Prestigious Health Services Inc.

“Observed in Record Review. In 1 of 10 patient records reviewed, The surveyor noted on (RRAR#6) that an order for Azithromycin and Promethazine was obtained from the physician by the LVN. Also, the LVN noted indicated that the patient had sustained an unwitnessed fall prior to her visit and that the patient’s oxygen saturation levels has dropped to 83% and he had a cough. There was no evidence in the record to indicate that the registered nurse reassessed the patient when there was a change in condition, or since. The RN had not seen the patient since admission to assess the change in condition and update the comprehensive assessment. This was confirmed with the director.”

“Observed in Record Review. In 1 of 10 patient records reviewed, The surveyor noted on (RRAR#6) that an order for Azithromycin and Promethazine was obtained from the physician by the LVN. Also, the LVN note indicated that the patient had sustained an unwitnessed fall prior to her visit and that the patient’s oxygen saturation levels has dropped to 83% and he had a cough. There was no evidence in the record to indicate that the registered nurse was informed of the change. Also, there was no documentation of the communication between the LVN and the physician other than the verbal order. This was confirmed with the director.”

“Observed in Individual Tracer. In 8 of 14 patient records reviewed, The surveyor noted (RRHV#2) that the order for oxygen was incomplete and did not include parameters for dosing the range that was ordered. The order read Oxygen 2-5 LPM as needed NC and did not include an indication for use. Also, in (RRAR#6), the order for oxygen read O2 2-5 lpm as needed and did not include a route, indication or dosing parameters. In (RRAR#7), (RRAR#8), (RRAR#9), (RRAR#11) did not include dosing parameters indication for use and (RRAR#10) and (RRAR#12) did not include a route of administration for oxygen. This was confirmed with the director.”

“Observed in Individual Tracer. In 3 of 14 patient records reviewed, The surveyor noted (RRHV#1) that the comprehensive assessment indicated that the patient was experiencing hallucinations and agitation; however, the assessment did not describe the severity of the agitation and frequency of hallucinations. In (RRAR#8) the assessment and care plan indicated that the patient was experiencing behavioral disturbances of agitation and self-harm with biting her own arms; however, there was no description of the frequency or severity of the episodes or the extent of the self-injury. Also, in (RRAR#11), the assessment did not describe the frequency and severity of the patient’s agitation, crying episodes and hallucinations. This was confirmed with the director.”

“Observed in Individual Tracer. In 7 of 14 patient records reviewed, The surveyor noted (RRHV#1) that the plan of care goals were all timed for the end of the certification period and did not include short term outcomes for managing pain and falls risk. The surveyor noted that the goals in (RRHV#2), (RRHV#4), (RRARR#5), (RRAR#7), (RRAR#9) and (RRAR#10) all had time frames for outcome as the last date of the certification periods and did not include any short term outcomes for symptom management. This was confirmed with the director of nursing.”

“Observed in Record Review. In 4 of 14 patient records reviewed, The surveyor noted (RRHV#2) that the patient was admitted in June; however, the plan of care and IDG meeting notes did not provide information about the patient’s progress towards goals related to pain, falls risk, constipation and agitation. The care plan updates only included changing the target dates to the end of the next certification period. The surveyor noted in (RRAR#6) that the problems identified in March remained on the care plan and the target dates were changed; however the interventions were not updated. For example, the problem of immobility was opened in March; a physical therapy evaluation was completed in June with a therapy assessment that indicated a one month plan; however, the care plan as never updated and there was no evidence in the IDG notes of the patient’s progress. In (RRAR#9) there was no evidence of progress toward goals for managing pain. The medication orders were changed, but there was no evidence of the progress in relieving the pain since July. In (RRAR#14), the patient had experienced a fall prior to admission with swelling of the right wrist. The care plan included interventions to apply ice 4 x a day for 2 days. The care plan was not updated and there was no evidence in the IDG notes that the swelling was resolved or if further treatment was necessary. All the goals remained with movement of the outcome dates to the end of the current certification period. This was con firmed with the director.”

“Observed in HR File Review. In 1 of 8 employee files reviewed for staff requiring a license, the Hospice pharmacy surveyor noted that a current license for a certified home health aide was not validated using a primary source upon hire. However, this individual did have a current license at this time in May of 2022. The requirement to validate this staff person’s license using a primary source was confirmed with the administrator at the time of the survey.
 Observed in HR File Review. In 2 of 8 employees requiring a license to provide csre, the Hospice pharmacy surveyor noted that a current license for the Hospice administrator and an LVN were not validated using a primary source at the time the licenses were required to be renewed. , The administrator did frequently provide direct patient care.The administrator’s nursing license expired in September of 2023 and this license was not verified using a primary source until early in 2024. The LVN’s license expired on Oct 31, 2023, but was not validated with a primary source until 5/29/24. This requirement was validated with the administrator at the time of the survey.






thisnurse did provide direct patient care. provided direct patient care’s using a primary source was confired with the administrator at the time of the survey.
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