Every finding on record at Ultracare Hospice & Palliative Care, Inc.

Observed in Record Review. In 4 of 4 patient records reviewed, for active hospice patients the nurse surveyor noted that the goals were not consistently measurable. For example, “Patient will minimize episodes of dyspnea during exertion and chest discomfort and maintain optimal peripheral circulation until next review,” and “Patient’s needs will be met/anticipated on a daily basis until next review.” Additionally, goals were mostly the same from patient to patient with minimal individualization. Time frames for completion were all “until next review” which was not clear if that was meant to me next recert or next IDG review. Findings were discussed with the Administrator/DPCS and the DPCS Designee.

Observed in Patient Home. In 3 of 3 home visits conducted, it was observed by the Nurse Surveyor that the organization did not implement the infection prevention and control activities it had planned per their “Hand Hygiene Policy No.9-009.01 and Bag Technique Policy No, 9-014.1”. For example, during RRHV#1 the hospice aide washed his hands with soap and water then donned gloves, he then knocked on the patient’s door with his gloved hand, set up everything needed to perform a chair bath to include filling the wash basins, gathering towels and clean clothes, and putting soap in the bath water. He then began the patient’s bath, assisting her to wash her face, all with the same pair of gloves on, changing gloves and performing hand hygiene between tasks per policy. During RRHV#2 the skilled nurse washed her hands, then went to the patient’s room where she laid out barriers, going in and out of her bag. She then used hand sanitizer, donned gloves, and took the patent’s vital signs, completed a head-to-toe assessment to include pulling down the patient’s diaper all with the same pair of gloves on. She then removed her gloves, used hand sanitizer, donned clean gloves, and cleaned her equipment allowing for the 4-minute dry time, she then put the clean equipment back in her bag with the same gloves she had on the clean the equipment. While doing the medication reconciliation, at the kitchen table, she touched notebooks, documented in her binder, touched the medication bottles, all without hand sanitizing at all during the entire process. During RRHV#3 the skilled nurse, washed her hands, went into the patient’s room, hung her bag on a doorknob, set out barriers and donned gloves. She then put out her equipment, took the patient’s vital signs, documented in her binder, and began her assessment all without changing gloves or performing hand hygiene. Findings were discussed with the Administrator/DPCS who was present during the visits.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the nurse surveyor that for RRHV#1 the hospice aide did not provide care according to the hospice aide plan of care. The hospice aide care plan instructed the hospice aide to assist the patient with a shower however, prior to going into the visit, the hospice aide stated the patient no longer liked to get in the shower and he gives the patient a bed bath. During the home visit he gave the patient a chair bath. Finding was verified by the Administrator/DPCS who was present during the visit. The hospice aide care plan was updated while surveyor was on site.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the nurse surveyor that for RRHV#1, the patient did not have an individualized emergency plan or education regarding one in their home. Finding was validated by the Administrator/DPCS who was present during the home visits.

Observed in Patient Home. While reviewing the documents in the home folder at HV#1, the surveyor found that neither the policy on advance directives nor the California advance directive requirements were provided. There was no documentation of the patient/family having been educated on the organization’s policy and the state requirements regarding advance directives. This was discussed with the Administrator and Director of Patient Care Services.

Observed in Record Review. In 4 of 4 patient records reviewed, it was noted that most goals were generic and very few included specific, measurable, attainable, relevant, and/or timely outcomes. Examples include: Patient/caregiver is adequately informed of pain management at all times; Patient’s discomfort from SOB will be relieved and or minimized with the intervention; Patient/caregiver/responsible part will understand changes in urinary output related to progression of the disease. In addition, targeted resolution dates were the last day of current benefit periods. This was discussed with the Administrator and Director of Patient Care Services.

Observed in Patient Home. During HV#1 the surveyor noted that narcotics were present for the patient, but there was no policy included in the patient’s home folder on the use and disposal of controlled medications. This was discussed with the Administrator and Director of Patient Care Services.