Aria Hospice LLC

“Observed in Record Review. In 5 of 14 patient records reviewed, the organization failed to ensure that the plan of care includes all services needed for the palliation and management of the terminal illness and related conditions, including treatment necessary to meet the patient’s needs. For example, for records HOSRRHV#3, HOSRRNHV#5, HOSRRNHV#6, and HOSRRNHV#10, oxygen was ordered via nasal cannula at 2–5 L/min as needed for shortness of breath; however, the orders did not include defined parameters or clinical guidance specifying the appropriate flow rate based on the severity of shortness of breath. For record HOSRRNHV#4, the physician ordered staff to cleanse the right forearm with wound cleanser, pat dry, apply Xeroform dressing, cover with a non-adherent Telfa dressing, and secure with rolling gauze every other day or as needed; however, the order did not specify the clinical indications for performing the treatment as needed. This finding was discussed and validated by the Hospice Administrator/DPCS.”

“Observed in Patient Home. In 2 of 3 home visits conducted, the organization failed to follow accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions. For example, during home visits of HOSRRHV#1 and HOSRRHV#3, it was observed that the hospice nurse cleaned the blood pressure cuff using Lysol disinfecting wipes. Following application of the disinfectant, the nurse immediately returned the equipment to the nursing bag without allowing the surface to remain visibly wet for the manufacturer-recommended contact time of four minutes. This finding was discussed with and validated by the hospice Administrator/DPCS.”

“Observed in Record Review. In 5 of 6 patient records with hospice aide services, the organization failed to ensure that written patient care instructions for hospice aides were prepared by the registered nurse responsible for aide supervision. For example, in records HOSRRHV#3 and HOSRRNHV#6, the aide care plans did not include safety precautions for oxygen use, although the patient may receive oxygen via nasal cannula at 2–5 L/min as needed for shortness of breath. The patient also used Thick-It due to a history of dysphagia and risk for aspiration pneumonia, but aspiration precautions were not included. In record HOSRRNHV#4, the patient was prescribed Eliquis 2.5 mg, one tablet PO BID; however, the aide care plan did not address bleeding precautions. In record HOSRRNHV#7, the patient was prescribed Aspirin 81 mg, one tablet daily, but bleeding precautions were not included in the aide care plan. In record HOSRRNHV#10, the patient also took Aspirin, but no bleeding precautions were documented. This finding was discussed and validated by the Hospice Administrator/DPCS.”

“Observed in Patient Home. In 2 of 3 home visits conducted, it was observed that the patient’s medication profile was not accurate and did not reflect the medications currently being taken by the patient. For example, during home visit of HOSRRHV#1, several medications that the patient had reportedly started taking one to two months prior – including Ibuprofen 800 mg, Hydroxyzine HCL, and Imodium PRN for loose BM – were not included in the medication profile. During home visit of HOSRRHV#3, the patient was reported to be taking Acetaminophen 500 mg 1 tablet PO PRN for approximately one month ago; however the medication profile had not been updated to reflect the change. This finding was discussed with and validated by the hospice Administrator/DPCS.”

“Observed in Record Review. In 10 of 10 patient records reviewed, The organization did not ensure that documentation entries were properly authenticated. Clinical record review found that paper documents for HOSRRHV#1, HOSRRHV#2, HOSRRHV#3, HOSRRNHV#4, HOSRRNHV#5, HOSRRNHV#6, HOSRRNHV#7, HOSRRNHV#8, HOSRRNHV#9, and HOSRRNHV#10—including the Home Oxygen Fire Risk Assessment, Election of Hospice Benefit Informed Consent form, Request for Confidential Medical Records Regarding Medical Information, Fire, Gas, and Electrical Safety Checklist, Assessing Patient’s Capacity for Self-Administration of Medication, and Tuberculosis Questionnaire—lacked the required professional credentials. This finding was discussed with and validated by the hospice Administrator/DPCS.”

“Observed in Patient Home. In 2 of 3 home visits conducted with home oxygen therapy, the organization failed to ensure that the patient, when appropriate, and the family and/or other caregiver received education and training regarding the storage, handling, and access to medical gases and supplies. During home visit observations for HOSRRHV#1 and HOSRRHV#3, two backup oxygen tanks were observed standing upright and unsecured in the home. The home visit observation did not provide evidence that hospice staff educated the patient, family, and/or caregiver regarding oxygen safety during the visits. This finding was discussed with and validated by the hospice Administrator/DPCS.”