Every finding on record at Topkare Hospice Inc

Observed in Emergency Management Session. the organization did not initially educate and train staff, and individuals providing services under arrangement on the following: education on activation and deactivation of the plan; the communication plan; emergency response policies and procedures; evacuation, shelter-in-place, lockdown, and surge procedures; and obtaining resources and supplies. This was learned during the Emergency Management system tracer and confirmed by the CEO, Medical Director, and Director of Patient Care Services.

Observed in Record Review. In 2 of 19 patient records reviewed, the organization failed to complete an initial comprehensive assessment no later than five calendar days after the election of the hospice benefit. In record RRNHV#4 a spiritual assessment was not completed within the required number of days. This RFI was reviewed, discussed, and validated with the CEO, Medical Director, and Director of Patient Care Services.

Observed in Record Review. In 1 of 19 patient records reviewed, the organization failed to document a patient specific comprehensive assessment. For example, record of RRHV#1 did not include an initial bereavement assessment. This RFI was reviewed, discussed, and validated with the CEO, Medical Director, and Director of Patient Care Services.

Observed in Record Review. In 19 of 19 patient records reviewed, the organization did not ensure that patients’ plans of care were based on required goals and time frames. For example, goals were not specific and measurable. As well, targeted completion dates passed without resolution or revision, or coincided with interdisciplinary meetings. This RFI was reviewed, discussed, and validated with the CEO, Medical Director, and Director of Patient Care Services.

Observed in Record Review. In 19 of 19 patient records reviewed, the organization did not ensure that all services necessary to meet the patient's needs were represented in the plan of care. For example, there were no regularly scheduled visits ordered for spiritual and psychosocial care providers. Rather, both disciplines were ordered to visit patients for certification/recertification and prn. This RFI was reviewed, discussed, and validated with the CEO, Medical Director, and Director of Patient Care Services.

Observed in Record Review. In 4 of 19 patient records reviewed, where an oxygen concentrator was present, the organization did not ensure that all services necessary to meet the patient's needs were represented in the plan of care. In records RRHV#4, RRNHV#1, RRNHV#5, and RRNHV#8 there were orders for the oxygen concentrator, but none for the oxygen that included liter flow settings, delivery mode, frequency, and rationale for use. This RFI was reviewed, discussed, and validated with the CEO, Medical Director, and Director of Patient Care Services.

Observed in Record Review. In 3 of 3 patient records reviewed, where death occurred, the organization provided bereavement services, but failed to document interdisciplinary approval of the plans of care in records RRBR#1, RRBR#2, and RRBR#3. This RFI was reviewed, discussed, and validated with the CEO, Medical Director, and Director of Patient Care Services.

Observed in Patient Home. In 2 of 2 home visits conducted, where equipment was used and cleaned, the organization did not implement its infection prevention and control activities. For example, during RRHV#1 and RRHV#4 the surveyor observed that nurses used Sanicloths but did not follow the manufacturer's guidelines for use requiring dwell time of two minutes. This RFI was reviewed, discussed, and validated with the Owner/CEO/Administrator, Medical Director, and Director of Patient Care Services.

Observed in Record Review. In 3 of 3 patient records reviewed, where death occurred, the organization provided bereavement services to families, but failed to document a plan of care that specified the type of bereavement services offered and the frequency of service delivery in records RRBR#1, RRBR#2, and RRBR#3. This RFI was reviewed, discussed, and validated with the CEO, Medical Director, and Director of Patient Care Services.

Observed in Patient Home. In 1 of 2 home visits conducted, where medications were reconciled, the list at the board and care facility where patient RRHV#4 lived was inaccurate. For example: there were two separate orders for Atrovent 0.02% created five days apart with the same instructions; an order for Lorazepam 2mg/ml 0.25 ml daily at bedtime was not discontinued when a new order for Lorazepam 2mg/ml 0.5 ml daily at bedtime was ordered; an order for Tylenol 325 mg two tablets every 4 hours as needed for pain did not include a warning not to exceed 3,000 mg in 24 hours; the patient refused to take Simethicone 80 mg chewable 1 tablet 20 to 30 minutes before each meal since it was ordered four months prior to this survey date; Seroquel 25 mg 1 tablet twice daily ordered 11 days prior to this survey date had not been delivered; a comfort kit medication, Levsin SL 0.125 mg sublingual every 6 hours as needed for secretions was missing; and an order for Lotrimin 1% 3 cms daily for one week written four months prior to this survey date was not discontinued and the tube was still with the current medications. This RFI was reviewed, discussed, and validated with the Owner/CEO/Administrator, Medical Director, and Director of Patient Care Services.

Observed in Record Review. In 1 of 1 patient records reviewed, the surveyor observed that the Aide plan of care did not reflect the care needed by the patient. Observed in home visit #1, the patient stated he had become to weak to sit or stand in the shower and the Aide was now giving him a bed bath. The Aide documentation on 12/8 and 12/10 reflected giving a bed bath, however, the plan of care had not been changed to reflect the care needed. Additionally, there was no communication note from the Aide to the RN, regarding the change n the patient's condition. This observation was reviewed and discussed with the Medical Director .