constipation without and indication for use as needed. The choices for medications included Bisac-Evac suppository daily as needed, Milk of Magnesia daily as needed and Fleet Enema daily as needed and did not indicate the order in which to administer the medications. Also, the order for Oxygen was unclear and read O2 NC 2-4LPM continuous however the patient was not on oxygen during the home visit. In discussion with the clinical director the order was suppose to be as needed prn for dyspnea. Also, in (RRHV#2) there were three medications ordered as needed for pain including Tylenol 325 mg. two tablets every 6 hours prn, Morphine 0.25 ml oral every 4 hours prn and Morphine 0.5 ml oral every 4 hours prn, however, there was no indication as to which medication to administrator for which type or degree of pain. Also, there were three medications for constipation that did not specify which order to administer. In (RRNHV#7) the orders included both Tramadol and Morphine for pain as needed without specification of which medication to administer either first or based on the level of pain. This was confirmed with clinical director.

Observed in Document Review. In 4 of 5 contracts reviewed, The surveyor noted that the manner in which contracted services will be coordinated, supervised, and evaluated by the hospice was not identified in the Medical Director, Associate Medical Director, SNF/GIP/Respite or the pharmacy contract. This was confirmed with the clinical director.

Observed in HR File Review. In 1 of 9 HR files reviewed, The surveyor noted that there was no evidence in the personnel file of the alternate medical director (HR#2AMD) that an orientation had been completed. This was confirmed with the clinical director.

Observed in Individual Tracer. In 1 of 14 patient records reviewed, The surveyor noted (RRHV#2) that a hospice nurse visit note, found in the skilled facility hospice chart, was scribbled over. The name, date and first line item entry was redacted in pen and did not follow the organizational policy. This was confirmed with the clinical director .

Observed in Infection Control Tracer. In 2 of 10 patient records reviewed, The surveyor noted (RRHV#2) that the hospice failed to insure that a care plan was created to identify which provider was responsible for performing the functions that have been agreed upon. There was no delineation of responsibility indicated for managing and performing treatments, including medication monitoring and administration, wound assessment and wound care and personal care needs. Also, in (RRNHV#6) the surveyor noted that the patient was admitted to hospice in the skilled nursing facility; however, the care plan did not specifically identify which provided was responsible for the respective functions. This was confirmed with the clinical director.

Observed in Individual Tracer. In 1 of 3 home visits conducted, The surveyor noted (RRHV#2) that the hospice file in the skilled nursing facility record was incomplete. The file did not include the Certification of Terminal Illness, hospice physician orders or the hospice plan of care since admitted 12 days ago. This was confirmed with the clinical director.