Every finding on record at Vision Home Health Care, Inc

Observed in HR File Review. In 2 of 2 HR files reviewed, During the HR file review the Hospice surveyor noted that in the MSW and Chaplain files, the education degree was present and the organization stated the verification cl had been made, however there was no documentation of the time and date and who verified the education. This was validated in a discussion with and observation with the DCPS.

Observed in Record Review. In 2 of 3 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions. In HO RR#1 the skilled nurse documented that the patient had an episode of chest pain resolved with nitroglycerin; the patient was slow to respond; pain was rated at 8 of 10; legs, arms and hands were edematous; and the patient complained of increased anxiety especially at night. In HO RR#3 it was documented that the patient completed antibiotics for a UTI. This assessment finding was not addressed in the plan of care. This was reviewed and discussed with the Administrator Designee and Director of Patient Care Services.

Observed in Record Review. In 3 of 3 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions. For example, in every record reviewed the registered nurse documented in the comprehensive admission assessment that the patient needed spiritual services. However, the spiritual coordinator did not document an initial comprehensive assessment in any record. HO RR#1 included the following documentation: Phone call/text initiated by chaplaincy team to offer spiritual support to patient and the family/caregiver. Please note the patient’s family/caregiver stated, “would you please connect us with the local Roman church to make a visit and to pray with us.” In HO RR#2 and HO RR#3 “no to chaplaincy services” was written in the interdisciplinary meeting note. This was reviewed and discussed with the Administrator Designee and Director of Patient Care Services.

Observed in Record Review. In 3 of 3 patient records reviewed, the hospice medical director did not document that clinical information was reviewed and that the patient’s life expectancy was six months or less on the certificate of terminal illness. As well, none were signed by the medical director and attending physician. This was reviewed and discussed with the Administrator Designee and Director of Patient Care Services.

Observed in Emergency Management Session. In 1 of 7 HR files reviewed, During HOSHR#9 employee file review, it was noted lack of initial training in the organization's emergency preparedness policies and procedures and assigned emergency response role. This was discussed with the DPCS/Administrator Designee.

Observed in Record Review. In 1 of 11 patient records reviewed, During HOSRR#4 it was noted the patient had an order for Basaglar KwikPen SQ insulin injection, daily in the AM, hold if blood sugar less than 100. The initial RN evaluation lacked an assessment of the patient's diabetic status. This was discussed with the DPCS/Administrator Designee.

Observed in Record Review. In 1 of 11 patient records reviewed, During HOSRR#1 it was noted the patient record was not systematically organized to facilitate identifying the deficits, interventions and goals documented in different sections of the POC. The section of the EMR that contained the IDG/POC was inconsistent with other parts of the EMR that also contain deficits, interventions and goals that were identified by headers; POC/IDG section, POC goals and interventions, history of issues, and current issues. The following are examples: there was one deficit identified in POC/IDG section of the EMR, history of POC listed one intervention and goal, history of issues listed 5 issues without viewable interventions, current issues are the same 5 without viewable interventions and one issue documented as resolved is in the current issues list and the history of issues list. This was discussed with the DPCS/Administrator. Observed in Record Review. In 2 of 11 patient records reviewed, During HOSHV#1 record review it was noted by the hospice surveyor that the patient record was not complete, promptly and accurately documented. Documentation by the chaplain during IDG meetings of phone calls placed to the patient's son to provide prayers. The patient record lacked further documentation of the dates the spiritual care phone call visits was provided during three certification periods to present. During HOSRR#1 it was noted the SC documented during an IDG meeting in March a phone call placed to the patient/PCG. The patient record lacked further documentation of the date the call was initiated by the SC. This was discussed with the DPCS/Administrator Designee.

Observed in Record Review. In 6 of 11 patient records reviewed, It was noted during HOSHV#1 record review the hospice IDG did not update patient Information that was needed to justify the patient’s care, treatment, or services. The patient developed a coccyx pressure ulcer with physician orders for wound care. The pressure ulcer was not added to the POC as a related diagnosis/condition when identified by the SN. During HOSHV#3 it was noted the POC contained interventions and goals related to a history of DVT in 2022 with current Eliquis medication orders. DVT was not added to the POC as a related condition or history. During HOSHV#2 it was noted in the H&P completed by a physician 5 days prior to admission the following related diagnosis/conditions and history that were not added to the POC but were identified with deficits, interventions and goals on the POC. They included depression, anxiety, chronic hip pain and neuritis. During HOSRR#3 it was noted the following dx, related condition and history was not added to the POC. They included and were documented on the RN initial assessment; hypertensive CKD stage 3, anemia, depression and constipation. During HOSRR#4 it was noted the following dx, related conditions and history documented on the RN initial assessment were not included on the POC; DM II, HTN, acute encephalopathy, UTI. During HOSRR#7 it was noted the following dx, history, related conditions was not added to the POC but documented by the RN during the initial assessment; anxiety, NSTEMI with aortic stenosis, HTN, hyperlipidemia. During HOSRR#8 it was noted on the RN initial assessment that the patient had 2 pressure ulcers on the mid back and coccyx area. The pressure ulcers were not added to the POC as a related condition. This was discussed with the DPCS/Administrator.

Observed in Record Review. In 7 of 11 patient records reviewed, During HOSHV#1, #3 and HOSRR#1, #5-#8 it was noted the fall risk assessment for each patient was either moderate or high risk for falls. The records lacked documentation that patient specific fall reduction strategies were taught to the patient/caregivers. This was discussed with the DPCS/Administrator Designee.

Observed in Record Review. In 3 of 11 patient records reviewed, During HOSRR#4 it was noted lack of assessment, interventions and goals related to the patient's diabetes mellitus type 2 who received daily insulin injections if blood sugar was above 100. During HOSRR#5 it was noted 2 comm notes describing a report from the PCG that the patient was having increased pain causing sleeplessness with ineffective relief from the pain medication ordered. The POC lacked an update to include assessment of pain, assessment of pain medication regimen with additional interventions and goals established. During HOSRR#8 it was noted lack of an update to the POC in August 2022 to include skin assessment, intervention and goals related to the pressure ulcers documented on the coccyx and mid back. In addition the POC lacked an update to include assessment, interventions and goals related to the patient c/o anxiety and new antianxiety medication ordered. Observed in Record Review. In 1 of 11 patient records reviewed, During HOSHV#1 record review it was noted the interventions and goals established by the physical therapist the beginning of August 2022 were not added to the POC. They included Therapeutic Exercise, Transfer Training, Establish Home Program, Stretching/Flexibility, Safety Training, Balance, Pt/CG Training Education, Fall Risk. This was discussed with the DPCS/Administrator. Observed in Record Review. In 1 of 11 patient records reviewed, During HOSRR#7 it was noted the patient was prescribed Clopidogrel 75 mg PO daily. The POC lacked assessment, interventions and goals related to bleeding precautions. This was discussed with the DPCS/Administrator.

Observed in Regulatory Review. In 1 of 11 patient records reviewed, During HOSHV#1 record review it was noted an order for physical therapy in August 2022 was not added to the POC to include the frequency of services necessary to meet the patient and family needs. This was discussed with the DPCS/Administrator. Observed in Record Review. In 2 of 11 patient records reviewed, During HOSHV#1 record review it was noted by the Hospice surveyor, the spiritual counselor (SC) documented at IDG meetings, that phone calls were placed to the patient's son to provide a prayer. The POC stated SC was declined after the initial SC visit attempt and at each IDG the declination statement was not updated. The documentation of phone calls by the SC was documented regularly at IDG meetings as written: phone call initiated by the hospice chaplain to the patient and family to offer spiritual care since the hospice nurse reported that the patient is declining. The patient's son stated he wants prayers and support for himself and the patient through phone call. The chaplain was able to bless the patient's son and the patient via tele-health. The chaplain will follow up with the patient and the family to provide spiritual support. This was the identical note written during IDG meetings from August 2022 to present. The frequency on the POC was not updated to include phone calls or frequency of phone calls as the means to communicate with the patient's son. During HOSRR#1 it was noted the SC added bereavement interventions and goals to the POC. The POC indicated the SC visits were declined. The POC was not updated to include a frequency of visits/phone calls established by the SC when the spiritual issue was added. This was discussed with the DPCS/Administrator.

Observed in Record Review. In 1 of 11 patient records reviewed, During HOSHV#1 record review, the documented care was not provided in accordance with the POC. It was noted in January 2023 an order for the SN to treat stage 2 ulcer on coccyx: cleanse with normal saline, pat dry, apply medihoney, cover with dry dressing and secure with foam island dressing daily. PCG to do wound care on non SN days until closed. There is lack of documentation that the son was instructed on the wound care on SN notes until the beginning of March 2023 when the wound care order changed. This was discussed with the DPCS/Administrator.

Observed in Record Review. In 1 of 11 patient records reviewed, During HOSHV#3 it was noted lack of collaboration between the hospice team members in March 2023. A comm note documentation stated PCG called and reported that patient is having mood issues. Patient is verbally abusive toward both PCG. Patient is threatening to kill herself. Patient also plotting to escape from new apt. PCG also reported that patient is having non verbal cues of pain when being cleaned or changed. Requested pain meds. MD made aware and new orders given. New orders placed. PCG made aware. There was lack of documentation that the RN, MSW and other IDG members were notified of the report on the pt. condition. An additional comm note written in March 2023 documented the PCG called and reported the current anxiety medication was not working, PCG requested alternative, MD notified and new order given, PCG made aware of the new medication order. There was lack of documentation that the RN and other IDG members were notified. This was discussed with the DPCS/Administrator Designee.

Observed in Data Session. During review of the Hospice QAPI program annual program audit for 2022, it was noted although performance measures were trended over time, an analysis to identify patterns and assess the effectiveness of the program were not identified. This was discussed with the DPCS/Administrator Designee.

Observed in Patient Home. In 1 of 3 home visits conducted, During HOSHV#3 it was noted by the Hospice surveyor, the hospice aide failed to perform hand hygiene consistent with Policy No. 9-009 Hand Hygiene. The aide donned 2 pairs of gloves to provide personal care. Upon completing peri care, the aide assisted the patient with upper body dressing without removing her gloves and performing hand hygiene. The aide then completed the bed bath, cleaning the patient buttocks and rectal area and removed one pair of gloves, while the second pair remained on her hands. This was observed with the DPCS during the visit. This was discussed with the DPCS/Administrator.

Observed in Infection Control System Tracer. During review of the Hospice infection control plan it was noted, the organization's written plan lacked a goal limiting the spread of infections associated with the use of medical equipment, devices, and supplies. This was discussed with the DPCS/Administrator Designee. Observed in Infection Control System Tracer. During review of the Hospice infection control plan it was noted the plan lacked a goal limiting unprotected exposure to pathogens. This was discussed with the DPCS/Administrator Designee. Observed in Infection Control System Tracer. During review of the Hospice infection control plan it was noted the organization's plan lacked a goal limiting the spread of infections associated with procedures. This was discussed with the DPCS/Administrator Designee.

Observed in Record Review. In 3 of 3 patient records reviewed, for Hospice bereavement care related to the survivor. The IDG was not updated on the post death bereavement assessment findings by the SC in order to participate in a discussion of the bereavement needs of the survivor. Per Policy No. 2-010 Bereavement services it was noted in #5 after the death has occurred the bereavement assessment will be updated and the family needs will be discussed at the next IDG meeting. During HOSBRRR#1-3 it was noted lack of documentation of a bereavement dicussion at the IDG meeting after the patient's death. This was discussed with the DPCS/Administrator.

Observed in Leadership Session. There was lack of evidence that the governing body and leadership had established requirements to support patient care treatment and services as evidenced by lack of an infection control (IC) program that met the standards to assess and measure the effectiveness of its control, prevention and education policies and processes. For example, goals were not established to limit the spread of infection of unprotected exposure to pathogens, when performing procedures and with the use of medical equipment, devices and supplies during patient care visits. In addition, non compliance of staff with adherence to organization policy on hand hygiene.

Observed in HR File Review. In 1 of 7 HR files reviewed, During HOSHR#9 file review, it was noted lack of documentation that the employee was oriented to the organizational hospice philosophy. This was discussed with the DPCS/Administrator Designee.

Observed in HR File Review. In 1 of 7 HR files reviewed, During HOSHR#8 file review, it was noted lack of an initial orientation to the volunteer's specific job duties. This was discussed with the DPCS/Administrator Designee.

Observed in Document Review. During review of the Hospice contract with a SNF the hospice surveyor noted lack of a provision that stated the hospice will report all mistreatment, neglect, or verbal, mental, sexual, and physical abuse to the SNF, NF, or ICF/IID administrator within 24 hours of the hospice becoming aware of the alleged violation, including injuries of unknown source, and misappropriation of patient property by anyone unrelated to the hospice. This was corrected with an addendum signed by the SNF designated person while onsite during the survey.

Observed in Document Review. During review of the hospice SNF contract it was noted lack of the delineation of the responsibilities of the hospice and the SNF, NF, or ICF/IID to provide bereavement services to SNF, NF, or ICF/IID staff. This was corrected with an addendum signed by the SNF designated person while onsite during the survey.

Observed in Document Review. During review of the organization consents and Election of Benefit (EOB) forms in the patient admission information packet, it was noted the Election of Benefit (EOB) form did not contain the information that the patient may choose their physician by name with address and NPI number if available entitled Right to choose an Attending Physician. Also noted, the EOB did not contain the Notification of Hospice Non-Covered Items, Services, and Drugs with the patient's choice to request information if indicated. This was discussed with the DPCS/Administrator.