Human Touch Palliative and Hospice Care, Inc.

“Observed in Record Review. In 3 of 3 patient records reviewed, During review of RR#1, it was noted on three of four problems identified on the POC the established goals lacked measurable outcomes on the POC. For example: Patient will demonstrate proper use of assistive device (Walker), Patient will report a reduction in itching and pain to a tolerable level. During RR#2 it was noted lack of goals for the SC and the MSW on the POC. During RR#3 it was noted lack of goals for the MSW and the SC on the POC. In addition it was noted 2 out of 5 goals on the POC lacked measurable, individualized outcomes. For example: Patient will maintain orientation to person and place, with verbal cueing as needed, Patient will experience a sense of security and comfort in her environment and under Impaired Activity there was lack of goals identified. This was discussed with the organization leadership.”

“Observed in Emergency Management Session. During review of the emergency plan, it was noted a disaster drill in 2025 was identified as an earthquake drill, participating in the national shakeout earthquake drill initiated by the shake out org. The drill lacked the following documentation: the disaster scenario and documentation that the planned drill stressed the limits of its emergency response procedures in order to assess how prepared the organization may be if a real event or disaster were to occur. The outcome and after action evaluation of the organization documented everyone participated and took cover, everyone exited in appropriate exits and met at the designated areas. This was discussed with the organization leadership.”

“Observed in Record Review. During review of the organization admission packet information on patient’s rights to make decisions about their care, treatment or services it was noted lack of the Patient Notification of Hospice Non-Covered Items, Services and Drugs form for the patients to review. This was discussed with the organization leadership. Observed in Record Review. In 1 of 2 patient records reviewed, who were discharged alive. During LiveD/C record review #1 it was noted the Notice of Non Medicare Coverage (NOMNC) was signed by the patient on the date of discharge. This was discussed with the DPCS.”

“Observed in Record Review. In 2 of 14 patient records reviewed, During LiveD/C#1 record review it was noted the RN summary during the IDG meeting the end of March 2025 lacked documentation that the physician ordered a new bowel regimen for the patient. In addition the patient was placed on contact precautions due to the results of a wound culture the middle of March 2025 that was not documented on the RN summary at the IDG meeting. During HV#1 record review it was the IDG RN summary the end of February 2024 lacked the documentation that medications were ordered for a UTI. This was discussed with the organization leadership.”

“Observed in Record Review. In 12 of 14 patient records reviewed, During review of 14 patient medical records, HV#1-3, RR #1,2,3,5,and 7, Live D/C RR#1 and BRRR#1-2, it was noted lack of goals with measurable outcomes on the POC. The goals were not based on the individual patient assessments. The goals from patient to patient with the same for the deficits identified during comprehensive assessments. For example, the goals for alteration in bowel elimination was Verbalizing understanding of etiology and factors affecting bowel disturbance, and appropriate interventions, demonstrating the safe use of bowel regimen, establishing or regaining normal pattern of bowel function was the same for all the patients. .This was discussed with the organization leadership.”

“Observed in Record Review. In 14 of 14 patient records reviewed, During HV#1 record review it was noted during an IDG meeting in October 2024 the patient has a UTI and was started on Cipro 500 mg twice a day for 3 days. The POC lacked an update that included interventions related to the GU system and UTI. During review of the IDG POC it was noted lack of interventions on the POC for the MSW and the SC. During HV#3 it was noted lack of interventions on the POC for the MSW and SC. During the 7th certification for HV#3 the POC was not updated to include wound care and interventions for a coccyx pressure ulcer and a pressure ulcer on the left malleolus was not added to the POC. In addition the POC was not updated to include assessment and interventions of the respiratory system when antibiotics were ordered for a respiratory infection. During the 8th certification the patient developed an infection in the suprapubic region with an order for wound care and antibiotics. There was lack of an update to the POC to include interventions related to the suprapubic wound. During HV#2 record rview it was noted dysphagia was checked on the nutritional assessment portion of the RN initial assessment however instruction on aspiration precautions were not added to the POC. The POC lacked MSW and SC interventions. During RR#2 it was noted a new right leg wound documented on the RN summary in March 2025 however the POC was not updated to include interventions related to the wound. In addition the POC lacked interventions for the MSW and SC with a discipline frequency for both of 1x/month. During RR#3 it was noted lack of interventions related to aspiration precautions added to the POC. In addition the POC lacked MSW and SC interventions with frequencies of 1x/month for both disciplines. There was an order for Fentanyl 25 mcg patches for pain the end of December 2024 however the POC was not updated to add interventions related to the new medication effectiveness. During LiveD/C#1 it was noted a physician order for medications for a new bowel regimen however bowel assessments and interventions were not added to the POC in March 2025. The patient was prescribed antibiotics and placed on contact precautions due to wound culture results, however infection control measures and interventions were not added to the POC. The POC lacked MSW and SC interventions. During BRRR#1 it was noted lack of MSW and SC interventions on the POC. During RR#6 it was noted lack of MSW and SC interventions on the POC with MSW and SC frequencies of once a month. During RR#6 it was noted the patient had a G-tube with feedings ordered. The POC lacked assessment and interventions related to the nutritional deficit documented on the RN initial assessment. The patient had oxygen therapy at 4L/min per the initial RN assessment. The POC lacked interventions on the use and safety of oxygen use. During HV#1-3, RR#1,2,3,4,5,7, BRRR#1, BRRR#2, LiveD/C#1 and #3, it was noted patients had oxygen ordered for PRN use. The POCs lacked interventions on 02 safety and use. During RR#7 it was noted during an IDG meeting the patient had a foley catheter inserted for urinary issues. The POC was not updated with GU deficit interventions. This was discussed with the organization leadership. Observed in Record Review. In 2 of 14 patient records reviewed, During HV#3 it was noted the following medications ordered for constipation without clear direction in what order to take which medication: senna 8.6mg 2 tabs 3x per day, senna 8.6 mg 2 tabs daily as needed for no BM x 2 days, MiraLAX 17 grams 3x/day however in the treatment column it is written as 17 grams for constipation daily, lactulose 30 ml 3x/day as needed for constipation, Colace 100mg 3x/day for constipation and Dulcolax supp every 3 days as needed for constipation. During HV#2 record review it was noted orders on the POC for Senna, MiraLAX in addition to Dulcolax and Colace in the comfort kit without direction on which medication to take first. This was discussed with the organization leadership.”

“Observed in Record Review. In 5 of 14 patient records reviewed, During HV#1, HV#2, HV#3 and RR#5 it was noted lack of documentation of progress toward goals. The patients had multiple certification periods with SOCs 9-12 months prior to the current survey. The same goals were documented as completed with each certification. During each subsequent certification, the goals remained the same, however the goal date would be changed to the new certification period. For example, RR#5 SOC was February 2024 with goals and interventions documented as accomplished for that certification period in February. The next certification in May 2024 had the same goals with the dates advanced to the new certification period and continued on the same way through 5 additional 60 day certifications. During RR#6 it was noted the goals on the certification in January 2025 lacked documentation of progress to date in May 2025. This was discussed with the organization leadership.”

“Observed in Document Review. There was lack of evidence that the governing body and leadership had established processes to support patient care treatment and services through sustained compliance as evidenced by repeat findings from the previous survey in the areas of establishing individualized goals, updating the POCs, and demonstrating progress toward goals. This was discussed with the organization leadership. Observed in Document Review. There was lack of evidence that the governing body and leadership had established processes to support patient care treatment and services through sustained compliance as evidenced by CLD findings at 418.54, 418.56 and 418.100. This was discussed with the organization leadership.”