Every finding on record at Visiting Nurse & Hospice of Fairfield County, Inc

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including measurable outcomes anticipated from implementing and coordinating the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed, the agency did not ensure that the plan of care (POC) included measurable outcomes anticipated from implementing and coordinating the plan of care. Clinical Record 4: The patient elected the hospice benefit on 4/28/23. Review of the clinical record, revealed that the POC for the benefit period dated 6/27/23 to 8/25/23, lacked evidence of measurable skilled nursing (SN) goals. The SN goal was documented as, patient will achieve personal goal of, be comfortable prior to death; with the intervention of, assess skin integrity and overall skin condition. The SN goal was documented as, skilled observation & assessment of safety, and early detection & intervention for s/sx of complication of disease process; with intervention of, skilled observation & assessment of nutrition/hydration. During a joint clinical record review and interview, the Director of Clinical Services confirmed the finding and stated that the skilled nursing goals were vague and lacked measurable outcomes.

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions such as, hand hygiene. This standard was not met as evidenced by observation, document review, and interview. In 2 of 4 (50%) observed home visits, the agency did not ensure that the staff member used standard precautions that followed accepted standards of practice and agency policy. Agency policy, Hand Hygiene (revised November 2012), stated in part, "Procedure: Hand Decontamination with an alcohol-based hand rub (hand-sanitizer); Hand decontamination using alcohol-based hand rub (sanitizer) should be performed: Before direct contact with patients; After contact with a patient's skin; After contact with body fluids or excretions, mucous membranes, non-intact skin, and wound dressings if hands are not visibly soiled; When moving from a contaminated body part to a clean body site during patient care; and After contact with inanimate objects (including medical equipment) in the immediate area of the patient." Home Visit 1 / Staff 2: A home visit was conducted with the Chaplain in an Assisted Living Facility (ALF) on 7/11/23. The Chaplain was observed touching/pushing the patient's wheelchair, and then proceeded to have direct contact with the patient, without first performing hand hygiene. The Chaplain failed to perform hand hygiene at any time before, during, or after the visit. Home Visit 4 / Staff 13: A home visit was conducted on 6/12/23 with the Hospice Aide. The Aide was observed providing perineal care to the patient during a sponge bath, and proceeded with bathing the patient's legs and feet, without first changing gloves and performing hand hygiene. During an interview on 7/12/23, the Director of Clinical Services confirmed the finding and stated that staff did not follow standard precautions and established policy for hand hygiene.

It is required that counseling services include spiritual counseling and is provided in accordance with the patient’s and family’s acceptance of the services. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed, the agency did not ensure that spiritual counseling was provided in accordance with the patient’s and family’s acceptance of the services. Clinical Record 5: The patient elected the hospice benefit on 6/20/23. Review of the clinical record, revealed an initial spiritual evaluation was conducted on 6/23/23, by the chaplain who documented, “Will continue to provide emotional support.” The plan of care dated 6/20/23 to 8/18/23, included the following goal and intervention: Goal: patient/family will express feelings of increasing inner peace as evidenced by decreasing ESAS Wellbeing score; Intervention: provide spiritual support to caregivers. The record lacked evidence of any further spiritual care visits, or communication with the patient or family. During a joint clinical record review and interview on 6/12/23, the Director of Clinical Services confirmed the finding.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the interdisciplinary group and written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review, observation, and interview. In 2 of 8 (25%) clinical records reviewed, the agency did not ensure that written patient care instructions for a hospice aide included specific interventions to be performed by the aide. Clinical Record 1: The patient elected the hospice benefit on 4/12/23. The benefit period dated, 6/11/23 to 8/9/23, included a hospice aide (HA) care plan with the following interventions: "Assist with partial/complete bath; Assist with Tub/Shower Bath." The clinical record lacked evidence of instructions that differentiated the patient's need for the specific type of bath. During a joint home visit and interview, the HA stated that the patient is not able to shower or take a tub bath. Clinical Record 4: The patient elected the hospice benefit on 4/28/23. The benefit period dated 6/27/23 to 8/25/23 included a hospice aide (HA) care plan with the following interventions: "Complete Bath, Complete Bed Bath, Seated Shower, Shower bath." The clinical record lacked evidence of instructions that differentiated the patient's need for the specific type of bath. During a joint clinical record review and interview on 7/12/23, the Supervisor of Clinical Services confirmed the finding.