Every finding on record at Unitedcare Hospice Inc

Observed in Record Review. The written plan of care is based on the patient’s goals and the time frames, settings, and services required to meet those goals. During review of records 1,2,3,5,6 and 7 it was noted that goal statements lacked time frames or dates for when goals would be met. This was confirmed by the Director of Nursing.

Observed in Record Review. In 6 of 14 patient records reviewed, The organization did not provide care, treatment, or services in accordance with or prescriptions, as required by law and regulation. During review of records 1,2,4,5,7 and 9 it was noted that visits were not provided in accordance with physician orders. For example, in record 9 aide visits were ordered 2 x per week and only 1 visit was provided in the first week of care. This was confirmed by the Director of Nursing.

Observed in Individual Tracer. The organization did not implement activities for the prevention and control of infections and communicable diseases. During home visit 3 it was observed that the aide cleaned feces from the patient's genital area while wearing gloves. Then the aide removed gloved and doffed and donned new gloves without cleansing hands four times which is against agency policy. Observed in Individual Tracer. The organization did not implement activities for the surveillance, identification, prevention, control, and investigation of infections and communicable diseases, including the use of standard precautions. During home visit 3 it was observed that the aide cleaned feces from the patient's buttocks, removed gloves and then entered the nursing bag with out cleansing hands on three occasions. This was confirmed by the administrator.

Observed in Individual Tracer. Staff did not provide care, treatment, or services in accordance with professional standards of practice. During home visit 3 the aide was observed to use a basin with a height of approximately 7-9 inches to shampoo a patient's hair. The bed bound patient's head was lifted onto the edge of the basin such that the patient's head was resting on the narrow edge of the rigid basin and inclined at a very steep angle of 70-80 degrees. The aide then proceeded to dribble water on the patient's hair while the water ran down some into the basin and some onto the towel on the patient's bed. The bedding underneath the towel became soaked after wetting, shampooing and rinsing. The towel was removed and the bedding was left wet after the bath was finished. The aide washed the patient with disposable wash cloths that were wet with water and the aide did not dry the patient with a towel but simply pulled the bed clothes up over her wet body. The bed clothes were not changed. This was confirmed by the Administrator.

Observed in Record Review. In 4 of 4 patient records reviewed, The hospice did not inform the attending physician of the availability of a discharge summary. The discharge summary is provided to the practitioner upon the their request and includes the patient's medical and health status at the time of discharge. During review of discharged records 11-14 it was noted that there was no record of the being made aware of the discharge summary or the summary being sent to the attending physician. This was confirmed by the Director of Nursing.

Observed in Patient Home. In 3 of 3 home visits conducted, the Surveyor observed that the clinicians had not followed the organizations Bag Technique Policy No 9-014.1. During HV #1, the Hospice Aide (HA) had been observed going into the clinical bag 5 times without first disinfecting her hands. The HA also utilized a plastic clipboard during the visit that had been set down on the patient table and then placed into the clinical bag without disinfection. During HV #2, The nurse was observed going into his clinical bag 5 times without first disinfecting his hands. HV #3, the nurse was observed accessing the clinical the bag 6 times without hand disinfection, including returning cleaned equipment to the bag. This was validated with the Director of Patient Care Services. Observed in Patient Home. In 3 of 3 home visits conducted, the clinicians had not followed the agency policy No. 9-009.2 Infection prevention and control which states: 'Hand decontamination with an alcohol-based hand rub should be performed before having direct contact with patients, after contact with the patients intact skin (when taking a pulse, blood pressure or lifting a patient), and after removing gloves. During HV#1, The clinician had not performed hand decontamination when changing her gloves or when going from a contaminated body site to a clean one. The HA was also observed using hand sanitizer on procedure gloves. During HV #2, the clinician had not sanitized his hands after contact with the patient and after touching inanimate objects in the patient vicinity. This has also been observed during HV #3. This was validated with the Director of Patient Care Services.