Every finding on record at Visiting Angel Hospice, Inc.

Observed in Record Review. In 1 of 14 patient records reviewed, the Surveyor noted no initial bereavement assessment had been completed. In RRNHV#10, the patient had been on service for 29 days and no initial bereavement assessment had been documented. This was validated with the DOPCS.

Observed in Record Review. In 3 of 14 patient records reviewed, the Surveyor noted medication orders without clear indication or specific site for use. For example, in RRHV#1, the patient had 4 different ointments: Clotrimazole 1% cream, Calmoseptine Ointment, Santyl 250units, Triamcinolone Ointment and Triple Antibiotic Ointment all to ‘apply daily as needed’ without a specific site of application. In RRNHV#6, the patient had Diclofenac Sodium Arthritis Pain Reliever 1% Topical Gel ordered to apply to affected area and LidAll 4%-1% Topical Patch (Lidocaine) daily as needed, without a specific site of application. In RRNHV#9, the patient had Lidocaine 5% Transdermal Patch 1 patch daily as needed, without a site or clinical indication. This was validated with the DOPCS. Observed in Record Review. In 1 of 14 patient records reviewed, the Surveyor noted care provided without a physician order. For example, in RRNHV #6, the LVN documented that the patient had signs of an infection and that Cultures were drawn; however, there had been no physician order for cultures. This was validated with the Administrator.

Observed in Record Review. In 9 of 13 patient records reviewed, the organization had not ensured the patient's right to participate in decisions about their care, treatment, or services. For example the records of HV1, HV2 and RR's 1,2,3,4,5,7 and Berevement chart 1; the organization accepted other family members (other than spouse) signature on the consents for care and POLST orders without evidence of legal representative status i.e. Power of Attorney or Guardianship papers as per the organizations policy 1-0.26.1. This was confirmed by the Administrator.

Observed in Record Review. In 5 of 11 patient records reviewed, the organization had not ensured the comprehensive assessment considered progress toward goals. For example during RR's 1,2 and 3 and the records associated with HV1 and HV2,, th Social Worker and RN documentation failed to indicate progress toward goals in the individual notes or the IDG updates. This was confirmed by the Administrator.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization had not ensured the medical record reflected drugs and treatment necessary to meet the need of the patient. For example, during RR8 the Surveyor identified that while there was an order for Carezz cream, the plan of care did not indication the reason for use, where to apply, or the dosage of medication (if any). The second occurrence was associated with RR6 wherein atropine drops were ordered without a directing symptom. These were confirmed by the Administrator Designee.

Observed in Individual Tracer. In 1 of 3 home visits conducted, the organization had not followed the accepted standards of practice in applying standard precautions. For example during HV1 the Registered Nurse had not followed manufacturers instructions for the cleaning and drying of the equipment used during the patient assessment as per manufacturers recommendations. This was confirmed by the Administrator.

Observed in Record Review. In 7 of 11 patient records reviewed, the organization had not ensured the individual receiving the order must sign it immediately. For example during RR1,2,3,4,5,7 and bereavement record #1 the Surveyor identified on initial verbal Certificates of Terminal Illness missing the receiving Registered Nurse signatures. Another identified pattern was that many visit throughout the reviewed records had notes that were initiated by one nurse and signed by another. This omission results in the medical record failing to be clear as to which staff members are providing care or accepting verbal orders. This was confirmed by the Administrator.