Every finding on record at Valley Hospice

Based on observations, staff interviews, and a review of facility documents, it was determined the facility failed to ensure that the disinfection of reusable patient care equipment are in accordance with facility policy, in two of four home visits (Patient (P) 2 and P4). --- Findings include: On 11/25/24 at 12:45 PM, Staff (S)11, Home Health Aide (HHA), was observed providing care for Patient (P)4. At 1:50 PM, patient care was completed and P4 signed S11's tablet using his/her finger. S11 did not disinfect the tablet prior to leaving the P4's house. At 1:53 PM, when questioned about the process for cleaning the tablet, S11 stated that he/she usually disinfects the tablet before leaving the patient's home but did not want to make P4 uncomfortable by disinfecting the tablet in the home. S11 stated that he/she would disinfect the tablet in his/her car before the next patient visit. On 11/27/24 at 9:30 AM, a review of mandatory education on infection control provided to clinical staff was conducted. Facility document titled "Infection Prevention Clinical" last reviewed 10/18/22 stated "...Care of Electronic Device: Store tablet in separate reuse bag compartment... Use stylus for patient signature..." On 11/27/24 at 10:03 AM, an interview was conducted with S1, Director of Hospice, and S12, Director of Compliance and Operations. When questioned about cleaning of equipment, S12 stated that equipment should be cleaned before staff leave the patient's home. S12 also stated that the expectation is for staff to provide a stylus to the patient to sign the tablet rather than using their finger. On 11/25/24 at 1:45 PM, Staff (S) 9, Registered Nurse, was observed providing care for Patient (P) 2. S9 placed the pulse oximetry (pulse ox) monitor on the patient's finger while listening to the patient's heart and lung sounds with a stethoscope. At 1:50 PM, upon completion of the assessments, S9 placed the pulse ox monitor and the stethoscope back into the clinician's bag without cleaning the equipment. When the cleaning of equipment was discussed, S9 confirmed that the pulse ox monitor and stethoscope should have been cleaned prior to putting them back into the bag. Facility policy, titled, "Infection Control: Bag Technique", revised 5/24, states, "... 4. Clean Stethoscope ... pulse ox ... with alcohol wipe before and after patient contact. Once cleaned with alcohol return equipment to the reuse section of the clinician bag ..." On 11/27/24 at 10:02 AM, S1, Hospice Director, S12, Director of Compliance and Operations, and S24, Education Supervisor, were asked what the process was after using vital signs equipment on a patient and before putting the equipment back into the clinician bag. S1, S12, and S24 all confirmed that the vital signs equipment after patient use should be wiped down with alcohol pad and then returned to the front compartment of the clinician bag. N.J.A.C. 8:42C-10.2(b)

Based on review of four (4) medical records (#1, #2, #3, and #4), staff interviews, and review of facility documents, it was determined that the facility failed to implement Social Work and Chaplain Services in accordance with the Plan of Care for one (1) of (4) patients (Patient #4). Findings include: Reference #1: The Facility document titled, "Interdisciplinary Group Planning; Approved by Valley Hospice Management Staff: 07/10, 09/11, 08/12, 10/13, 11/15, 10/16, 12/19, 04/22" states, "Purpose: To exercise a coordinated effort for the provision of comprehensive hospice care by the hospice team to meet the healthcare needs of the hospice patients facing terminal illness and their families. Policy: ... .3. Ensure that the care and services are provided in accordance with the plan of care. ... ." On 6/7/22 and 6/8/22, a medical record review was conducted and facilitated by Staff #2. Upon medical record review, the following was noted for Patient #4: The Plan of Care, for the Certification Period 5/2/22 to 6/30/22 indicated that the patient would be receiving visits from a Skilled Nurse, Home Health Aide, Chaplain, and Social Worker. A Physician Order dated 5/4/22 at 9:37 AM states, "... . Service Changes: Calendar Frequency MSW [Social Work] effective 5/15/22; 1 Every 3 WK 6 [One visit every three weeks for six visits]; 2 PRN [two visits as needed] for emotional support. CH [Chaplain] effective 5/15/22; 1 Every 3 WK 3 [one visit every 3 weeks for three weeks]; 1 Every 4 WK 4 [one visit every four weeks for four weeks]. The visit frequency was not met for the MSW for the week of 5/15/22. The visit frequency was not met for the CH for the week of 5/29/22. The above was confirmed by Staff #1 and Staff #2 on 6/8/22 at 10:25 AM. N.J.A.C. 8:42C-5.1(b)7

Based on (4) four patient visit observations (Patient #1, Patient #2, Patient #3, and Patient #4), staff interviews, and review of facility policy and procedure, it was determined that the facility failed to ensure that infection control guidelines are adhered to by staff for one (1) of four (4) patient visits (Patient #4). Findings include: Reference: Facility policy titled, "Infection Control: Bag Technique; Approved By VHC Management Staff-05/18; Revised-12/19, 3/21, 9/21, 4/22" states, "Purpose: To maintain the integrity of the clinician bag and prevent transmission of infection. ... . 3. Open reusable equipment section to access equipment needed for patient care. 4. Clean diaphragm of stethoscope, thermometer, pulse ox, and stylus with alcohol wipe before and after patient contact. Once cleaned with alcohol, return equipment to reuse section of the clinician bag. ... . " The following observations were made on 6/6/22 between 1:00 PM to 1:30 PM, during a hospice visit for Patient #4, who resides at an assisted living facility: Staff #7 took a large Ziploc bag out of his/her Hospice Visit Bag. The contents of the Ziploc bag consisted of a Blood Pressure Cuff, Stethoscope, Thermometer, and Pulse Oximeter. He/she placed the bag directly on the bed next to the patient. He/she took each piece of equipment out of the Ziploc bag to perform a vital signs assessment. The equipment was returned to the Ziploc bag after use. The Ziploc bag was then placed back into the Hospice Visit Bag. The Ziploc bag was in contact with the patient environment and then returned to the Hospice Visit Bag. Upon interview on 6/6/22 at 1:30 PM, Staff #7 stated that he/she sees five (5) to six (6) patients each day. Staff #7 stated that he/she changes the Ziploc bag once per week (on Wednesdays). Upon interview on 6/7/22 at 2:45 PM, Staff #3 confirmed that the above is not congruent with facility policy and procedure for correct bag technique. The above was confirmed by Staff #3 and Staff #4 on 6/8/22. N.J.A.C 8:42C-10.1(a)