Every finding on record at Traditions Hospice of Scottsdale, LLC

Observed in Record Review. In 1 of 2 discharged patient records reviewed for ineligibility, During RR# 6's patient record review it was noted the organization had not ensured it complied with law and regulation. For example: review of RR# 6's patient record revealed a discharge due to ineligibility as no longer terminally ill. Review of IDG/POC updates dated 26 days and 12 days prior to discharge revealed no documentation RR# 6's was no longer eligible for hospice or that a discharge was being planned. Review of the patient record revealed a discharge order for extended prognosis dated five days prior to the discharge date. Review of the RN visit note, dated one day prior to discharge date, revealed documentation that the daughter and group home owner were aware of discharge. Further review of the record revealed a Notice of Medicare Non-Coverage with the patient's name and no documentation of a signature. In addition, a Five Day Discharge form had documentation of an employee signature with no documentation of a phone call or signature from the patient/family representative. Further review of the record revealed a note from the scheduler dated approximately 12 days after the discharge date that the family refused to sign. This was reviewed, discussed, and validated with the Branch Director.

Observed in Record Review. In 1 of 7 active patient records reviewed, During RR# 4's patient record review it was noted the organization had not ensured the initial bereavement assessment was completed. For example: review of RR# 4's patient record revealed RR# 4 start of care was approximately 40 days prior to the surveyor review of the record. Further review of RR# 4's patient record revealed no documentation of an initial bereavement assessment. This was discussed and validated with the Branch Director.

Observed in Record Review. In 4 of 7 active patient records reviewed, During HV# 1, HV# 2, HV# 3, and RR# 1's patient records review it was noted the organization had not ensured the Chaplain documented in the Interdisciplinary group (IDG) meeting notes progress toward desired outcomes. For example: review of HV# 1's IDG/POC updates revealed multiple IDG/POC updates with no Chaplain documentation. Review of HV# 2's IDG/POC updates revealed multiple IDG/POC updates with no Chaplain documentation. Review of HV# 3's IDG/POC updates revealed multiple IDG/POC updates with no Chaplain documentation. Review of RR# 1's IDG/POC updates revealed multiple IDG/POC updates with no Chaplain documentation. This was discussed and validated with the Branch Manager.   Observed in Record Review. In 1 of 7 active patient records reviewed, During HV# 1's patient record review it was noted the organization had not ensured the registered nurse updated the comprehensive assessment no less than every 15 days. For example: review of HV# 1's patient record revealed the RN did not visit the hospice patient for 21 days and the LPN conducted the assessments every week. This was reviewed, discussed, and validated with the Branch Director.

Observed in Record Review. In 5 of 7 active patient records reviewed, During HV# 1, HV# 2, HV# 3, RR# 1, and RR# 2's patient records review it was noted the organization had not ensured the plan of care was based on the patient's goals and the time frames, settings, and services required to meet those goals. For example: review of HV# 1's plan of care revealed a terminal diagnosis of Senile Degeneration of the Brain. further review of the plan of care revealed a Chaplain goal, Patient/Caregiver will fee relief from spiritual concerns, and a MSW goal Patient/caregiver will have decreased fear/anxiety regarding death and dying process.” However, the goals were not measurable or have time frames for achieving the goals. Review of HV# 2’s plan of care revealed the goal “Patient will verbalize/demonstrate reductions of relief of cardiopulmonary symptoms” and a Chaplain goal “patient/caregiver will feel relief from spiritual concerns”. However, the goals were not measurable or have time frames for achieving the goals. Review of HV# 3’s plan of care revealed the goal “Pain will be managed at a level acceptable to the patient” with no indication on what was acceptable to the patient. Further review of the plan of care revealed the goals “Patient/Caregiver will feel relief from spiritual concerns” and “Patient/caregiver will have decreased fear/anxiety regarding death and dying process”, with no time frames and not measurable. Review of RR# 1’s plan of care revealed the goals “Patient and Caregiver will have decreased fear/anxiety regarding death and dying process” and Patient/caregiver will feel relief from spiritual concerns” with no time frames and not measurable. Review of RR# 2’s plan of care revealed the goal “Pain will be managed at a level acceptable to the patient within 3 days” with no indication what is an acceptable pain level was for the RR# 2. Further review of the plan of care revealed the goals “Patient/caregiver will have decreased fear/anxiety regarding death and dying process” and “Patient/caregiver will feel relief from spiritual concerns” with no time frames and not measurable. This was reviewed and validated with the Branch Director.

Observed in Record Review. In 4 of 7 active patient records reviewed, During HV# 1, HV# 3, RR# 1, and RR# 2's patient records review it was noted the organization had not ensured the plan of care included interventions to manage pain and symptoms. For example: review of HV# 1's medication profile revealed Oxycodone 5mg every four hours as needed for pain and Tramadol 50 mg every eight hours as needed for pain with no indication on when to take the pain medication, such as mild, moderate, or severe pain. Review of HV# 1's patient record revealed HV# 1 had dysphagia and mechanical soft diet. Review of HV# 1's plan of care revealed no documentation of aspiration precautions. Review of HV# 3’s medication profile revealed Morphine 5 mg every four hours as needed for pain and Tylenol 650 mg every four hours as needed for pain with no indication on when to take pain medication, such as mild, moderate, or severe pain. Review of RR# 2’s medication profile revealed Tylenol 650mg every four hours for pain and Tramadol 50mg every six hours for pain with no indication on when to take the pain medication. Review of RR# 2’s Skilled Nursing visit notes revealed RR# 2 was on oxygen at 2lpm per nasal cannula as needed. However, review of the plan of care revealed no documentation of oxygen. Review of RR# 1’s patient record revealed documentation, nine days prior to the IDG/POC update, of a “Boil to the Butt”. Review of the IDG/POC update revealed no documentation of the new finding. This was reviewed and validated with the Branch Director.

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 did not ensured it implemented infection prevention and control activities when cleaning and performing disinfection of medical devices to include contact time (wet time) as specified by the disinfectant manufacturer's IFU. For example: during HV# 1's home observation the registered nurse (RN) was observed cleaning the stethoscope, B/P Cuff, thermometer, and pulse oximetry with Kim tech wipe and immediately placed the equipment into the bag. During HV# 2 and HV# 3's home observations the RN was observed cleaning the stethoscope, B/P cuff, thermometer, and pulse oximetry with a Sani-cloth and immediately placed the equipment into the bag. This was reviewed and discussed with the 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 followed organization policy Hand Hygiene no IC15 that included performing hand hygiene prior to entering the nurse bag. For example: during HV# 1 the registered nurse was observed cleaning the stethoscope, B/P cuff, thermometer, and pulse oximetry and placed each one into the bag immediately with out performing hand hygiene prior to entering the bag. During HV# 2 and HV# 3's home observations the RN was observed cleaning the stethoscope, B/P cuff, thermometer, and pulse oximetry and placed each one into the bag immediately with out performing hand hygiene prior to entering the bag. This was reviewed, discussed, and validated with the Branch Director. Observed in Patient Home. In 1 of 3 home visits conducted, During HV# 1's home observation it was noted the organization had not ensured the registered nurse followed the organization's Bag Technique policy IC12, that included Bag should never be placed on the floor. For example: during HV# 1's home observation the RN placed a barrier on the floor and then placed the bag on the floor. This was reviewed, discussed, and validated with the Branch Manager

Observed in Record Review. In 1 of 7 active patient records reviewed with hospice aide services, During HV# 1's patient record review it was noted the organization had not ensured the registered nurse prepared complete written patient care instructions for the hospice aide. For example: review of HV# 1's patient record revealed HV# 1 used a Hoyer lift or a Sara lift as needed for transfers. However, there was no documentation of a Hoyer lift or Sara lift for transfers on the hospice aide written instructions. This was discussed and validated with the Branch Director.

Observed in Record Review. In 2 of 7 active patient records reviewed with hospice aide services, During HV# 2 and HV# 3's patient records review it was noted the organization had not ensured the hospice aide provided services as ordered in the plan of care. For example: review of HV# 2 and HV# 3's hospice aide written instructions revealed the task of documenting the last BM (bowel movement) and notifying the RN if it was greater than three days. Review of HV# 2 and HV# 3's Hospice aide visit notes revealed documentation of Y or N, n/a under last BM date, with no documentation of a date of the last BM. This was discussed and validated with the Branch Director.

Observed in Record Review. In 1 of 7 active patient records reviewed, During HV# 1's patient record review it was noted the organization had not ensured the Hospice aide supervision was done every 14 days per law and regulation. For example: review of HV# 1's patient record revealed RN supervisory visit completed 21 days apart, as the LPN provided services weekly for two weeks during that time frame. This was reviewed and discussed and validated with the Branch Director.

Observed in HR File Review. In 5 of 11 HR files reviewed, During HR# 1 (LPN), HR# 3 (MSW), HR# 4 (Medical Director), HR# 5 (associate Medical Director), and HR# 11 (HHA) it was noted the organization had not ensured staff received annual Bloodborne Pathogen education per OSHA regulation. For example: review of the HR files revealed no documentation of annual education of Bloodborne Pathogens. This was reviewed, discussed, and validated with the Branch Director.

Observed in Record Review. In 2 of 7 active patient records reviewed, During HV#1 and RR# 1's patient record review it was noted the organization had not ensured the patient record contained information that reflected the patient's care, treatment, or services. For example: review of HV# 1's patient record revealed two IDG/POC updates with inaccurate dates. Review of RR# 1's patient record revealed RR# 1 was a resident of a Skilled Nursing Facility (SNF). Further review of the patient record revealed no documentation of coordination of care with the SNF, as the coordination of care notes were in the SNF patient record. This was reviewed, discussed, and validated with the Branch Manager. Observed in Patient Home. In 1 of 2 home visits conducted with medication review, During HV# 1's home observation it was noted the organization had not ensured the patient record contained information that reflected the patient's care, treatment, or services. For example: during HV# 1's home observation the registered nurse was observed performing a medication reconciliation. During the medication reconciliation it was noted HV# 1's group home medication administration record contained the order for MiraLAX 17mg daily as needed for constipation. Review of HV# 1's medication profile revealed no documentation of MiraLAX. This was observed and discussed with the RN during the home observation and discussed and validated with the Branch Director.