Lifeguard Hospice Care, Inc.

“Observed in Record Review. In 14 of 14 patient records reviewed, for active records, it was noted by the nurse surveyor that for RRHV#1, RRHV#2, RRHV#3, RRHV#4, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5, RRNHV#6, RRNHV#7, RRNHV#8, RRNHV#9, and RRNHV#10 the physician’s certificate of terminal illness (CTI) did not contain the required narrative. The CTI was mostly blank stating “medical record reviewed” or was blank and did not contain any information regarding patient physical findings or the facts that were taken into account that demonstrated the patient was hospice appropriate. Findings were validated by the Administrator, the DPCS, and the Nurse Case Manager.”

“Observed in Record Review. In 14 of 14 patient records reviewed, for active patients, it was noted by the nurse surveyor that PRN frequencies for the skilled nurse, medical social worker, and spiritual counselor did not have a reason for when to make the as needed PRN visits (they were not qualified). For RRHV#1, RRHV#2, RRHV#3, RRHV#4, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5, RRNHV#6, RRNHV#7, RRNHV#8, RRNHV#9, and RRNHV#10, all PRN visit frequencies were quantified for a number of how many could be made, but not for the reason in which they would be made.. Finding was verified by the DPCS and the Nurse Case Manager.”

“Observed in Record Review. In 3 of 14 patient records reviewed, for active patients, it was noted by the nurse surveyor that medication orders were not clear or complete. For RRHV#1 and RRHV#2, the families were encouraged to use zinc oxide on reddened areas on the patients’ coccyx, however, there were no physician orders for the use of zinc on the plan of care. Findings were verified with the DPCS and the Nurse Case Manager. Observed in Record Review. In 1 of 14 patient records reviewed, It was noted during RRHV#3 that patient was prescribed zinc oxide for wound care, family was educated on use, but an order was not found and it was not listed on the medication list. This was discussed with the DPCS and administrator.”

“Observed in Record Review. It was noted by the nurse surveyor that for RRHV#3 the hospice aide care visit was missed without orders or documentation of reason for missed visit noted. Findings were discussed with the administrator. Observed in Record Review. In 2 of 14 patient records reviewed, for active patients, the nurse surveyor noted that care was not provided according to the hospice plan of care. For RRHV#2, the skilled nurse frequency was 2xwk, however on the third week of service, the patient was seen by the SN one time. There was no explanation in the electronic record for the missed nurse visit. Finding was verified by the DPCS and the nurse case manager.”

“Observed in Patient Home. In 4 of 4 home visits conducted, it was noted by the nurse surveyor that the staff failed to follow acceptable practice and agency policy when performing patient care. During RRHV#1, the registered nurse hand sanitized, went over to the patient and before touching him, came across the room and touched other objects, he then went back to the patient without hand sanitizing. The skilled nurse did not hand sanitize again until he donned gloves for cleaning his equipment, then doffed the gloves without hand sanitizing per policy. During RRHV#2, the registered nurse set up her barriers, went into her bag without hand sanitizing, put her equipment on her barrier, cleaned it, put it back where she had initially laid it, then took the patient’s vital signs. She then put the equipment back in the same place on the barrier then later returned her equipment back to her bag without cleaning. The Registered nurse also went into her bag several times without hand sanitizing. Findings were verified by the Director of Patient care services (DPCS) who was present on the visits. Observed in Patient Home. it was noted by the nurse surveyor that the hospice staff did not complete hand hygiene consistent with policy. For RRHV#3, the chaplain went in and out of his bag without hand sanitizing after anointing the patient with oil, and placed the container back into the bag without cleaning it. For RRHV#4, the CHHA did not perform hand hygiene between glove changes after providing a bath/perineal care and before picking up notepad to chart per policy. Findings were verified by the Director of Patient Care Services (DCPS) who was present on the visit.”

“Observed in Record Review. it was noted by the nurse surveyor that the hospice aide care plan did not contain all the necessary or current information. For RRHV#3, RRHV#4, RRNHV#6, RRNHV#7, RRNHV#8, RRNHV#10, the patient is on continuous oxygen, the hospice aide care plan did not have any information regarding what the hospice aide was supposed to do with the oxygen during the patient’s shower/bath Findings were observed by the Director of Patient Care Services (DCPS) who was present onsite. Observed in Record Review. In 13 of 14 patient records reviewed, for active patients, it was noted by the nurse surveyor that the hospice aide care plan did not contain all the necessary or current information. For RRHV#1, the patient was on continuous oxygen, the hospice aide care plan did not have any information regarding what the hospice aide was supposed to do with the oxygen during the patient’s bath. For RRHV#2, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5. the patient is was on PRN oxygen yet the care plan did not address what the aide should do regarding the oxygen should the patient be on it during the bath. Findings were discussed with the DPCS and the Nurse Case Manager.”

“Observed in Record Review. In 3 of 3 patient records reviewed, for active patients who were recertified, it was noted by the nurse surveyor that for RRHV#1 (4 recertifications), RRNHV#4 (1 recertification), and RRNHV#7 (1 recertification), the physician’s certificate of terminal illness (CTI) for recertification did not contain the required narrative. The CTI was mostly blank stating “medical record reviewed” or was blank and did not contain any information regarding patient physical findings or the facts that were considered that demonstrated the patient was hospice appropriate. Findings were validated by the Administrator, the DPCS, and the Nurse Case Manager.”

“Observed in Patient Home. In 1 of 4 home visits conducted, it was noted by the surveyor during the medication review by the nurse that the medication profile did not accurately reflect what the patient was taking. For RRHV#2, there was an order for nebulizer treatments, DuoNeb 3mg-).5mg/3ml. Solution for inhalation, 1 via nebulizer every 4 hours while awake, the medication profile did not reflect the specific instruction of using every 4 hours. This portion of the order had been left off. Finding was validated by the DPCS who was present during the visit.”

“Observed in Record Review. In 14 of 14 patient records reviewed, for active records for patients with oxygen, it was noted by the nurse surveyor that education related to the safe use of equipment or medical gases provided by the agency. For RRHV#1, RRHV#2, RRHV#3, RRHV#4, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5, RRNHV#6, RRNHV#7, RRNHV#8, RRNHV#9, and RRNHV#10.there was no documentation in the EMR related to use of the oxygen concentrator or back up cylinders. The written material provided was very limited and did not include any information regarding the care of the equipment. Finding was discussed with the DPCS and Nurse Case Manager.”