Every finding on record at Tri County Hospice

Based on record reviews and interview, the hospice failed to complete the patient's initial comprehensive assessment for two of 19 patient charts reviewed (Patient 7 and 18) when the Interdisciplinary Team (IDT) did not collaborate within 5 days after the patient election of hospice care. --- The findings are: On 9/11/23 at 2:15 PM, review of Patient 7's record revealed Patient 7 elected hospice care on 7/13/23. There was no documented evidence the IDT collaborated to complete the initial comprehensive assessment. The first IDT meeting was on 7/25/23 which 12 days after the patient's election of hospice services. On 9/13/23 at 3:46 PM, during an interview with the Regional Administrator (RA), she/he reviewed Patient 7's record and confirmed the findings. On 9/13/23 at 12:22 PM, review of Patient 18's record revealed Patient 18 elected hospice care on 7/18/23. There was no documented evidence that the IDT collaborated to complete the patient's initial comprehensive assessment within 5 days of the patient's election of hospice care. The first IDT meeting was on 7/27/23 which was 9 days after the patient's lection of hospice care. On 9/13/23 at 3:35 PM, during an interview with the RA, she/he reviewed Patient 18's record and confirmed the findings. On 9/13/23, the hospice's policy, titled, "Comprehensive Assessment", reads, "...The comprehensive assessment is completed by the interdisciplinary care members, in consultation with the individual's attending physician (if any), no later than five (5) calendar days after the election of the hospice benefit...".

Based on record reviews and interview, the hospice failed to ensure the hospice medication profiles were accurate for two of 18 applicable patients. (Patient 7 and 17) --- The findings are: On 9/11/23 at 9:12 AM, review of Patient 7's record revealed Patient 7 was admitted on 7/13/23 with a diagnosis of Benign Neoplasm of the Soft Tissue of the Peritoneum. There was a physician order for Morphine Sulfate Contin 15 mg (milligrams) dated 8/22/23. The medication was not listed on the patient's hospice medication profile. On 9/13/23, at 3:52 PM, during an interview with the Regional Administrator (RA), she/he reviewed Patient 7's record and confirmed the findings. On 9/13/23 at 1:00 PM, review of Patient 17's record revealed Patient 17 was admitted on 7/6/23 with a diagnosis of diffuse Large B-Cell Lymphoma. The nursing note dated 8/2/23 showed the nurse instructed the caregiver to increase the patient's medication Colace to two times a day. Colace was not on the patient's hospice medication profile. Further review of Patient 17's record on 9/13/23 at 1:00 PM revealed a nursing note dated 8/11/23 that reads, "... (the caregiver) reports she has not administered new antibiotic for UTI (urinary tract infection)..." There was no antibiotic listed on the patient's hospice medication profile. On 9/13/23, at 5:00 PM, during an interview with the RA, she/he reviewed Patient 17's record. The RA stated there was a laboratory urinalysis report that showed the urine sample was collected on 8/4/23 which indicated Patient 17 had a UTI. The RA printed the report which revealed a handwritten note at the top of the report, "Macrobid 100 mg BID (twice a day) 7 days." The RA confirmed the Macrobid antibiotic was not on the patient's hospice medication profile. On 9/13/23, the hospice policy, titled, "Comprehensive Assessment," revealed, "...The comprehensive assessment addresses the following...Prescribed medications, over the counter drugs, herbal remedies and alternative treatments that could affect drug therapy..."

Based on record reviews and interview, the hospice failed to ensure an initial bereavement risk assessment was completed for two of 19 applicable patients reviewed. (Patient 8 and 13) --- Chart review of Patient #8 on 09/12/2023 at 1:48 PM revealed Patient #8 was admitted on 10/26/2022 with a diagnosis of Alzheimers Disease, unspecified. There was no documented evidence that an initial bereavement risk assessment was completed. On 09/13/2023 at 2:50 PM, an interview was conducted with the Administrator who confirmed there was no documented evidence an initial bereavement risk assessment. On 9/13/23, at 10:13 AM Patient 13's record was reviewed. Patient 13 was admitted to hospice services with a diagnosis of Heart Failure on 3/17/23. There was no documented evidence an initial bereavement risk assessment was completed. On 9/13/23, at 3:28 PM the Regional Administrator (RA) reviewed Patient 13's record and confirmed the findings. On 9/13/23, the hospice policy titled, "Comprehensive Assessment" was reviewed. The policy indicated, "The comprehensive assessment addresses the following...Bereavement needs of the patient's caregiver and/or family..."

Based on observations and interview, the hospice failed to provide instruction and education for patient care and safe use of equipment for Patient #10. --- The finding includes Observations during a visit in Patient #10 home on 09/12/2023 from 12:00 PM to 12:35 PM revealed Patient #10 has a Hoyer lift that was not being used. The Caregiver revealed, ";We need something she can grab hold of...get some strength in her arms...this (handle of Hoyer) moves around too much." Caregiver also reported ";No training in how to use this (Hoyer Lift)...Im doing all the care on the weekends...learned by watching (the Aides)...hard to turn her." Caregiver also reported "; (Patient) has lots of pain...ran out of Tramadol...took a week to get it...pharmacy said it was never called in...dont think the nurse is following through...We asked her to call (MD/pharmacy) from the bedside...She doesnt...says she will call when she gets home or later". On 09/13/2023 at 2:45 PM, an interview was conducted with the Administrator who reported ";I need to hear these things."

Based on record reviews and interview, the hospice failed to develop an individualized written plan of care for two of 19 patients reviewed (Patient 7 and 17) when the patient's plans of care were not based on the problems identified in the patient's initial, comprehensive, and updated comprehensive assessments and did not include all services necessary for the palliation and management of the patient's terminal illness and related conditions. --- The findings are: On 9/13/23 at 9:12 AM, review of Patient 7's record revealed Patient 7 was admitted on 7/13/23 with a diagnosis of Benign Neoplasm of the Soft Tissue of the Peritoneum. The RN (Registered Nurse) Initial Assessment dated 7/13/23 showed, "...Fall Assessment...Total...7...A score of 4 or greater is considered at risk for falling...had a fall 1 week ago and hit his head...". The "RN Comprehensive Assessment," dated 8/22/23 showed, "...Patient had a fall on Friday 8/18 and was admitted to hospital for severe pain...". Further review of Patient 7's record of "Events" revealed another fall on 8/27/23. Review of the patient's plan of care for the benefit period 7/18/23 to 10/10/23 revealed there was no plan of care for safety/fall prevention. On 9/13/23 at 3:46 PM, during an interview with the Regional Administrator (RA), she/he reviewed Patient 7's record and confirmed the findings. The RA stated, "There should have been a fall/safety care plan." On 9/13/23 at 1:00 PM, review of Patient 17's record revealed Patient 17 was admitted on 7/6/23 with a diagnosis of Diffuse Large B Cell Lymphoma. The RN Comprehensive Assessment dated 8/2/23, showed, "... (family member) reports patient's urine has a strong odor...Requests a UA (urinalysis) to be completed due to patient history of UTI's...Specimen cup provided and (family member) will collect urine in the morning for nurse to pick up...". The RN Comprehensive Assessment dated 8/11/23, revealed, "... (family member) reports she has not administered new antibiotic for UTI...". There was a urinalysis report in Patient 17's record dated 8/8/23. Review of the care plan for the benefit period 7/6/23 to 10/3/23 revealed there was no care plan regarding UTI's. On 9/13/23, during an interview with the RA, she/he reviewed Patient 17's record and confirmed the findings.

Based on chart reviews and interview, the Registered Nurse (RN) failed to provide the hospice aide staff with accurate instructions for patient care for 5 of 14 applicable patients. (Patient 3, 4, 10, 15, and 16) --- The findings include: Chart review for Patient #3 on 09/13/2023 at 8:54 AM revealed the Aide Plan of Care (POC) for Patient #3 showed a visit schedule of 4 visits per week. Instructions included "Complete Bed Bath first and last visit; Partial bath and shower second and third visits, and shampoo hair first and last visit" were confusing. On 09/13/2023 at 2:50 PM, an interview was conducted with the Administrator who confirmed the findings. Chart review for Patient #4 on 09/13/2023 at 9:30 AM revealed the Aide POC for Patient #4 revealed visit schedule of 3 visits per week. Instructions included "Complete Bed Bath at patient request; Shampoo Hair ";once weekly on Wed (Wednesday); Shave "per patient request; Complete shower at patient request " were confusing. On 09/13/2023 at 2:23 PM, an interview was conducted with the Administrator who confirmed the findings. Chart review for Patient #10 on 09/13/2023 at 3:00 PM revealed the Aide POC for Patient #10 revealed a visit schedule of 5 visits per week. Instructions included "Change linen ";1 x(times) week on the first visit of the week". Patient is on a low loss air mattress which does not require linen to provide best practice to prevent pressure. There were no instructions for Aide to Check Pressure areas. On 09/13/2023 at 2:45 PM, an interview was conducted with the Administrator who confirmed the findings and reported ";Dont use linen on those mattresses". Chart review for Patient #15 on 09/13/2023 at 10:30 AM revealed the Aide POC for Patient #15 revealed visit schedule of 3 visits per week. Instructions included "Shampoo hair, ";1 X week on 1st visit of the week"; Nail Care 1 X week 2nd visit of the week" are confusing. On 09/14/2023 at 9:22 AM, an interview was conducted with the Administrator who confirmed the findings. Chart review for Patient #16 on 09/13/2023 at 11:23 AM revealed the Aide POC showed Patient #16 had a visit schedule of 3 visits per week. Instructions included "Nail Care ";3rd"" and :Change linen ";1st" are not specific and confusing. On 09/13/2023 at 2:55 PM, an interview was conducted with the Administrator who confirmed the findings.

Based on record reviews and interview, the hospice failed to provide scheduled or requested services on a holiday for two of 19 patient charts reviewed. (Patient 10 and 17) --- Chart review of Patient #10 on 09/13/2023 at 3 PM revealed Aide visit schedule 5 visits per week. Week of 09/03/2023 only has 4 visits. There was no documentation in the chart of missed visit. On 09/13/2023 at 2:45 PM, an interview was conducted with the Administrator who reported ";it was Labor Day holiday" and confirms the finding. On 9/13/23, at 1:00 PM Patient 17's record was reviewed. Patient 17 was admitted to hospice services on 7/6/23 with a diagnosis of Diffuse Large B-Cell Lymphoma. The Medical Social Worker (MSW) note dated 8/29/23 indicated, "(family member)...requested that I visit on Monday (9/4/23) when the paid caregiver is present as she has questions for me. Due to the upcoming holiday next Monday (9/4/23), a visit is tentatively scheduled for September 11th..." On 913/23, at 5:00 PM during an interview with the Regional Administrator (RA), she/he confirmed the family member requested a visit on a holiday and the MSW did not visit that day because it was a holiday. The RA confirmed the MSW should have visited the patient on the holiday.

Based on chart reviews, interviews, and hospice policy, entitled, ";Home Use and disposal of Controlled Substances HC.37", the hospice staff failed to follow policy regarding safe disposal of controlled drugs in the patients home for 2 of 2 applicable patients. (Patient #3 and Patient #4) --- The finding includes: Chart review for Patient #3 on 09/13/2023 at 8:54 AM revealed Patient #3 expired at home on 01/12/2023. There was no documentation in the patient's chart of signature from witness to drug disposal. On 09/13/2023 at 2:50 PM, an interview was conducted with the Administrator who confirmed there was no documented signature. Chart review for Patient #4 on 09/13/2023 at 9:30 AM revealed Patient #4 expired at home on 02/04/2023. There was no documentation in the patient's chart of signature from witness to drug disposal. On 09/13/2023 at 2:23 PM, an interview was conducted with the Administrator who confirmed there was no documented signature. Facility policy, entitled, ";Home Use and Disposal of Controlled Substances HC.37", revealed ";7 ... If conducting immediate disposal at the site of care, the nurse should perform the disposal in the presence of a witness, who shall sign a document indicating their witnessing of the disposal...".