Silverado Hospice-Los Angeles

“Based on observation, interview, and record review, the Hospice Agency (HA, agency providing care to terminally ill patients who has six months or less to live) failed to ensure the Condition of Participation regarding Initial and Comprehensive Assessment (an assessment to identify the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient’s well-being, comfort, and dignity throughout the dying process of the patient) of the Patient was met as follows: Based on observation, interview and record review, the Hospice Agency (HA, agency providing care to terminally ill patients who has six months or less to live) failed to ensure the Condition of Participation regarding Initial and Comprehensive Assessment of the Patient was met as follows: 1. The hospice agency failed to ensure the patient’s eligibility for hospice services related to the palliation (relief of symptoms and suffering cause by life threatening diseases) and management of the terminal illness and related conditions were accurately assessed, for two of 19 sampled patients (Patient 1 and Patient 9). (Refer to L524) 2. The hospice staff failed to accurately assess one of 19 sampled patients (Patient 9). For Patient 9, the hospice skilled nurse did not fully assess the patient for signs and symptoms of heart failure. (Refer to L525) 3. The hospice agency failed to maintain an accurate, current medication profile for one of 19 sampled patients (Patient 9). (Refer to L530) These systemic practices resulted in the failure of the hospice to deliver statutorily mandated compliance with Federal regulation for Initial and Comprehensive Assessment of the Patient to ensure the highest quality of care are being provided to patients certified to receive the Medicare hospice benefits. Based on observation, interview and record review, the hospice staff failed to accurately assess two of 19 sampled patients (Patients 5 and 9). For Patient 5, the SN (skilled nurse) did not assess the patient’s existing portacath (is a small chamber that sits under the skin. It’s attached to a long plastic tube that goes into a large vein close to the heart) during initial and consecutive SN visits.”

“Based on interview and record review, the Hospice Agency (HA, agency providing care to terminally ill patients who has six months or less to live) failed to ensure the Condition of Participation for Interdisciplinary Group (IDG, team members from different disciplines working collaboratively, with a common purpose, to set goals, make decisions and share resources and responsibilities), Care Planning, and Coordination of Services was met as follows: 1. The Hospice agency failed to ensure to assess the vital signs (clinical measurements, specifically pulse rate, temperature, respiration rate, and blood pressure, that indicate the state of a patient’s essential body functions) of one of 19 sampled patients (patient 17) and document in Patient 17s clinical record. This deficient practice had the potential to affect the care of Patient 17. (Refer to L543). 2. The hospice agency failed to ensure to develop a plan of care for three of 19 sampled patients (Patient 1, Patient 5, and Patient 12). This deficient practice had the potential not to meet the health care needs and goals of Patient 1, Patient 5, and Patient 12 (Refer to L545). 3. The HA failed to ensure to implement physician orders for one of 19 sampled patients (Patient 2) who had an elbow skin tear. (Refer to L549). This deficient practice had the potential for Patient 2 to develop a skin infection. These systemic practices resulted in the failure of the hospice to deliver statutorily mandated compliance with Federal regulation for Interdisciplinary Group, Care Planning, and Coordination of Services to ensure the quality of care are being provided to patients certified to receive hospice benefits.”

“Based on observation, interview, and record review, the hospice agency (HA, agency providing care to terminally ill patients who has six months or less to live) failed to conduct and document a comprehensive assessment (an assessment to identify the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient’s well-being, comfort, and dignity throughout the dying process of the patient) that reflected the patients current health status and identify the patients’ needs for hospice care and services related to hospice eligibility and management of terminal illness for one of 19 sampled patients (Patient 9). This deficient practice had the potential for Patient 9s needs not to be met. Findings: During a review of Patient 9s General Patient Details form, the General Patient Details form indicated a start of care (SOC) date of 8/22/2023 with a terminal diagnosis of chronic systolic heart failure (a condition in which the heart does not pump blood as well as it should). The General Patient Details form indicated the frequency of visits by the agencys skilled nurse (SN) to one visit weekly and three times prn (as needed) visits every 90 days. During a review of Patient 9’s Comprehensive Assessment visit, dated 12/7/2023, the Comprehensive Assessment indicated Patient 9 was alert, oriented to person and place, able to make her needs known, easily dyspneic (one who is suffering from shortness of breath) with simple exertion (effort). The Comprehensive Assessment indicated Patient 9 would ambulate (walk) using an assistive, and was on NYHA Class IV level for heart failure (New York Heart Association Class IV: Patient who should be at complete rest, confined to bed or chair, any physical activity brings on discomfort and symptoms occurs at rest). During a review of Patient 9’s Hospice Certification of Terminal Illness (or CTI, physician’s certification of the patient being terminally ill to have Medicare hospice benefit) for the benefit period 11, from 12/20/2023 to 2/17/2024, the CTI indicated the hospices Medical Director certified Patient 9 was terminally ill with a life expectancy of six months or less if the terminal illness runs it normal course. The CTI indicated the hospice’s Medical Director did not communicate with Patient 9s primary physician to certify Patient 9 had a life expectancy of six months or less if the terminal illness runs its normal course. The CTIs “Brief Narrative Statement and Attestation,” section indicated there was no supporting narrative from the Medical Director that included laboratory test results, imaging data, history and physical, and biopsy results prior to the SOC to support Patient 9s terminal illness diagnosis. The CTIs “;Face to Face Visit Details,” dated 12/2/2023, indicated the Medical Directors nurse practitioner (NP 1) documented Patient 9 had a regular heart rhythm, was comfortable at rest, no edema (swelling caused by too much fluid trapped in the body’s tissues), and was on NYHA Class III level for heart failure (New York Heart Association Class III – comfortable at rest; less than ordinary physical activity causes fatigue, dyspnea, palpitations, or angina). During a review of Patient 9s Local Coverage Determination (LCD, describes guidelines to be used by National Government Services [NGS] in reviewing hospice claims and by hospice providers to determine eligibility of beneficiaries for hospice benefits) worksheets for Heart Disease indicated Patient 9 was eligible per LCD guidelines. The LCD worksheet indicated Patient 9 was optimally treated for heart disease, was either not a candidate or had declined surgical procedures or had symptoms of heart failure at rest. The LCD Guidelines for heart disease indicated patients should meet the criteria for NYHA Class IV level and not NYHA Class III to qualify for hospice eligibility. During an observation on 6/6/2024, at 12:05 p.m., at Patient 9s residence, with Licensed Vocational Nurse 1 (LVN1), Patient 9 was sitting on a sofa awake, alert, oriented but hard of hearing. Patient 9 walked using an assistive device accompanied by a family member (FM 1). During an interview on 6/6/2024, at 12:22 p.m., with FM 1, FM 1 stated Patient 9 was doing good, eating well, would walk around the house using a walker (assistive device), and did not complain of any chest pain. FM1 stated Patient 9s blood pressure was within normal levels every time the HAs SN (in general) would check during their visits. During an interview on 6/7/2024, at 11:20 a.m., with the Director of Patient Care Services (DPCS), the DPCS stated she was not able to find documented evidence Patient 9 had declined surgical procedures or any documentation prior to hospice admission or that Patient 9 was on complete rest or confined to bed or chair or was optimally treated for heart disease with medications. During a review of the hospice agencys policy and procedure titled, “;Admission Criteria”, revised June 19, 2023, indicated the hospice only admits patients who meet the admission criteria. In reaching a decision to certify that the patient is terminally ill, the hospice physician must consider at least the following information: a. Diagnosis of the terminal condition of the patient; b. Other health conditions, whether related or unrelated to the terminal condition; c. clinically relevant information supporting all diagnoses; d. Current medication and treatment orders; e. Information about the medical management of the patients conditions unrelated to the terminal condition; f. Following Medicare LCD guidelines.”

“Based on observation, interview and record review, the hospice agency (agency providing care to terminally ill patients who has six months or less to live) failed to assess the health status of two of 19 sampled patients (Patients 5 and Patient 9) during the initial and consecutive Skilled Nurse (SN) visits. a. For Patient 5, the HA licensed nurses (in general) did not assess Patient 5s existing Portacath (is an implanted device that gives access to the veins) during initial and consecutive SN visits. b. For Patient 9 who had a diagnosis of heart failure (a condition that develops when your heart does not pump enough blood for the body’s needs), the HA licensed nurses (in general) did not assess Patient 5 for signs and symptoms of edema (swelling caused by too much fluid). These deficient practices placed Patient 5 and Patient 9 at risk for harm and complications. (Refer to L525) Findings: During a review of Patient 9s General Patient Details form indicated a start of care (SOC) date of 8/22/2023 with a terminal diagnosis of chronic systolic heart failure (a condition in which the heart does not pump blood as well as it should). The form further indicated the frequency of visits by the agencys skilled nurse (SN) to one visit weekly and 3 prn (pro re nata, or as needed) visits every 90 days. During a review of Current Care Plan Problem, initiated on 12/14/2023, indicated Patient 9 was at risk for lower extremity (is everything from your hip to your toes) edema (swelling due to fluid retention) related to heart disease. The goal indicated patient will have less than +2 edema to lower extremities in next 2 months. The care plan interventions indicated to for the agency SN to assess grade of edema to lower extremities, collaborate with physician with increased edema, educate on causes of increased edema, educate on diet modifications that could help manage edema, educate to elevate lower extremities whenever sitting or lying, and to monitor effectiveness of diuretic (medications that help the body get rid of extra fluid) therapy. During a joint home visit, on 6/6/2024 at 12:05 p.m. with the licensed vocational nurse (LVN 1) at Patient 9s residence, Patient 9 was observed sitting in a sofa awake, alert, oriented, and ambulatory using an assistive device. During an observation, on 6/6/2024 at 12:16 p.m., LVN 1 assessed Patient 9 but did not remove the patient’s socks to assess for pedal edema (foot and ankle swelling). During an interview with LVN 1, on 6/6/2024 at 12:38 p.m., LVN 1 stated, “I did not fully assess for pedal edema. I should have removed the patients socks.” According to the American Heart Association (organization dedicated to fighting heart disease and stroke [damage to the brain from interruption of its blood supply]), signs and symptoms of heart failure include swelling in the feet, ankles, legs, fingers, abdomen and in other tissues and organs, shortness of breath, and increased heart rate. During an interview on 6/7/2024 at 11:20 a.m., with the Director of Patient Care Services (DPCS), the DPCS stated the agencys skilled nurse should be checking for pedal edema for patient that have heart failure including checking patients foot for any swelling. During a review of the hospice agencys undated policy and procedure titled, “;Initial and Comprehensive Assessment”, indicated hospice conducts and documents a patient specific comprehensive assessment that identifies the patients need for hospice care and services, and the patients need for physical, psychosocial, emotional and spiritual care. This includes all areas of hospice care related to the palliation and management of the terminal illness and related conditions. Assessments are made at each visit/contact with the patient/family or caregiver. A review of Patient 5’s demographics (identifying information such as patients name, date of birth and address, along with insurance information) indicated she was admitted to the hospice agency on 4/19/2024, with a terminal diagnosis of malignant neoplasm of the ovary (a cancer that begins in the female organs that produce eggs). The form further indicated the frequency of visits by the agencys skilled nurse (SN) to two visits weekly and 3 prn (pro re nata, or as needed) visits every 60 days. A review of Patient 5’s Physician’s order dated 4/19/2024, indicated to administer Sodium Chloride 0.9 percent to administer 80 ml (milliliters) per hr (hour) via portacath for 12 hours once weekly every Monday as needed for dehydration. During a review of Patient 5’s Initial comprehensive assessment dated 4/19/2024, indicated no documented evidence of an assessment for an existing portacath device, of it’s location and skin condition around the area. A further review of Patient 5’s SN Clinical Visit Chart from dates 4/19/2024 to 5/26/2024, indicated no entry of an existing portacath device, of the location and the skin condition of the area. During an interview on 6/7/2024 at 1 p.m., with the Director of Patient Care Services (DPCS), the DPCS stated Patient 5 has a portacath with one port huber needle at right upper chest. The DPCS further stated the visiting nurse should have assessed and document the existing portacath and skin surrounding in their nursing notes on every visits.”

“Based on observation, interview and record review, the hospice agency (HA, agency providing care to terminally ill patients who has six months or less to live) failed to maintain a current medication profile (a written summary of all the medicines a person takes regularly, including over the counter) for one of 19 sampled patients (Patient 9). This deficient practice had the potential to place Patient 9 at risk for medication errors and adverse drug reactions (a harmful, unintended result caused by taking medication). Findings: During a review of Patient 9s General Patient Details form indicated a start of care (SOC) date of 8/22/2023 with a terminal diagnosis of chronic systolic heart failure (a condition in which the heart does not pump blood as well as it should). The General Patient Details form indicated the frequency of visits by the agencys skilled nurse (SN) to one visit weekly and three prn (as needed) visits every 90 days. During a review of Patient 9’s Current Care Plan Problems, the Current Care Plan Problems indicated for the HA skilled nurses (in general) to assess for safety, educate regarding medications that increase fall risk, to frequently monitor patient for status change, and to consult with pharmacy for medication review. During an observation on 6/6/2024, at 12:05 p.m., at Patient 9s residence, with Licensed Vocational Nurse1 (LVN 1) Patient 9 was sitting on a sofa awake, alert, and oriented. During a review and interview of Patient 9s current medication, on 6/6/2024, at 12:35 p.m., with LVN 1, and Patient 9s family member (FM 1), a bottle of hyoscyamine sulfate (used to treat many different stomach and intestinal disorders) 0.125 milligram (mg, a unit of measure) one tablet oral every four hours as needed for excess secretions could not be found. Patient 9s current medication list provided by the HA indicated Patient 9 was taking the medication. During the concurrent observation and interview, FM 1 stated Patient 9 did not use the medication and was not aware if the HA provided them with the medication bottle since the SOC. During an interview on 6/7/2024, at 11:20 a.m., with the Director of Patient Care Services (DPCS), the DPCS stated nursing staff (in general) needed to review patients current medication on every visit and update the medication list in the patients clinical record. During a review of the hospice agencys policy and procedure titled, “;Medication, Medical Supplies and DME (durable medical equipment) Management”, revised June 19, 2023, indicated adequate patient care medications and supplies are made available to provide quality care at all times. An ongoing, updated list of all medication the patient is taking, including over the counter drugs, is maintained in the patients clinical record and reviewed by Medical Director / hospice physician at scheduled interdisciplinary group (IDG) meetings.”

“Based on interview and record review, the hospice agency (HA, agency providing care to terminally ill patients who has 6 months or less to live) failed to ensure to assess the vital signs (clinical measurements, specifically pulse rate, temperature, respiration rate, and blood pressure, that indicate the state of a patient’s essential body functions) of one of 19 sampled patients (patient 17) and document in Patient 17s clinical record. This deficient practice had the potential to affect the care of Patient 17. Findings: During a review of Patient 17’s untitled admission record indicated a start of care date of 11/28/2022, with a terminal diagnosis Alzheimers disease, (progressive disease with mild memory loss) unspecified. During a review of Patient 17s Skilled Nurse (SN) notes dated 5/23/2024, the SN notes indicated the HA did not check Patient 17s blood pressure, apical pulse (a pulse point on the chest), and temperature. During an interview on 6/7/2024, at 11 a.m., with Registered Nurse2 (RN 2), RN2 stated the importance of checking and documenting the vital signs was to stablish the baseline of a patient (in general). RN 2 stated she did not document on Patient 17s SN notes that Patient 17 refused vital signs on 5/23/2024. During a concurrent interview and record review, on 6/7/2024, at 11 am, with the Director of Patient Care Services (DPCS), Patient 17s SN notes dated 5/23/2024 were reviewed. The DPCS stated there was no documentation for Patient 17s blood pressure, apical pulse, temperature, and no other documented evidence. The DPCS stated the importance of checking Patient 17s vital signs were to assess for any decline. The DPCS stated that taking the vital signs was a standard nursing practice (in general). During a review of the hospice agency’s policy and procedure titled, “;Plan of Care-Revised,” dated June 19, 2023, indicated revised plan of care must include information from the patients updated comprehensive assessment and must note the patients progress towards outcomes and goals as specified in the plan of care.”

“Based on interview and record review, the hospice agency (HA, agency providing care to terminally ill patients who has 6 months or less to live) failed to failed to ensure to develop a plan of care for three of 19 sampled patients (Patient 1, Patient 5, and Patient 12). This deficient practice had the potential not to meet the health care needs and goals of Patient 1, Patient 5, and Patient 12. Findings: During a review of Patient 12s General Patient Details form indicated a start of care (SOC) date of 5/18/2024 with a terminal diagnosis of malignant neoplasm (a cancerous tumor) of the lungs. The form further indicated the frequency of visits by the agencys skilled nurse (SN) to three visits weekly and 3 prn (pro re nata, or as needed) visits every 60 days. During a review of Patient 12’s Initial comprehensive assessment dated 5/18/2024, indicated Patient 12 had a gastrostomy tube (G-tube, a tube inserted through the abdomen that delivers nutrition directly to the stomach). During a review of Patient 12s Current Care Plan for the certification period starting on 5/18/2024, indicated it did not contain goals and specific interventions for care of the patients G-tube site. During a concurrent interview and record review, on 6/7/2024 at 11:20 a.m., with the Director of Patient Care Services (DPCS), the DPCS confirmed Patient 12s plan of care did not have specific interventions for care of G-tube site. During a review of the hospice agency’s policy and procedure titled, “;Plan of Care-Revised”, dated June 19, 2023, indicated the IDG (Interdisciplinary Group, a group composed of individuals who work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of the hospice patients and families facing terminal illness), in consultation with the attending physician, develops a plan of care for each patient. The plan of care must specify the hospice care and services necessary to meet the patient and familys specific needs identified in the comprehensive assessment. A review of Patient 1’s demographics (identifying information such as patients name, date of birth and address, along with insurance information) indicated she was admitted to the hospice agency on 6/27/2023, with a terminal diagnosis of senile degeneration of the brain (loss of intellectual ability that is associated with or the characteristics of old age). The form further indicated the frequency of visits by the agencys skilled nurse (SN) to three visits weekly and 3 prn (pro re nata, or as needed) visits every 60 days. A review of Patient 1’s Physician’s order dated 11/1/2023, indicated to administer Seroquel (psychotropic medication [any drug that affects mental function, behavior, and mood]) 25 mg (milligrams, a unit of measurement) one tablet two times a day for hallucinations. A further review of Patient 1s clinical record did not indicate a Plan of Care (POC) was developed and/or completed for psychotropic medication management (Seroquel) for Patient 1. On 6/7/2024, at 12 p.m., during an interview with the Director of Patient Care Services (DPCS), when she was asked if the Seroquel medication dosages were safe to give to Patient 1, she stated yes, that it was safe to help control Patient 1s disease process. She further stated that there was no plan of care developed for psychotropic medication management for Patient 1. Findings: a. During a review of Patient 1’s Demographics (identifying information such as patients name, date of birth and address, along with insurance information) indicated the HA on 6/27/2023, with a terminal diagnosis of senile degeneration of the brain (loss of intellectual ability that is associated with or the characteristics of old age). The Demographics indicated the frequency of visits by the agencys skilled nurse (SN) for three visits weekly and three prn (as needed) visits every 60 days. During a review of Patient 1’s Physician’s order dated 11/1/2023, indicated for Patient 1 to receive Seroquel (psychotropic medication [any drug that affects mental function, behavior, and mood]) 25 milligrams (mg, a unit of measurement) one tablet two times a day for hallucinations (an experience involving the apparent perception of something not present). During a concurrent interview and record review, on 6/7/2024, at 12 p.m., with the Director of Patient Care Services (DPCS), Patient 1s clinical record was reviewed. The DPCS stated the HA did not develop a plan of care for psychotropic medication management (Seroquel). b. A review of Patient 5’s Demographics indicated the HA admitted Patient 5 on 4/19/2024, with a terminal diagnosis of malignant neoplasm of the ovary (a cancer that begins in the female organs that produce eggs). The Demographics indicated the frequency of visits by the agencys SN to two visits weekly and three prn visits every 60 days. During a review of Patient 5’s Physician’s order dated 4/19/2024, the Physician Order indicated for Patient 5 to receive Sodium Chloride 0.9 percent (is an electrolyte that regulates the amount of water in the body) 80 ml (milliliters, a measure of volume) per hour via Patient 5s portacath (is an implanted device that gives access to the veins) for 12 hours once weekly every Monday as needed for dehydration (a condition that occurs when the body loses too much water and other fluids that it needs to work normally). During a concurrent interview and record review, on 6/7/2024 at 1 p.m., with DPCS), Patient 5s clinical record was reviewed. The DPCS stated the HA did not develop a plan of care for Patient 5 and did not have specific interventions for the nursing care of the portacath device. c. During a review of Patient 12s General Patient Details form indicated a start of care (SOC) date of 5/18/2024 with a terminal diagnosis of malignant neoplasm (a cancerous tumor) of the lungs. The General Patient Details indicated the frequency of visits by the agencys SN to three visits weekly and three prn visits every 60 days. During a review of Patient 12’s Initial comprehensive assessment dated 5/18/2024, the Initial comprehensive assessment indicated Patient 12 had a gastrostomy tube (G-tube, a tube inserted through the abdomen that delivers nutrition directly to the stomach). During a review of Patient 12s Current Care Plan for the certification period starting on 5/18/2024, the Current Care Plan for the certification indicated there were no goals and specific interventions for the nursing care of Patient 12s G-tube site. During a concurrent interview and record review, on 6/7/2024, at 11:20 a.m., with the DPCS, Patient 12s clinical record was reviewed. The DPCS stated Patient 12s plan of care did not have specific goals and interventions for the nursing care of Patient 12s G-tube site. During a review of the hospice agency’s policy and procedure titled, “;Plan of Care-Revised,” dated June 19, 2023, indicated the IDG (Interdisciplinary Group, a group composed of individuals who work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of the hospice patients and families facing terminal illness), in consultation with the attending physician, develops a plan of care for each patient. The plan of care must specify the hospice care and services necessary to meet the patient and familys specific needs identified in the comprehensive assessment.”

“Based on interview and record review, the hospice agency (HA, agency providing care to terminally ill patients who has 6 months or less to live) failed to ensure to implement physician orders for one of 19 sampled patients (Patient 2) who had an elbow skin tear. physician orders were implemented for 1 of 19 sampled patients (Patient 2). This deficient practice had the potential for Patient 2 to develop a skin infection. Findings: During a review of Patient 2’s Demographics (identifying information such as patients name, date of birth and address, along with insurance information) indicated the HA admitted Patient 2 on 11/16/2023, with a terminal diagnosis of senile degeneration of the brain (loss of intellectual ability that is associated with or the characteristics of old age). The Demographics indicated the frequency of visits by the agencys skilled nurse (SN) to one visit weekly and three prn (as needed) visits every 60 days. During a review of Patient 2’s Physician’s Order dated 3/23/2024, the Physician’s Order indicated for Patient 2 to receive a wound treatment for the right elbow skin tear as follows: to clean wound with wound cleanser, pat dry, apply triple antibiotic, and cover with dry dressing. During a concurrent interview and record review, on 6/7/2024, at 12 p.m., with the Director of Patient Care Services (DPCS), Patient 2s SN Visit Notes dated 3/26/2024, 3/26/2024, 4/3/2024, and 4/10/2024, were reviewed. The DPCS stated she could not find any documentation by the visiting nurse that wound care was provided for Patient 2. During a review of the HA’s undated policy and procedure titled, “Physician Orders Communications and Implementation,” indicated the nursing staff should be implementing orders received and updating the plan of care.”

“Observed in Surveyor review but corrected onsite pending acceptable Evidence of Standards Compliance. In 5 of 14 patient records reviewed, the organization did not assess the patient according to defined timeframes. In RRHV#1, the MSW did not complete the initial assessment within five (5) days of the election of hospice care. It was documented the Social Worker was unavailable for the assessment visit due to time off. In RRNHV#10, the initial MSW assessment was not completed within five days of the patient’s election of hospice, with no documentation as to the reason for the delay. In RRHV#3, RRNHV#4, and RRNHV#5, the initial bereavement assessment was not completed/documented within five days of the patient’s election of hospice care. This was reviewed and verified with the Director of Patient Care Services.”

“Observed in Record Review. In 3 of 14 patient records reviewed, the organization did not plan the patient’s care by ensuring the plan of care included all services needed for the palliation and management of the terminal illness and related conditions. In RRHV#2, the patient was assessed at high risk for falls based on the fall risk assessment, but fall prevention/safety was not included in the plan of care. In RRNHV#1, the patient was on Oxygen at 2-4 liters per nasal cannula and assessed at high risk for falls. Care interventions and goals related to the oxygen safety and fall prevention was not included in the patient’s plan of care. In RRNHV#4, the patient’s diagnoses included Alzheimer’s Disease and Dysphagia. It was also documented the patient was on a pureed diet. There was no interventions/goals related to the Dysphagia included in patient’s plan of care. This was reviewed and verified with the Director of Patient Care Services
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“Observed in Patient Home. In 1 of 4 home visits conducted, the organization did not implement the infection prevention and control activities it had planned to minimize reduce, or eliminate the risk of infection. In RRHV#2, the RN did not follow the organization’s bag technique policy. Upon entry to the patient’s residence, the main compartment of the RN’s canvas field bag, where care equipment and other items were stored, was open to the outside environment. Upon completion of the visit and exiting the patient’s room, the RN’s backpack field bag remained open. This was reviewed and verified with the Director of Patient Care Services.”