Every finding on record at Uhs Corona Inc

Based on observation, interview, and record review, the agency failed to regularly monitor, update, and reconcile the agency's medication profile for changes in medications, to ensure the patients were educated in medication administration, potential medication and vitamin interactions, and adverse side effects of medication, for two of 11 sampled patients (Patients 1 and 2). This agency failure increased the potential of medication administration errors and placed Patients 1 and 2 at risk to experience adverse side effects and/or medication interactions. Findings: 1. On February 22, 2022, a record review for Patient 1 was conducted. Patient 1 was admitted to the hospice agency on January 10, 2022, with diagnoses which included heart failure (the inability of the heart to pump blood effectively). Patient 1's recertification period was January 10, 2022, through April 9, 2022. On February 23, 2022, at 9:22 a.m., a home visit for Patient 1 was conducted with Registered Nurse (RN) 1. On February 23, 2022, beginning at 9:59 a.m., a comparison of the agency's medication profile (according to physician's order) and the medications present in Patient 1's home was conducted with Registered Nurse (RN) 1. Three medications and three vitamin supplements were observed readily available for use and were not included on the agency's medication profile: - Six individually wrapped acetaminophen (medication to treat fever) 650 mg (milligram - unit of measurement) suppository with a label which indicated, "...unwrap and insert 1 (one) suppository rectally (administer through the anus) every six hours as needed for temperature 101 or above...;" - Multiple packs of polyethylene glycol (medication to treat constipation) powder with a label which indicated, "...mix 1 (one) packet in 4-6 (four to six) ounces of water and drink it daily...;" and - One bottle of Senna - S (medication used as a stool softener and for constipation) 50 mg/8.6 mg; - One bottle of Vitamin D3 (supplement for bone health) 125 mcg (microgram - unit of measurement); - One bottle of Centrum Silver (multiple vitamins); and - One bottle of PreserVision (supplement for vision). In a concurrent interview with Patient 1's family member, she stated the medications and vitamin supplements were being administered to Patient 1 since admission to hospice on January 10, 2022. Further review of Patient 1's record indicated skilled nursing visits were conducted on January 10, 13, 18, 21, 25, 28, 2022, February 2, 10, 15, 18, 22, 23 (total of 12 skilled nursing visits). There was no documented evidence the agency medication profile was updated by the licensed nurse during the 12 skilled nursing visits. On February 23, 2022, at 10:58 a.m., RN 1 was interviewed. She stated medication reconciliation (medication profile compared to medication at hand) should be completed at each skilled nursing visit. 2. On February 22, 2022, a record review for Patient 2 was conducted. Patient 2 was admitted to the hospice agency on December 23, 2021, with diagnoses which included Alzheimer's disease (memory loss). Patient 2's recertification period was December 23, 2021, through March 22, 2022. On February 23, 2022, at 2:05 p.m., a home visit for Patient 2 was conducted with RN 1. On February 23, 2022, beginning at 2:40 p.m., during review and comparison of the agency's medication profile and medications present in Patient 2's home was conducted with RN 1. There were three medications discrepancies found during medication profile reviews for Patient 2. a. The physician's order, dated December 23, 2021, indicated, "...Donepezil HCL (medication to treat dementia - memory loss) Oral Tablet 5 MG (milligram - unit of measurement) TAKE ONE TABLET PO (by mouth) Q (every) HS (bedtime)." During comparison review of the donepezil medication on hand, the label indicated, "...Start 5 mg (1 tablet) nightly for 1 month, then 10 mg (2 tablets) nightly, date ordered October 10, 2021..." In a concurrent interview with RN 1, She stated Patient 2 should have received donepezil 10 mg since admission on December 23, 2021. b. The physician's order, dated December 23, 2021, indicated, "...Levothyroxine (medication to treat thyroid disorder) Sodium Oral Tablet 25 MCG (microgram - unit of measurement) TAKE ONE TABLET PO DAILY." During medication comparison review of the levothyroxine medication on hand, the label indicated, "Levothyroxine 50 mcg every morning." In a concurrent interview with RN 1, she verified the physician's order of levothyroxine 25 mcg was not administered to Patient 2 correctly. RN 1 stated she should have clarified with the physician the order for donepezil and levothyroxine. c. The physician's order, dated December 23, 2021, indicated, "...Diclofenac Sodium External Gel 1% (medication applied to skin, to treat pain) 60 gm (gram - unit of measurement) APPLY 2 GMS TO SHOULDER Q PRN (as needed) PAIN." RN 1 was observed to search for the diclofenac gel inside the bags and was not able to locate the medication. In a concurrent interview with RN 1, she confirmed the diclofenac medication was not readily available to use for Patient 2. In addition, the following medications were observed readily available for use and were not included on the the agency's medication profile: - One bottle of Tylenol Extra Strength (medication to treat pain and fever) 500 mg (milligram) caplet; - One bottle of Senna S (medication to treat constipation) 50 mg/8.6 mg; and - One bottle of famotidine (medication to treat stomach acid) 40 mg, with a label indicating to take one tablet twice a day. In a concurrent interview with Patient 2, she stated she had been taking Tylenol, Senna, and famotidine. Further review of Patient 2's record indicated the skilled nursing visits were conducted on: - December 23, 27, and 29, 2021; - January 3, 6, 11, 13, 16, 17, 21, 25, and 28, 2022; - February 1, 4, 7, 15, and 18, 2022 (total of 17 skilled nursing visits) There was no documented evidence indicating the agency medication profile was reviewed and updated during the 17 skilled nursing visits. In a concurrent interview with RN 1, she confirmed the Tylenol Extra Strength, Senna S, and famotidine medications were not included on Patient 2's medication profile. She stated the Tylenol Extra Strength, Senna S, and famotidine medications should have been included on the agency's medication profile for Patient 2. On February 24, 2022, at 10:53 a.m., the Interim Director of Hospice (ID) was interviewed. The ID stated it was the responsibility of the skilled nurse to compare the agency's medication profile and the medications at hand during each skilled nurse visit. The ID stated the licensed nursing staff should have reviewed the agency's medication profile during the certification visit and any subsequent visits for Patients 1 and 2 and should have clarified with the patient's physician if there were discrepancies with the agency's medication profile and the medication at hand. The facility's policy and procedure titled, "Physician Order Process," revised date February 2021, was reviewed. The policy indicated, "...To ensure that all clinical services are implemented only in accordance with a plan of care established by a physician's written orders and physician orders are reviewed for appropriateness and accuracy, communicated to staff, and processed in a timely manner to meet regulation deadlines..." The facility's policy and procedure titled, "Medication Management," revised date October 2017, was reviewed. The policy indicated, "...The clinician will review all the medications the patient currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and non compliance with drug therapy...The clinician will assess adherence to the prescribed medication regimen and the effect of medications on the patient at every visit..."

Based on interview and record review, the agency failed to ensure an initial bereavement assessment was completed timely, for six of 11 sampled patients (Patient 1, 2, 5, 8, 10, and 11). This agency failure had a potential for the patient's families, significant others, and caregivers for Patients 1, 2, 5, 8, 10, and 11, to be at risk for not having their bereavement needs met after the patient's death. Findings: The facility's policy and procedure titled, "Bereavement Services," revised date July 2007, was reviewed. The policy indicated, "...A bereavement risk assessment will be completed upon admission to the Hospice program...A Bereavement Risk Assessment will be completed by the social worker on admission to Hospice..." 1. On February 24, 2022, Patient 1's record was reviewed. The record indicated Patient 1 was admitted to the agency on January 10. 2022, with a primary diagnosis of heart failure (the inability of the heart to pump blood effectively). There was no documented evidence an initial bereavement assessment was conducted for Patient 1. 2. On February 24, 2022, Patient 2's record was reviewed. The record indicated Patient 2 was admitted to the agency on December 23. 2021, with a primary diagnosis of Alzheimer's disease (memory loss). There was no documented evidence an initial bereavement assessment was conducted for Patient 2. 3. On February 25, 2022, Patient 5's record was reviewed. The record indicated Patient 5 was admitted to the agency on October 11, 2021, with a primary diagnosis of Alzheimer's disease. There was no documented evidence an initial bereavement assessment was conducted for Patient 5. 4. On February 25, 2022, Patient 8's record was reviewed. The record indicated Patient 8 was admitted to the agency on October 18, 2021, with a primary diagnosis of vascular dementia (loss of memory). There was no documented evidence an initial bereavement assessment was conducted for Patient 8. 5. On February 28, 2022, Patient 10's record was reviewed. The record indicated Patient 10 was admitted to the agency on June 21, 2021, with a primary diagnosis of end stage renal disease (kidneys having difficulty filtering urine). There was no documented evidence an initial bereavement assessment was conducted for Patient 10. 6. On February 28, 2022, Patient 11's record was reviewed. The record indicated Patient 11 was admitted to the agency on October 20, 2021, with a primary diagnosis of atherosclerotic heart disease (hardening of the blood vessels). There was no documented evidence an initial bereavement assessment was conducted for Patient 11. On February 25, 2022, at 11:35 a.m., the Medical Social Worker (MSW) was interviewed. The MSW confirmed she did not conduct an initial bereavement assessment for Patients 1, 2, 5, 8, 10, and 11. She stated, "It should be done by the Bereavement Coordinator." On February 28, 2022, at 2:27 p.m., a concurrent interview and record review was conducted with the Interim Director of Hospice (ID). The ID confirmed there was no documented evidence an initial bereavement assessment was conducted for Patients 1, 2, 5, 8, 10, and 11. The ID stated a bereavement assessment for Patients 1, 2, 5, 8, 10, and 11, should have been completed upon admission.

Based on interview and record review, the agency failed to ensure: 1. The order for the frequency of the visits by the Medical Social Worker (MSW) was obtained from the physician, for 10 of 11 sampled patients (Patients 1, 2, 3, 4, 5, 6, 7, 8, 10, and 11); and 2. The order for the frequency of visits by the Chaplain was obtained from the physician, for 11 of 11 sampled patients (Patients 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, and 11); These agency failures had the potential for Patients 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, and 11, to not receive the necessary care and services. Findings: 1. On February 24, 2022, Patient 1's record was reviewed. The record indicated Patient 1 was admitted to the agency on January 10. 2022, with a primary diagnosis of heart failure (the heart is not pumping as well as it should be). The physician's order, dated January 10, 2022, indicated, "...MEDICAL SOCIAL WORKER: Frequency: PER ASSESSMENT...CHAPLAIN for spiritual support and comfort PER ASSESSMENT..." There was no documented evidence the agency obtained a physician order for the frequency of the plan of care visit for the MSW and the Chaplain after the initial assessment or visit for Patient 1. 2. On February 24, 2022, Patient 2's record was reviewed. The record indicated Patient 2 was admitted to the agency on December 23, 2021, with a primary diagnosis of Alzheimer's disease (memory loss). The physician's order, dated December 28, 2021, indicated, "...MEDICAL SOCIAL WORKER: Frequency: PER ASSESSMENT...CHAPLAIN for spiritual support and comfort PER ASSESSMENT..." There was no documented evidence the agency obtained a physician order for the frequency of the plan of care visit for the MSW and the Chaplain after the initial assessment or visit for Patient 2. 3. On February 24, 2022, Patient 3's record was reviewed. The record indicated Patient 3 was admitted to the agency on May 4, 2021, with a primary diagnosis of respiratory failure (lung failure). The physician's order, dated May 5, 2021, indicated, "...MEDICAL SOCIAL WORKER: Frequency: x (times) 1 (one)...CHAPLAIN for spiritual support and comfort PER ASSESSMENT..." There was no documented evidence the agency obtained a physician order for the frequency of the plan of care visit for the MSW and the Chaplain after the initial assessment or visit for Patient 3. 4. On February 28, 2022, Patient 4's record was reviewed. The record indicated Patient 4 was admitted to the agency on April 12, 2021, with a primary diagnosis of COPD (chronic obstructive pulmonary disease - a lung disease that makes it difficult to breathe). The physician's order, dated April 13, 2021, indicated, "...MEDICAL SOCIAL WORKER: Frequency: ASSESSMENT...CHAPLAIN for spiritual support and comfort..." There was no documented evidence the agency obtained a physician order for the frequency of the plan of care visit for the MSW and the Chaplain after the initial assessment or visit for Patient 4. 5. On February 25, 2022, Patient 5's record was reviewed. The record indicated Patient 5 was admitted to the agency on October 11, 2021, with a primary diagnosis of Alzheimer's disease. The physician's order, dated October 11, 2021, indicated, "...MEDICAL SOCIAL WORKER: Frequency: PER SOCIAL WORKER ASSESSMENT...CHAPLAIN for spiritual support and comfort PER CHAPLAIN ASSESSMENT..." There was no documented evidence the agency obtained a physician order for the frequency of the plan of care visit for the MSW and the Chaplain after the initial assessment or visit for Patient 5. 6. On February 25, 2022, Patient 6's record was reviewed. The record indicated Patient 6 was admitted to the agency on May 7, 2021, with a primary diagnosis of cardiomyopathy (heart disease where the heart could not efficiently pump blood to the rest of the body). The physician's order, dated May 8, 2021, indicated, "...MEDICAL SOCIAL WORKER: Frequency: ASSESSMENT...CHAPLAIN for spiritual support and comfort ASSESSMENT..." There was no documented evidence the agency obtained a physician order for the frequency of the plan of care visit for the MSW and the Chaplain after the initial assessment or visit for Patient 6. 7. On February 25, 2022, Patient 7's record was reviewed. The record indicated Patient 7 was admitted to the agency on April 4, 2021, with a primary diagnosis of atherosclerotic heart disease (hardening of the blood vessels). The physician's order, dated April 4, 2021, indicated, "...MEDICAL SOCIAL WORKER: Frequency: PER SOCIAL WORKER ASSESSMENT...CHAPLAIN for spiritual support and comfort..." There was no documented evidence the agency obtained a physician order for the frequency of the plan of care visit for the MSW and the Chaplain after the initial assessment or visit for Patient 7. 8. On February 25, 2022, Patient 8's record was reviewed. The record indicated Patient 8 was admitted to the agency on October 18, 2021, with a primary diagnosis of dementia (loss of memory). The physician's order, dated October 19, 2021, indicated, "...MEDICAL SOCIAL WORKER: Frequency: ASSESSMENT...CHAPLAIN for spiritual support and comfort ASSESSMENT..." There was no documented evidence the agency obtained a physician order for the frequency of the plan of care visit for the MSW and the Chaplain after the initial assessment or visit for Patient 8. 9. On February 28, 2022, Patient 10's record was reviewed. The record indicated Patient 10 was admitted to the agency on June 21, 2021, with a primary diagnosis of end stage renal disease (the kidneys are unable to filter urine). The physician's order, dated June 21, 2021, indicated, "...MEDICAL SOCIAL WORKER: Frequency: ASSESSMENT...CHAPLAIN for spiritual support and comfort..." There was no documented evidence the agency obtained a physician order for the frequency of the plan of care visit for the MSW and the Chaplain after the initial assessment or visit for Patient 10. 10. On February 28, 2022, Patient 11's record was reviewed. The record indicated Patient 11 was admitted to the agency on October 20, 2021, with a primary diagnosis of atherosclerotic heart disease. The physician's order, dated October 21, 2021, indicated, "...MEDICAL SOCIAL WORKER: Frequency: ASSESSMENT...CHAPLAIN for spiritual support and comfort..." There was no documented evidence the agency obtained a physician order for the frequency of the plan of care visit for the MSW and the Chaplain after the initial assessment or visit for Patient 11. 11. On February 28, 2022, Patient 9's record was reviewed. The record indicated Patient 9 was admitted to the agency on February 21, 2021, with a primary diagnosis of atherosclerotic heart disease. The physician's order, dated February 21, 2021, indicated, "...CHAPLAIN for spiritual support and comfort: SPIRITUAL ASSESSMENT..." There was no documented evidence the agency obtained a physician order for the frequency of the plan of care visits for the Chaplain after the initial assessment or visit for Patient 9. On February 28, 2022, at 11:15 a.m., the Interim Director (ID) of Hospice was interviewed. The ID confirmed there was no physician's order to indicate the frequency of visits for the plan of care by the MSW for Patients 1, 2, 3, 4, 5, 6, 7, 8, 10, and 11, . She stated there was no physician orders to indicate the frequency of visits for the plan of care by the Chaplain for Patients 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, and 11. She stated there should be a physician's order for the frequency of visits in the plan of care after the initial assessments were conducted by the MSW and the Chaplain. The facility's policy and procedure titled, "Reassessments," revised date October 2017, was reviewed. The policy indicated, "...The physician is contacted when changes in the patient suggest the need to alter the plan of care/ treatment or to verify the continued care/ services, and his/ her agreement with continued plan of care...Change/ verbal orders are generated and forwarded to the physician whenever the reassessment determines a need to change the plan of care/treatment...The Nurse manager or designee will review all reassessments completed for recertification..." The facility's policy and procedure titled, "Spiritual Services," revised date date October 2009, was reviewed. The policy indicated, "...A physician's order is necessary for the chaplain visits. The frequency is approved by the IDG (Interdisciplinary Group - a group of health professionals working together for the benefit of the patient) team. The initial physician's orders should specify the frequency and duration of the visits..."

Based on observation, interview, and record review, the agency failed to ensure: 1. The hospice aide home visits (HAHV) were received according to the physician's order, for two of 11 sampled patients (Patients 1 and 11); and 2. The skilled nursing visits (SNV) were received according to the physician's order, for one of 11 sampled patients (Patient 1). These failures had the potential for Patients 1 and 11 to not receive the visits according to the plan of care and the physician's order and increased the potential for unrecognized decline in the patient's condition. Findings: 1. On February 24, 2022, Patient 1's record was reviewed. The record indicated Patient 1 was admitted to the agency on January 10, 2022, with a primary diagnosis of heart failure (inability of the heart to pump blood effectively). Patient 1's certification period was January 10, 2022, through April 9, 2022. a. The physician's order, dated January 10, 2022, indicated, Patient 1 required two HAHV beginning the week of January 10, 2022, for one week, then three HAHV for 13 weeks thereafter. The HAHV records indicated the hospice health aide conducted visits on the following dates: - Week 2 (January 16 to January 22, 2022); January 21, 2022 (one visit); - Week 3 (January 23, 2022 to January 29, 2022); January 25 and 28, 2022 (two visits); - Week 4 (January 30, 2022 to February 5, 2022); February 1 and 4, 2022 (two visits); - Week 5 (February 6 to 13, 2022); February 8 and 10, 2022 (two visits); and - Week 6 (February 14 to 20, 2022); February 15 and 18, 2022 (two visits). There was no documentation indicating the reason for the missed HAHVs for Weeks 2, 3, 4, 5, and 6. b. The physician's order, dated January 10, 2022, indicated Patient 1 required two to three skilled nursing home visits for 14 weeks and five as needed visits. The SNV records indicated the licensed nurse conducted SNV on February 2, 2022 (one visit) on the week of January 30 to February 5, 2022 (Week 4). The skilled nursing visit records indicated the licensed nurse conducted SNV on February 10, 2022 (one visit) on the week of February 6 to 13, 2022 (Week 5). There was no documentation indicating the reason for the missed SNVs for Weeks 4 and 5. 2. On February 28, 2022, Patient 11's record was reviewed. The record indicated Patient 11 was admitted to the agency on October 18, 2021, with a primary diagnosis of atherosclerotic heart disease (hardening of the blood vessels). Patient 11's certification period was October 20, 2021, through January 17, 2022. The physician's order, dated October 21, 2021, indicated Patient 11 required two HAHV for one week then three HAHV for 13 weeks thereafter. The hospice health aide visits were conducted by the HA on October 21, 2021 (one visit) on Week 1 (October 20 to October 23, 2021). There was no documentation indicating the reason for the missed HAHV for Week 1. On February 28, 2022, at 3:12 p.m., the Interim Director of Hospice (ID) was interviewed. The ID confirmed Patients 1 and 11 had missed health aide and skilled nursing visits. She stated the HAHV and SNV for Patients 1 and 11 should have been conducted according to the physician's order.