Every finding on record at Unified Hospice Care, LLC

Observed in HR File Review. In 2 of 7 HR files reviewed, the agency failed to document emergency management training every 2 years. In HR#1 and HR#2 the agency documented initial training on the emergency management plan but could not produce documentation of training every 2 years. This was validated with the Administrator.

Observed in Record Review. In 1 of 1 patient records reviewed, for patients discharge alive the discharge notice was not signed at least two days in advance of discharge. In HORR#5 the NOMC was signed on the day of discharge.

Observed in Record Review. In 1 of 11 patient records reviewed, the agency failed to complete a multidisciplinary assessment within 5 days of the election of hospice In HOHV#3 the initial social work assessment occurred on day 16 of care and there was no documentation of the reason for delay. This was validated with the administrator.

Observed in Record Review. In 9 of 11 patient records reviewed, the patient record included duplicate medications. In HOHV#1 the medication list included DuoNeb every 4 hours for SOB/wheezing and DuoNeb every 6 hours for SOB/congestion/wheezing; acetaminophen Every 4 hours - PRN Mild to Moderate Pain/Fever and Morphine Every 4 hours - PRN pain/shortness of breath. HOHV#2 the medical record included Tylenol tabs and suppository for pain/fever and Morphine for pain/sob. HOHV#3 had Tylenol tablets and suppositories and morphine for pain; Docusate pills and Dulcolax suppositories for constipation. HORR#1 had Tylenol caplets and suppository for mild to moderate pain/fever and Morphine for pain/sob; Senna and Dulcolax for constipation. HORR#2 had Tylenol suppository for mild to moderate pain, Norco for moderate pain, and Ultram for pain. HORR#4 had Tylenol suppositories for mild to moderate pain/fever and morphine for pain/sob. HORR#5, HORR#6 and HORR#7 had multiple prn meds for the same indication without differentiation. This was validated with the administrator.

Observed in Record Review. In 1 of 11 patient records reviewed, the plan of care did not include any short term goals. In HORR#3 the initial plan of care did not have any target dates or any other method to document the priority of the established goals. This was validated with the administrator.

Observed in Record Review. In 7 of 11 patient records reviewed, the plan of care did not include the scope and frequency of all services necessary to meet the patient/family needs. In HOHV#2 the MSW created a frequency but there was no psychosocial plan of care. Additionally the initial MSW assessment indicated that funeral arrangements were pending but there was nothing on the plan of care to address funeral arrangements. Spiritual care established a visit frequency at start of care but there was no spiritual plan of care until 10 months after start of care. In HOHV#3 the MSW assessment documented that the daughter identified an interest in getting a wheelchair ramp and transferring funeral arrangements from Wisconsin. The social worker supplied a phone number to the Disabled Resource Center. At the social work monthly visit the daughter was still working on funeral arrangement. There was no psychosocial plan of care established. In HORR#1 the social work assessment documented that the daughter was trying to get additional IHSS hours but did not address this issue in the plan of care. In HORR#2 the MSW established a visit frequency but there was no psychosocial plan of care documented. In HORR#3 the social work assessment documented that the daughter was requesting IHHS reassessment. This need was not addressed in the plan of care. In HORR#5 and HORR#6 the social worker identified the lack of funeral arrangements but did not address in the plan of care. This was validated with the administrator.

Observed in Record Review. In 2 of 11 patient records reviewed, the agency failed to address all treatments necessary to meet the patient needs. In HORR#2 the patient had incontinence of bowel and bladder but there was no plan for maintaining skin integrity. There was a Foley catheter placed during the course of care but there were no orders for the placement or management of the Foley included in the plan of care. Wound care was also provided with no orders for same in the plan of care. In HORR#3 at start of care the nursing assessment documented staples in place from a recent surgery to repair a femur fracture. The plan of care did not address removal of the staples. This was validated with the administrator.

Observed in Record Review. In 1 of 2 patient records reviewed, for patients who had wounds the agency failed to follow their policy on wound assessments. Agency policy requires that a wound be assessed weekly. In HOHV#3 the patient had two wounds. One wound was retired from the active record with no documentation of healing or progress to healing of the wound. The agency provided care to the other wound with no reassessment documented over two and half months of care. This was validated with the administrator.

Observed in Data Session. In review of the agency's QAPI program and conversation with the alternate administrator, there was no documented aggregation of patient satisfaction, hand hygiene data, or hospitalization rate (one of the agency's indicators). The agency collected raw data but it was not aggregated and analyzed to provide a picture of current performance.

Observed in Patient Home. In 2 of 3 home visits conducted, the clinician failed to follow agency policy and CDC guidelines for hand washing. In HOHV#2 the nurse put soap on her hands and immediately rinsed. She also turned the faucet off with her hands while the policy requires using a paper towel to turn off the faucet. In HOHV#3 the clinician turned the water off with bare hands, and changed gloves several times without doing hand hygiene between glove changes, This was validated with the administrator. Observed in Patient Home. In 1 of 3 home visits conducted, the clinician failed to follow manufacturer instructions for cleaning equipment. In HOHV#3 the nurse did not allow for any drying time after cleaning her equipment but returned it to her bag immediately after wiping with a disinfectant. This was validated with the administrator.

Observed in Record Review. In 3 of 7 patient records reviewed, for patients receiving aide services the agency failed to document an aide supervision every 14 days. In HOHV#1 there were gaps of 20 days, and 23 days between documented aide supervision. In HOHV#2 the patient had received aide services for 17 days at time of survey but there was no aide supervision documented in the record. In HORR#2 there was a 29-day gap in documented aide supervision. This was validated with the administrator.

Observed in HR File Review. In 2 of 8 HR files reviewed, the agency did not have documentation of having provided annual education on Infection Control and Blood Borne Pathogens. The was no documentation of this education in HR#1 and HR#2.

Observed in Record Review. In 1 of 1 patient records reviewed, for patients discharged alive the agency failed to document a discharge summary sent to or offered to a clinician who would assume care once the hospice services ended. In HORR#8 there was a discharge summary completed but no documentation that it was provided or offered to other medical providers. This was validated with the administrator.

Observed in Patient Home. In 2 of 11 patient records reviewed, for patients who had oxygen, the agency failed to provide appropriate education on the use of oxygen equipment. In HOHV#1 the caregiver stated that he does not use the oxygen in the home and would call the agency for guidance if he were to need it. However the oxygen bubbler did have water in it and when asked the caregiver stated that the water had been there about a month. IN HORR#8 the initial nursing assessment and the discharge summary indicated that patient was still smoking. There was no documentation in the medical record to indicate that the patient was instructed as to the dangers of smoking while on oxygen or what her level of compliance was. This was validated with the administrator.

Observed in Document Review. During contract review and in discussion with the Administrator, the Administrator stated that the agency is not monitoring and evaluating any of their vendors on any regular basis as required by agency policy and regulation.