St Joseph Hospice of South Alabama LLC

“Observed in Record Review. In 8 of 14 patient records reviewed, the organization failed to ensure the plan of care reflect patient and family goals based on problems identified in the initial, comprehensive and updated comprehensive assessment that were Specific, Measurable, and time-bound. On review of RRHV#1 there were goals established that were not specific and measurable such as Patient/caregiver will verbalize understanding of effects of urinary (date), and Patient/caregiver will verbalize/demonstrate understanding of managing cardiopulmonary symptoms within constraints of the disease by (date). In RRHV#2 an example of a non-specific, not measurable goal was Medications will be managed appropriately as evidenced by steady symptom control. In RRHV#3 a goal was Blood glucose level is obtained and any applicable action taken and in RRHV#4 a goal was Patient exhibits reduction/relief of any cardiopulmonary symptoms. In RRNHV#6 an example of a goal was Patient/caregiver will understand measures to cope with depression. Patient’s depression will be reduced AEB symptoms controlled by (date). Further examples of non specific, not measurable goals could be seen in RRNHV#9, and RRNHV#11. In RRNHV#12 an example of a goal that had a target/achieve by date that was not individualized to the goal was Patient/caregiver will verbalize/demonstrate how to use oxygen safely and effectively by (Mid August) yet the goal was established in May. These observations were reviewed with the Executive Director, Director of Nursing, and Clinical Supervisor.”

“Observed in Record Review. In 7 of 14 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. On review of RRHV#1 there was documentation of issues with edema, shortness of breath, cough and diarrhea with multiple medication adjustments to address the issues however the issues were not addressed nor updated in the care plans to guide the care. In RRNHV#5, RRNHV#6, RRNHV#10, and RRNHV#12 there was documentation of the patient’s difficulty with swallowing and aspiration risk yet there was no care plan related to aspiration precautions to guide the care. In RRNHV#9 the documentation noted a focus of the patient was nerve pain yet the care plan for pain was not specific to the patient’s focus on nerve pain and did not address the issue. In RRNHV#13 there was documentation of weight loss and falls yet the issues were not addressed on the care plan. These observations were reviewed with the Executive Director, Director of Nursing and Clinical Supervisor.”

“Observed in Record Review. In 3 of 14 patient records reviewed, the organization failed to ensure the plan of care include all services necessary for the palliation and management of the terminal illness and related conditions. On review of RRNHV#5 there was an order for IV fluids that read Sodium Chloride 0.9% IV solution 1000ml weekly in the vein> The order was incomplete as there was no further instruction as to how to administer such as where and what type of line, who to administer, and over how much time. In RRNHV#6 there was documentation a skin tear but no orders for treatment noted on the record. In RRNHV#10 the documentation noted the patient was admitted with a foley catheter and the documentation showed the foley was changed in May yet there were no orders for the catheter or catheter changes on the record. These observations were reviewed with the Director of Nursing, and Executive Director. Observed in Record Review. In 13 of 14 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. On review of RRHV#4 there were medications with range orders without detailed explanations for when to give what dose for what situation . Examples were: Morphine concentrate 100mg/5ml oral solution. give 0.5 - 1 ml hourly PRN for pain/dyspnea/restlessness, and Tramadol 50 mg tablet give 1 - 2 tab PO Q6H PRN. Further, there were 3 pain medications ordered as needed, Tramadol was noted for mild pain, Hydrocodone was for Moderate pain, and Morphine was noted simply As needed for Pain/Dyspnea/Restlessness without further instruction. Throughout all the records reviewed (except RRNHV#14 in a SNF) there were further examples of medications with ranges without instruction on when to give what dose as all patients had the same Morphine order (as above) from the comfort kit (or oxycodone range for RRNHV#12). Multiple pain medications without instructions for which medication to give for which situation could be seen in RRHV#2, RRHV#3, RRNHV#5, RRNHV#7, and RRNHV#11. These observations were reviewed with the Executive Director and Clinical Supervisor.”

“Observed in Patient Home. In 1 of 14 patient records reviewed, The organization failed to provide care, treatment, or services according to the patient’s individualized plan of care. In RRNHV#5 the patient medication profile noted orders for IV fluids weekly, however there was no documentation noted in the record of the fluid being administered per the plan of care. Upon discussion with the Director of Nursing it was noted the fluid were never initiated yet there was no documentation in the record to explain why the fluids were not started nor was the medication profile updated to reflect the change. These observations were reviewed with the Director of Nursing and Executive Director.”

“Observed in Record Review. In 3 of 11 patient records reviewed, with aide services provided, the organization failed to ensure written patient care instructions for the hospice aide were prepared the Hospice Aide by the Registered Nurse. On review of RRHV#3 there was no instructions on the Aide plan of care for mobility. On home observation the patient was bed bound and unable to assist with bed mobility or transfers yet there was no indication if the patient was one or two person assist. Further, there was a hoyer lift noted in the home yet the lift was not list on the aide plan of care. In RRHV#1 the patient had a foley catheter, yet there were no instructions on how the aide was to handle the foley catheter wile providing perineal care. In RRNHV#9 the patient was anticoagulants yet the aide plan of care failed to address bleeding precautions. These observations were reviewed with the Executive Director and the Clinical Supervisor.”

“Observed in Record Review. In 1 of 14 patient records reviewed, the organization failed to ensure the patient record contain information that reflected the patient’s care, treatment, and/or services. On review of RRNHV#9 the patient was admitted in the Skilled Nursing Facility (SNF) and then was transitioned to home, yet there was no documentation in the record besides a address change to note that the patient was no longer residing in the SNF and the details surrounding the transition. These observations were reviewed with the Director of Nursing, and Executive Director.”

“Observed in Patient Home. In 2 of 4 home visits conducted, the organization failed to ensure the patient record contain all information to reflect the patient’s care, treatment and services. On home observation for RRHV#1 during medication reconciliation there were multiple medications that were ordered per the plan of care yet the patient was no longer taking and not in the patient home. The patient was not taking Ativan, Morphine, Aleve, Ipratropium/Albuterol, and Omeprazole. Per the patient’s wife the patient had not taken the medications for quite some time which she described as up to a year. The medication profile ordered Mucinex 600mg extended release yet the medication in the home was 1200 mg/Dextromethorphan 60 mg. Further, In RRHV#4 home medication reconciliation, the hydrocodone/acetaminophen on the medication profile was 5mg/325mg yet in the home the bottle was for 7.5 mg (the bottle had been filled in March). Hydroxyzine HCL 25 mg tablet was ordered 1 tab PO Q6H PRN but the bottle in the home read Q4h PRN. For Vitamin B12 the order was for 1 tablet daily yet the caregiver confirmed she gave it 3 times a week. These observations were reviewed with the RN, Executive Director, and Clinical Supervisor.”

“Observed in Patient Home. In 1 of 2 home visits conducted, with oxygen in place, the organization failed to ensure the patient as well as family and/or other caregivers receive instruction in the safe use of oxygen and supplies. On home observation for RRHV#1 there was an unsecured e-tank standing upright in the room. The patient’s wife noted the tank along with a secured tank had been delivered for a storm in 2025 and had been stored since that time and had not ever been used. When inquired about the unsecured tank the wife stated she was not aware the upright tank was a hazard. This observation was reviewed with the Executive Director and Clinical Supervisor.”