Ziba Hospice LLC

“Observed in Record Review. In 8 of 10 patient records reviewed, the organization failed to ensure the plan of care reflect patient and family goals that were specific, measurable and time-bound. Throughout the active records reviewed there were goals established that were not specific, not measurable or not time-bound. In RRHV#1 an example of a non-specific goal was Family/caregiver will express satisfactory control of symptoms.. In RRHV#2 a not measurable goal was Husband/caregiver will demonstrate the ability to cope with limitations. In RRNHV#4 the goals were more measurable yet the goals were not time bound as target dates were not individualized and did not correlate with the goal. In RRNHV#5 examples of goals that were not measurable were Anxiety/agitation controlled through course of care and Patient will be free of preventable complications. In RRNHV#6, RRNHV#8, RRNHV#9, and RRNHV#10 goals target dates were not individualized as they all had the same target dates. An example of an goal that was not measurable in RRNHV#6 was Anxiety reduced and within manageable level during dyspneic episodes and an example in RRNHV#9 was Patient will experience optimal comfort with minimized anemia-related symptoms. These observations were reviewed with the DPCS.”

“Observed in Record Review. In 4 of 10 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#3 the documentation noted a wound/non-blanchable redness to the buttocks with orders for treatment yet the care was not reflected in the care plan as the care plan had been resolved. Most care plans were noted to be closed yet the issues were ongoing. On home observation there was a dressing observed to the buttocks area and the caregiver noted it was for protection yet there was no order and the care was not reflected on the care plans. In RRNHV#6 there was documentation of the patient with a URI that required antibiotics yet the infection was not reflected in the care plan. In RRNHV#9 the wound care treatment was discontinued yet the plan of care was not updated as order remained as an intervention on the plan of care. In RRNHV#10 there was documentation of wounds yet the skin integrity care plan was not specific to the wound on the coccyx or the lateral malleolus. Further there was oxygen in the home with orders for use as needed yet there was no respiratory or oxygen safety care plan established. These observations were reviewed with the DPCS.”

“Observed in HR File Review. In 1 of 1 HR files reviewed, for hospice aide, the organization failed to ensure the registered nurse supervisor evaluate the required areas of: Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other staff - Reading and recording temperature, pulse, and respirations - Appropriate and safe techniques in personal hygiene and grooming that include bed, sponge, tub, or shower bath; sink, tub, or bed shampoo; nail and skin care; oral hygiene; toileting and elimination - Safe transfer techniques and ambulation and Normal range of motion and positioning, by observing the hospice aide’s performance of the tasks with a patient or pseudo-patient as part of a simulation. On review of HR#7 for the Aide the initial competency was documented as being conducted only verbally with the required skills not being observed. This observation was reviewed with the DPCS.”

“Observed in Record Review. In 3 of 10 patient records reviewed, the organization failed to ensure the patient was accurately documented. On review of RRHV#1 the LVN documentation noted the patient continued to take Breyna inhaler for shortness of breath yet the plan of care orders noted that the medication was discontinued in December of last year. In RRNHV#5 there was a note from the LVN that was specified as a post-mortem visit yet the documentation in the note was for a skilled nursing visit on a live patient. In RRNHV#9 the psychosocial care plan noted plan to provide volunteer services to assist with home management yet volunteer services had been declined on admission. These observations were reviewed with the DPCS.”

“Observed in Tracer Activities. In 1 of 4 contracts reviewed, the organization failed to ensure the written agreement for the Skilled Nursing Facility (SNF) contained all required elements. On review of the contract for the SNF there was no provision stating that the hospice will report all mistreatment, neglect, or verbal, mental, sexual, and physical abuse to the SNF, NF, or ICF/IID administrator within 24 hours of the hospice becoming aware of the alleged violation, including injuries of unknown source, and misappropriation of patient property by anyone unrelated to the hospice. This observation was reviewed with the DPCS.”