Every finding on record at Traditions Hospice of Tucson, LLC

Observed in Record Review. In 1 of 3 patient records reviewed, where patients were discharged, the surveyor noted in the records of RR#6 that the Notice of Medicare Non-Coverage was not signed by the patient. This was confirmed by the Administrator.

Observed in Record Review. In 3 of 3 patient records reviewed, where the patient had wounds, the hospice did not document comprehensive assessments and re-assessments that identified the severity of symptoms of the terminal illness and related conditions. For example, in the records of HV#1, RR#4, and RR#5 wound measurements were not documented weekly as required by the Wound Assessment policy 213. This was confirmed by the Administrator and Branch Director

Observed in Record Review. In 4 of 13 patient records reviewed, the hospice failed document a bereavement assessment as part of the initial comprehensive assessment in the records of HV#1, HV#3, RR#2, and RR#5. This was confirmed by the Administrator and Branch Director.

Observed in Record Review. In 11 of 13 patient records reviewed, where the interdisciplinary group had met more than twice, the organization did not update comprehensive assessments to reflect changes that had occurred since the initial assessment. The surveyor found that notes did not document on-going patient decline, progress toward goals, and plans for the next two weeks in the records of HV#1, HV#2, HV#3, RR#1, RR#3, RR#4, RR#5, RR#6, RR#7, RR#8, and RR#10. This was reviewed with the Administrator and Branch Director.

Observed in Record Review. In 1 of 13 patient records reviewed, the hospice did not ensure that all services, medications, and treatments necessary to meet patients’ needs were represented in the plan of care. For example, in the records of HV#2, RR#2, and RR#7 prn visits for the spiritual counselor or social worker were ordered without having a regular visit schedule. This was reviewed with the state Administrator and Branch Director.

Observed in Record Review. In 7 of 7 patient records reviewed, where oxygen was ordered, ranges were used without identifying the circumstances for use of each liter flow setting in the records of HV#1, HV#2, RR#2, RR#3, RR#5, RR#8, and RR#9. This was reviewed with the Administrator and Branch Director.

Observed in Patient Home. In 1 of 3 home visits conducted, the hospice did not use standard precautions to reduce the risk of infection. At HV#2 the CNA did not perform hand hygiene prior to entering the home, or donning gloves before starting care. These observations were reviewed with the Administrator and Branch Director.

Observed in Record Review. In 1 of 13 patient records reviewed, the medical director did not provide written certification that the patient’s life expectancy was six months or less if the illness ran its normal course. In the record of RR#2 the surveyor found that the medical director signed the Certificate of Terminal Illness but did not complete the narrative section. This was confirmed by the Administrator and Branch Director.