Every finding on record at Vitality Hospice LLC

Based on staff interview and review of one (1) of one (1) medical record, it was determined that the facility failed to ensure implementation of the patient's individualized plan of care. Findings include: 1. On 10/27/21 and 10/28/21, during review of Patient #1's medical record, the following was revealed: a. The Care Plan update # (number) 8 (eight) dated 6/30/21 stated, "Problem description Continues with slow healing wound to LLE (left lower extremity) ... Interventions/outcomes ... Document appearance, measurements (length, width, depth), drainage, and stage of any area of skin breakdown at least weekly. Assess for actual and potential skin breakdown during each visit. ..." (i) The weekly Nursing Visit Note dated 7/8/21 at 10:25 AM indicated that there was a wound on the LLE (left lower extremity) and on the RLE (right lower extremity). The weekly assessment did not contain documentation of the wound's appearances, measurements, drainage, and stage of any area of skin breakdown. (ii) The weekly Nursing Visit Note dated 7/22/21 at 10:40 AM indicated that there was a wound on the LLE (left lower extremity), the RLE (right lower extremity) and the Right Wrist. The weekly assessment did not contain documentation of the wound's appearances, measurements, drainage, and stage of any area of skin breakdown. b. This is not in accordance with the patient's individualized plan of care. 2. The above findings were confirmed by Staff #3.

Based on observation of two (2) of two (2) home visits, staff interviews, and review of facility policy and procedure, it was determined the facility failed to adhere to recommended infection control standards of practice regarding hand hygiene, equipment cleaning, and dress code. Findings include: Reference #1: Facility policy titled, "5.8-Hand Hygiene Policy and Compliance Program" states, " ...Procedure 1. Indications for hand hygiene are: Before and after direct patient care. ... Before re-entering nursing bag ... 7. ... CDC (Centers for Disease Control) Hand Hygiene Guidelines Recommendations I. Indications for handwashing and hand antisepsis ... B. ... Before direct patient contact Recommendations After removing gloves. ... After contact with inanimate objects or medical equipment close to patient ..." Reference #2: Facility policy titled, "Hand Hygiene Indications for Hand Hygiene" states, " ... Procedure: 1. Perform hand hygiene ... A. Immediately before having direct contact with a patient. B. Before donning personal protective equipment. ...E. After contact with a patient. F. After contact with the patient's immediate environment. ..." Reference #3: Facility policy titled, "Cleaning and Disinfection Medical Equipment: Noncritical Items" states, " ... Procedure: 1. Clean and disinfect a noncritical item that direct contact with a patient's intact skin ... before returning to the nursing bag ..." Reference #4: The facility document provided addressing facility dress code states, "... Dress Code: ... In consideration of our patients' delicate skin, fingernails should be neatly trimmed and cut short to avoid potential skin tears. ..." 1. On 10/27/2021 at 11:38 AM, during a home visit for Patient #2 with Staff #8, the following was revealed: a. At 11:47 AM, upon arrival to the patient's home, Staff #8 applied gloves without first performing hand hygiene and proceeded to have contact with the patient's feet. At 11:50 AM, Staff #8 did not perform hand hygiene, re-entered the nursing bag and removed a portable blood pressure cuff and thermometer from the bag. (i) At 11:51 AM, Staff #8 assessed the patient's blood pressure and temperature, did not perform hand hygeine, and then proceeded to re-enter the nursing bag with his/her gloved hands to return the contaminated equipment to the bag without first cleaning and disinfecting the noncritical medical equipment. This was not in accordance with facility policies and procedures. 2. On 10/27/2021 at 1:30 PM, during observation of patient care for Patient #3, at an Assisted Living facility, the following was revealed: a. Staff #6 was observed to have long fingernails. Facility policy indicates that fingernails should be cut short to avoid potential skin tears. This was not in accordance with the policy. (i) During interview, Staff #6 stated that he/she was not sure if long fingernails were allowed when on duty. (ii) Review of Staff #6's orientation file showed that Staff #6 was educated on the facility dress code policy. b. At 1:45 PM, Staff #6 was observed to don a glove in his/her right hand, obtained Patient #3's temperature and then doffed the glove. Staff #6 did not perform hand hygiene before donning or doffing the glove. c. At 1:46 PM, Staff #7 washed his/her hands, donned gloves and brought a Hoyer lift into the room to be used to transfer Patient #3 from the recliner to the bed. (i) Staff #7 then moved the closet door in the patient room, which was unattached, and obtained a chuck pad to place on Patient # 3's bed before transferring the patient. Staff #7 failed to perform hand hygeine after contact with inanimate objects and medical equipment. (ii) Staff #7 then proceeded to the transfer Patient #3 using the Hoyer Lift. After transferring Patient #3, Staff #7 doffed gloves and left the room without performing hand hygiene. 3. The above findings were confirmed by Staff #3 and Staff #5 on 10/27/2021 at 12:00 PM.