Every finding on record at White Wings Hospice Inc

Observed in Record Review. In 1 of 2 patient records reviewed, During RR#1 it was noted many goals were generic without a method to measure progress. For example: Potential for altered cardiac status r/t; Bilateral Lower extremities Pitting edema GOAL: Prevent discomfort due to increasing edema. Pt will maintain optimum peripheral circulation. Potential risk of harm r/t Ambulatory w/fall risk. slow and unsteady gait GOAL: Maintain optimal mobility and independence. Minimize complications due impaired mobility. Unable to balance r/t to blindness GOAL: Pt needs will be met on a day to day basis as communicated. Potential for altered nutritional status r/t disease progression as evidence by inadequate food intake. GOAL: Patient will have adequate food and fluids at least of 40% to maintain comfort as exhibited by expressed verbal and non-verbal communication. This was discussed with the DPCS.

Observed in Record Review. In 1 of 2 patient records reviewed, During RR#2 it was noted an incomplete order for the G-tube feeding, GT Feeding Jevity 1.2 Calories @ 30 ml/hr to increase feeding up to 60 ml/hr if tolerated, no order to change the G-tube dressing although supplies were included on the POC and no flushing orders when administering the patient medication via the G-tube. This was discussed with the DPCS.

Observed in Record Review. In 3 of 3 patient records reviewed, the patient's plan of care failed to specify all of the hospice services and interventions necessary to meet the patient needs. In RR#1 for a patient who had a Foley catheter and oxygen the plan of care care plan addressed the Foley catheter as: maintain Foley catheter care/maintenance. There were no orders present detailing the size of the catheter and balloon or any plans for catheter changes, irrigation etc. Additionally oxygen safety was not addressed in the plan of care. In RR#2 the initial nursing note indicated that the nurse suctioned the patient during the visit. A suction machine was listed on the DME supplied but there was no mention of suctioning on the plan of care. In RR#3 the RN frequency on the plan of care was ordered as prn and recert. The plan of care failed to address the need for an RN to visit every two weeks to do a comprehensive assessment and do home health aide supervisions. This was validated with the DPCS.

Observed in Record Review. In 3 of 3 patient records reviewed, the agency failed to identify and document individualized, prioritized goals specific to the patient's individual needs. In RR#1 all goals have the same target date of March 1 approximately 2 weeks before the end of the certification period. Therefore there were no short term goals that would indicate which goals should be accomplished in the near term to insure patient safety. In RR#2 goals included Pcg will verbalize/express understanding of medication /treatment orders and side effects. and Family/PCG will verbalize understanding of safety measures re; oxygen use. These goals had a target date 2 months after admission without explanation as to why it would take so long to insure patient safety with these skills. In RR#3 the need for wound care and the need to crush medications were not identified on the plan of care and therefore there were no goals associated with this patient need. This was validated with the DPCS.

Observed in Record Review. In 2 of 3 patient records reviewed, the agency failed to document care provided in accordance with the plan of care. In RR#2 LVN visits were ordered two times per week. There were three weeks in the course of care where only one LVN visit was documented without explanation in the record or notification to the IDG. In RR#3 RNs were doing visits every 2 weeks to complete a comprehensive assessment and supervise the hospice aide but there were no orders in the plan of care for those visits. This was validated with the DPCS.

Observed in Tracer Activities. The governing body/ leadership team did not ensure that the following Conditions of Participation were met as determined through observation, documentation and staff interview - 418.100 and 418.56. This was verified with the Administrator.

Observed in Record Review. In 7 of 11 patient records reviewed, the organization failed to reassess it's patients. In HV#1, RR#2, RR#3, RR#4, RR#6, RR#7 and RR#8, the Hospice Nurse Surveyor observed the agency Registered Nurse (RN) did not visit the hospice patient every 15 days to conduct an assessment. For example: in HV#1 the RN did not visit the patient from January to May. In RR#2 the visits were 9/27 and 10/23, more than 15 days apart and in RR#3, there had not been an RN visit since 10/05/21. This was verified with the Administrator.

Observed in Record Review. In 8 of 11 patient records reviewed, the organization failed to plan the patient's care. During record review for HV#1, HV#2, HV#3, RR#4, RR#5, RR#6, RR#7, and RR#8, the Hospice Nurse Surveyor observed the Plan of Care (POC) did not address all relevant needs. For example: in HV#1 the patient was actively suffering anxiety but anxiety was not addressed on the POC. In HV#2, the patient had active moderate dyspnea but dyspnea was not addressed on the POC and in RR#5 the patient had a recent fall but it was not addressed on the POC. This was verified with the Administrator.

Observed in Record Review. In 10 of 11 patient records reviewed, the organization did not plan the patient's care. In HV#1, HV#2, HV#3, RR#1, RR#2, RR#3, RR#5, RR#6, RR#7 and RR#8, the Hospice Nurse Surveyor observed the goals were not measurable or did not contain timeframes for achieving the goals. For example: in HV#1, all goal timeframes were passed but no updates had occurred and the goals had not been resolved. In HV#2, all goal target dates were for 1/11/22 which was the last day of the certification period. And in RR#3, all problems/ interventions/ goals with timeframes were added at Start of Care in July 2020 but the Plan of Care had not been updated since and the timeframes had not been extended or resolved. This was verified with the Administrator.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization failed to provide care, treatment, or services for each patient. During record review for HV#3 and RR#2, the orders for Home Health Aide (HHA) visits were out of compliance. For example: in HV#3 there were no HHA visits for the week of October 31st and for RR#2 there were missed HHA visits for the week of 10/25 and 10/31. This was verified with the Administrator.

Observed in Patient Home. In 1 of 3 home visits conducted, the LVN failed to perform hand hygiene consistent with organizational policy. During HV#1, the LVN did not do hand hygiene before providing direct care. This was discussed with the Administrator.

Observed in HR File Review. In 3 of 4 HR files reviewed, During human resource tracer activities, the Hospice Nurse Surveyor observed the LVNs did not have core competencies completed at orientation and/or annually per organizational policy. In HR#1, the employee was new and core competencies were not signed off by an RN and the employee was completing skills on the competency on her own. In HR#2, the core competency for 2020 and annual competency for 2021 was not completed. And for HR#3 the core competency for the current year is overdue.

Observed in Leadership Session. The governing body/ leadership team did not ensure that the following Conditions of Participation were met as determined through observation, documentation and staff interview - 418.100, 418.100 (b) and 418.56. This was verified with the Administrator.

Observed in Record Review. In 3 of 3 patient records reviewed, a completed discharge summary was not sent to the primary care practitioner or other health care professional who would be responsible for providing care and services to the patient after discharge from Hospice. This was noted in RR#5, RR#6 and RR#7. This was verified with the Administrator.

Observed in Patient Home. In 1 of 3 home visits conducted, the LVN failed to implement the organization's bag technique policy. During HV#1, the LVN placed her purse on the table with no barrier, pulled her equipment out of her purse which did not include sections for clean/ dirty equipment per policy and then put the equipment back into the purse after use without cleaning, per policy. This was discussed with the Administrator.