Every finding on record at Transcendence Hospice & Palliative Care, LLC

Observed in Emergency Management Session. On review of the organization's Emergency Management Plan and on interview with the Administrator and DON it had been found that the organization had not conducted any exercises to test its emergency operations plan in 2022 and 2023. The organization reported they thought a fire drill in the office was a exercise. Fire drills were completed for 2022 and 2023.

Observed in Individual Tracer. In 2 of 10 patient records reviewed, it was found that the RN had not made a visit to the patient every 15 days, as required. For example for HV # 1 the RN had made a visit in February and not again until 22 days later ( The LVN had seen the patient in between). For HV # 2, the RN had made a visit in February but not again until 22 days later ( the LVN had seen the patient in between).. This was validated by the DON and the Administrator.

Observed in Individual Tracer. In 12 of 12 patient records reviewed, it was found the the Hospice Plans of Care were defined/set computer generic, with generic problems, generic interventions, and generic goals. Also, the outcome/time frames were not specific or were the end of the episode. For example, for HV #1 the Problem was Cardiac output, the Intervention was assess for factors affecting cardiac/circulatory function, and the goal was display hemodynamic stability e.g. BP, cardiac output, peripheral pulses, renal perfusion, and the time frame was end of the episode. Another Problem for HV # 1 was Fall Risk, the Intervention was encourage use of non- slip footwear, the goal was being free of fall injuries, and the time frame was end of episode. ( The patient had a high fall risk score, had increase weakness and significant inability to move as noted in clinical notes in March. In April 2024 patient was now wandering at night and had increased dyspnea with moderate exertion). For HV # 2 the plan of Care for Cardiac had the exact same problem. interventions, goals and time frame as HV # 1 had . For HV #3 the Problem was Bladder disturbance, the Intervention was assess for signs and symptoms of infection, the Goal was demonstrate the safe use of bladder regiment , and the time frame was end of episode. For RR # 6 the patient had a high risk fall score of 24, the problem was Fall risk, the Intervention was evaluated the use, miss use or failure to use Assistive devices, the Goal was Being free of falls, and the time frame was end of episode. For RR # 1 , diagnosis moderate protein calorie malnutrition, the Problem was Nausea and Vomiting, the Intervention was provide supplemental fluid and electrolyte replacement, the Goal was demonstrate accurate knowledge of condition and understanding of treatment and regimen. These were validated by the DON and the Administrator.

Observed in Individual Tracer. In 1 of 12 patient records reviewed, it was identified that on the admission visit the RN had documented Wound dressing done and patient on p.o. antibiotic for wound infection. There was no evidence that a specific wound care intervention had been incorporated in the plan of care and no evidence of what antibiotic the patient was prescribed. The wound's assessed measurements , on admission, were length by width 4x3 cm, with a depth of 3 cm, tunneling of 3 cm , purulent yellow drainage and foul odor. The patient was seen the following day by the LVN but no wound care was evidenced as having been provided. The Administrator was unable to show evidence of what the current wound care order was or the antibiotic ordered. This was validated by the DON and the Administrator.

Observed in Individual Tracer. In 2 of 3 home visits conducted, it was observed that the nurse had not followed standard of practice and the organization's hand hygiene policy # 9.009.1 and the Bag technique policy # 9-014.1 for hand hygiene. The policy identified prior to administering care, alcohol - based hand rub will be removed and hands will be washed. Hand washing will always be completed before opening the nursing bag. After hand washing, supplies and or equipment needed for the visit will be removed from the bag. Hands will be decontaminated prior to returning clean equipment to bag. On observation the nurse had an open satchel type bag without a closure. She had to enter her bag to access her hand gel ( which she did not remove from the bag) and equipment . Each time she needed to access the hand gel she went back in her bag. She did clean the equipment after use, but did not decontaminate her hands prior to returning the cleaned equipment to the bag. This was validated by the nurse at the visit. Observed in Individual Tracer. In 2 of 3 home visits conducted, it was observed that the nurse had not followed the organization's bag technique policy # 9-014.1. The policy identified prior to administering care, alcohol - based hand rub will be removed and hands will be washed. Hand washing will always be completed before opening the nursing bag. After hand washing, supplies and or equipment needed for the visit will be removed from the bag. The bag will contain a designated clean and dirty area. Hands will be decontaminated prior to returning clean equipment to bag. On observation the nurse had an open satchel type bag without a closure. She had to enter her bag to access her hand gel ( which she did not remove from the bag) and equipment . Each time she needed to access the hand gel she went back in her bag. She did clean the equipment after use, but did not decontaminate her hands prior to returning the cleaned equipment to the bag. The bag did contain two sections however on observation , with the nurse, the sections were not well separated and various content appeared to be spilling over to the separate sections. This was validated by the nurse at the visit.

Observed in Individual Tracer. that received hospice aide services, it was found that the RN had not done a supervisory visit every 14 days to supervise the Hospice Aide. For HV # 1 a supervisory visit we done in February 2024 and not again for 22 days. For HV # 2 a supervisory visit was done in February 2024 and not again for 22 days. This was confirmed by the DON and Administrator.

Observed in Individual Tracer. In 2 of 3 home visits conducted, it was found that the medication profile in the computer and the printed medication profile the nurse had on the visit were not accurate. For example, for HOS HV #1 the patient had a prescription bottle for Levothyroxine 500 mg three times a day which was ordered on admission nine months ago, however, this was not on the medication profile. In addition the patient had a prescription for Simvastatin 20 mg daily in the evening , which again was initially order 9 months ago. It was not on the medication profile. The caregiver at the group home did validated these medications was on the MAR that the group home kept and the patient was receiving them as outlined on the prescription bottles. For HOS HV # 2 the medication profile had not been updated. For example Debrox drops 6.5% 5 gtts each ear daily for 5 days was ordered the second week of February 2024, however, this was still on the medication profile. These were validated by the RN on the visit.

Observed in Individual Tracer. In 6 of 6 patient records reviewed, of patients that had oxygen, it was found that a home oxygen safety risks assessment had not been completed on admission, therefore there had not been the ability to educate the patient, family and or caregiver about the following: the findings of the safety risk assessment , the causes of fire , fire risks for neighboring residences and buildings, precautions that can prevent fire-related injuries ,and recommendations to address the specific identified risk(s). This was validated by the Administrator.