Every finding on record at Vitas Healthcare Corporation of Ohio

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. 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 and interview. In 1 of 24 (4%) clinical records reviewed of patients receiving Hospice Aide (HA) services, the agency did not ensure that the HA received all updates to written patient care instructions. Clinical Record 27: The patient elected hospice care on 07/06/2024. A Hospice Aide plan of care was initiated on 07/07/2023 and continued through 04/17/2024 with updates. The HA plan of care dated 07/07/2023 documented the directive for the HA that the left lower arm cast would be removed within a week or two. The cast was removed within two weeks of 07/07/2023, but the Hospice Aide plan of care was not updated with the change through 04/17/2024. During an interview on 04/22/2024, the General Manager and Regional Patient Care Manager stated that the aide plan should have been updated but it was missed.

It is required that a hospice aide provides services: included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 7 of 24 (29%) clinical records reviewed of patients receiving Hospice Aide services, the agency did not ensure that the Hospice Aide (HA) provided services included in the plan of care. Clinical Record 3: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. The hospice patient was confused and at risk of elopement. A review of HA visit notes dated 11/08/2023 through 04/11/2024 revealed that monthly weights were documented as not performed/declined. No weights were documented for five (5) months. Clinical Record 5: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. The hospice patient was confused and at risk of elopement. A review of HA visit notes dated 12/08/2023 through 03/06/2024 revealed that monthly weights were documented as not performed/declined. No weights were documented for four (4) months. Clinical Record 8: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. A review of HA visit notes dated 12/20/2023 through 02/07/2024 revealed that a monthly weight was documented on 02/07/2024. After 02/07/2024, the HA visit notes dated through 04/11/2024 were reviewed and revealed no documented weights. No weights were documented initially for six (6) weeks then not for two (2) months. Clinical Record 12: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. The hospice patient had confusion and was at risk of elopement. A review of HA visit notes dated 01/18/2024 through 04/18/2024 revealed that monthly weights were documented as not performed/declined. No weights were documented for three (3) months. Clinical Record 13: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. The hospice patient had confusion and was at risk of elopement. A review of HA visit notes dated 11/20/2023 through 03/18/2024 revealed that monthly weights were documented as not performed/declined. No weights were documented for four (4) months. Clinical Record 15: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. The hospice patient had confusion and was at risk of elopement. A review of HA visit notes dated 10/06/2023 through 11/22/2023 revealed that monthly weights were documented as not performed/declined. No weights were documented for one (1) month. Clinical Record 23: The Hospice Aide Plan of Care assigned the HA the relevant tasks: inspecting/lotion applied to the skin, perineal care, showered with a bath chair each visit. For the HA visits dated 11/13/2023, 12/11/2023, 12/18/2023, 01/22/2024, and 01/29/2024 the HA documented that the assigned tasks were "Not performed/Not required for these visits." The HA note documented that the facility aide was updated. For the HA visits dated 01/04/2024 and 01/08/2024, the HA documented the assigned task showered with a bath chair as "not performed/not required" and "spoke to facility aide." During an interview, the General Manager and Regional Patient Care Manager confirmed the findings and stated that they would provide education.

It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. Hospice aide documentation complies with hospice policies and procedures. This standard was not met as evidenced by clinical record review and interview. In 7 of 24 (29%) clinical records reviewed of patients receiving Hospice Aide services, the agency did not ensure that the Hospice Aide (HA) reported changes in the patient's needs related to the plan of care to the Registered Nurse (RN). Clinical Record 3: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. A review of HA visit notes dated 11/08/2023 through 04/11/2024 revealed that monthly weights were documented as not performed/declined. No weights were documented for five (5) months. The hospice patient was confused and at risk of elopement. The HA visit notes documented "not answered" on the line with a printed response "... notification/report to the nurse and directions received." It was not clear if a message was left or not. There was no evidence that the hospice Registered Nurse (RN) was notified of the changes in the patient's needs and care plan. Clinical Record 5: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. A review of HA visit notes dated 12/08/2023 through 03/06/2024 revealed that monthly weights were documented as not performed/declined. The hospice patient was confused and at risk of elopement. No weights were documented for four (4) months. The HA visit notes documented "not answered" on the line with a printed response "... notification/report to the nurse and directions received." It was not clear if a message was left or not. There was no evidence that the hospice Registered Nurse (RN) was notified of the changes in the patient's needs and care plan. Clinical Record 8: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. A review of HA visit notes dated 12/20/2023 through 02/07/2024 revealed that a monthly weight was documented on 02/07/2024. After 02/07/2024, the HA visit notes dated through 04/11/2024 were reviewed and revealed no documented weights. No weights were documented initially for six (6) weeks then not for two (2) months. The HA visit notes documented "not answered" on the line with a printed response "... notification/report to the nurse and directions received." It was not clear if a message was left or not. There was no evidence that the hospice Registered Nurse (RN) was notified of the changes in the patient's needs and care plan. Clinical Record 12: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. A review of HA visit notes dated 01/18/2024 through 04/18/2024 revealed that monthly weights were documented as not performed/declined. The hospice patient had confusion and was at risk of elopement. No weights were documented for three (3) months. The HA visit notes documented "not answered" on the line with a printed response "... notification/report to the nurse and directions received." It was not clear if a message was left or not. There was no evidence that the hospice Registered Nurse (RN) was notified of the changes in the patient's needs and care plan. Clinical Record 13: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. A review of HA visit notes dated 11/20/2023 through 03/18/2024 revealed that monthly weights were documented as not performed/declined. The hospice patient had confusion and was at risk of elopement. No weights were documented for four (4) months. The HA visit notes documented "not answered" on the line with a printed response "... notification/report to the nurse and directions received." It was not clear if a message was left or not. There was no evidence that the hospice Registered Nurse (RN) was notified of the changes in the patient's needs and care plan. Clinical Record 15: The Hospice Aide Plan of Care assigned the HA the relevant task: monthly weights. A review of HA visit notes dated 10/06/2023 through 11/22/2023 revealed that monthly weights were documented as not performed/declined. The hospice patient had confusion and was at risk of elopement. No weights were documented for one (1) month. The HA visit notes documented "not answered" on the line with a printed response "... notification/report to the nurse and directions received." It was not clear if a message was left or not. There was no evidence that the hospice Registered Nurse (RN) was notified of the changes in the patient's needs and care plan. Clinical Record 23: The Hospice Aide Plan of Care assigned the HA the relevant tasks: inspecting/lotion applied to the skin, perineal care, showered with a bath chair each visit. For the HA visits dated 11/13/2023, 12/11/2023, 12/18/2023, 01/22/2024, and 01/29/2024 the HA documented that the assigned tasks were "Not performed/Not required for these visits." The HA note documented that the facility aide was updated. For the HA visits dated 01/04/2024 and 01/08/2024, the HA documented the assigned task showered with a bath chair as "not performed/not required" and "spoke to facility aide." There was no evidence that the hospice Registered Nurse (RN) was notified of the changes in the patient's needs and care plan. During an interview, the General Manager and Regional Patient Care Manager stated that they would provide education. Interviews with the HA revealed that the hospice case managers were called, and messages left, but documentation was not clear.

It is required that hospice inpatient facilities provide a sanitary environment by following current standards of practice, including nationally recognized infection control precautions, and avoiding sources and transmission of infections and communicable diseases. This standard was not met as evidenced by observation, document review, and interview. The hospice did not ensure that the inpatient facility provided a sanitary environment by avoiding sources and transmission of infections and communicable diseases. The tour of the inpatient unit on 04/23/2024 with the Inpatient Manager, Admission Director, and Facilities Maintenance Director revealed that a bathroom had been converted and labeled as a storage area. There were several commodes, approximately 5 fans, a wheelchair, and some IV (intravenous) poles in this room. Some of the commodes were tagged, but the majority of the equipment was not tagged. The equipment was intended for patient use, as verified through interview. One of the fan blades had a layer of dust that was visible. None of the fans were tagged. Cleaned equipment was not tagged to ensure that cleanliness was maintained. During an interview, the Housekeeping Director verified a log that documented the daily cleaning of equipment. LSC inpatient tour on 04/23/2024 with the inpatient manager, admission director, and facilities maintenance director revealed the following items which lacked proper sanitary processes and standard infection control processes to avoid sources of transmission of infections. The following items were confirmed through observation and interviews not to be stored in a manner to prevent infections. A bathroom had been converted and labeled as a storage area. There were several commodes, about 15 fans wheel chair and some IV poles in this room. A couple of commodes were bagged but the majority of equipment was not bagged. The equipment was intended for patient use, as verified through interview. One of the fan blades had a layer of dust that was visible. None of the fans were bagged. Interview with the housekeeping director verified a log that documented daily cleaning of equipment. Cleaned equipment was not bagged or tagged to ensure that cleanliness was maintained.

Based on interview and record review, the facility failed to ensure fire alarm inspections were completed (K-345), failed to ensure a complete fire safety plan with all requirements (K-711), failed to ensure completion of all sprinkler inspections (K-353). The accumulative effect of these deficiencies resulted in the facilitys failure to provide a safe environment for all patients, staff and visitors. See L-827

Based on record review and staff interview, the facility failed to meet the requirements for life safety, specifically, the applicable provisions of the 2012 edition of the Life Safety Code of the National Fire Protection Association. This had the potential to affect all patients, staff, and visitors to the facility. The facility census was six. Findings include: K-345 - failed to ensure fire alarm inspections completed K-353 - failed to ensure completion of all sprinkler inspections K-711 - facility failed to develop a complete fire safety plan Please see the Life Safety Report for more details.

Based on record review and staff interview, the facility failed to ensure Fire Alarm system components were maintained in accordance with NFPA 101 - 2012 Edition Sections 19.3.4.1, 9.6.1.3, 9.6.1.5, NFPA 72 - 2012 Edition Sections 10.1 through 10.3.3, 14.3 through 14.3.4, and 14.6.2.3 through 14.6.2.4. This deficient practice had the potential to affect all residents in the facility. The facility census was six. Findings include: Review of records on 09/11/23 at12:17 P.M. revealed the fire alarm system was not tested, inspected, and maintained according to code requirements. There were no records of the semiannual fire alarm inspection. The facility conducted quarterly inspections of the fire alarm system. Each quarterly inspection was of sections of the facility. At the end of the four quarterly inspections an annual inspection of the fire alarm system was completed. There was no semiannual inspection of devices being conducted. These findings were verified by the Lead Electrician and Facilities Manager at the time of discovery.

Based on record review and staff interview the facility failed to ensure sprinklers were inspected, tested, and maintained to ensure system integrity in accordance with NFPA 101 – 2012 Edition Sections 19.3.5.1, 9.7.5 through 9.7.8, and NFPA 25 – 2011 Edition Sections 4.3 through 4.3.3, 5.1 through 5.1.1.2, 7.1.1.2, and 13.4.4.2.9. This has the potential to affect all residents, visitors, and staff in the facility. The facility census was six. Findings include: During record review on 09/11/23 at 1:20 P.M. the sprinkler system had not been maintained according to applicable code requirements. There was no record of inspection and testing for the private fire hydrants. There was also no record of the three-year dry sprinkler system leak test. These findings were verified by the Lead Electrician and Facilities Manager at the time of discovery.

Based on record review and staff interview the facility failed to ensure the fire safety plan contained all components of a fire safety plan in accordance with NFPA 101 2012 Edition 19.7.2.1 through 19.7.2.3.3. This could potentially affect all residents, visitors, and staffs ability to assist in an emergency. The facility census was six. Findings include: Record review on 09/11/23 at 9:15 AM revealed the facility's Fire Safety Plan did not contain all required elements required by NFPA 101 - 2012 Edition. There were multiple copies of a fire safety plan. There was a shortened version located in the staff area, another version in the Emergency Preparedness Plan, and another version in the buildings management plan. The plans did not match and none of the plans included all the required elements for healthcare fire safety plan. Some of the items missing were transmission of the fire alarm, evacuation of the immediate area, and evacuation of smoke compartment. These findings were verified by the Team Lead at the time of discovery.

Based on record review and interview, the facility failed to ensure the nursing needs of the patient were met as identified in the patient's initial assessment and updated assessments for one of three medical records reviewed (Patient #3). The current patient census was 182. Findings include: Review of the admission orders for Patient #3 revealed he/she was living at home and admitted to hospice on 06/14/21. The primary diagnoses included chronic obstructive pulmonary disorder (COPD) and congestive heart failure (CHF). The medical record also included a diagnosis for Type 2 diabetes mellitus without complications. Review of the initial comprehensive assessment dated 06/15/21 revealed medications for Lantus (long acting insulin) 60 units at bedtime, Lispro (also know as Humalog - fast acting insulin) 22 to 24 units prior to meals and Metformin (anti-diabetic) 1000 milligrams (mg) two times a day. Patient #3 also wore a blood sugar monitoring device. Patient #3's blood sugar range was 100 milligrams/deciliter (mg/dL) to 150 mg/dL. The medical record revealed from 08/22/21 to 08/31/21 Patient #3 was in the general hospice inpatient unit (IPU). Review of the active medication list/signed physician orders dated 08/22/21 revealed orders for Humalog 100 milliliter (ml) vial, short acting, inject 22 to 24 units (0.22 to 0.24 ml) subcutaneous before meals for controlling blood sugars. Review of the medication administration record (MAR) revealed on 08/23/21 orders for Humalog to be given subcutaneously 22 to 24 units before meals. There was a line drawn through the 7:00 AM time and there was no blood sugar documented. Further review of the MAR for 08/23/21 revealed Humalog was signed off as being given at 11:00 AM and 4:00 PM but there was no blood sugar documented for these times. Interview with Staff B on 10/14/21 at 2:24 PM stated the expectation was that the nurses would document the blood sugar readings. Further interview with Staff B on 10/14/21 at 3:05 PM revealed they could not locate the blood sugar readings being documented. Interview with Staff B on 10/14/21 at 2:48 PM revealed the reader that stayed in the patient's arm or belly was a free style monitoring device which was the blood glucose monitor. It kept track of the patient's previous blood sugars and the current blood sugar. Based the current blood sugar compared to the previous blood sugar, an arrow would indicate the need to give the insulin on the higher or lower spectrum. The doctor could pull the tracking record up on a computer for any given date to determine how the blood sugars were trending. Further interview with Staff B on 10/14/21 at 3:00 PM revealed the nurses should have clarified with the physician how to give the Humalog 22 to 24 units before each meal based on the free style monitoring system.