St Elizabeth Hospice Care, Inc.

“Observed in Record Review. In 4 of 12 patient records reviewed, the Surveyor noted an RN had not visited the hospice patient every 15 days to conduct a comprehensive assessment. In RRNHV#4, the patient had the DOPCS Nurse Practitioner (NP) visiting the patient but only to complete the Hospice Aide supervisory visits. The NP had documented the supervisory note only, and had not documented any comprehensive assessment elements. All other patient visits had been completed by the LVN using a ‘short’ form and did not include a full patient assessment. The patient had been on service for 84 days. In RRBR#2, the patient had been on service for 52 days without a nursing comprehensive visit documented. The LVN completed ‘short’ visit notes and the NP documented HA supervisory visits only. In RRDC#1 There had been no RN comprehensive visits documented in the 36 days patient was on service. In RRDC#2, there had been no RN comprehensive visits in the 83 days patient had been on service. This was validated with the Administrator and DOPCS.”

“Observed in Record Review. In 2 of 12 patient records reviewed, the Surveyor noted not all patient identified care needs had been included on the plan of care (POC). For example, in RRHV#2, the patient had been bedbound and a high risk for skin breakdown; however this had not been included on the POC. In RRHV#3, the patient had been a high falls risk and at risk for skin breakdown, but these had not been on the POC. This was validated with the DOPCS. Observed in Record Review. In 1 of 12 patient records reviewed, the Surveyor noted a patient with visits but there had been no orders for the visits. For example, in RRBR#1, the patient had a Hospice Aide care plan written and the HA had made visits to the patient; however there had been no frequency orders present in the patient record. This was validated with the DOPCS. Observed in Record Review. In 1 of 12 patient records reviewed, the Surveyor noted the plan of care (POC) had not been updated as the patient condition had changed. For example, in RRHV#2, the patient had a documented UTI and started on antibiotics; however, this had not been discussed at IDG and added to the POC with prevention interventions. This was validated with the DOPCS. Observed in Record Review. In 3 of 12 patient records reviewed, the Surveyor noted orders for wound care and or medications had been incomplete. For example, in RRNHV#4, the patient had Hydrocodone Bitartrate/Acetaminophen 5mg-325mg Tablet and Acetaminophen 325mg both ordered every 6 hours as needed for pain. In RRHV#2, the patient had wound care being provided to right heel. The order had been missing what the wound was to be cleansed with and the type of wrap to secure it. In RRNHV#5, the patient had Clotrimazole/Betamethasone Dipropionate 1%-0.05% Topical Cream ordered to apply to affected area. This was validated with the DOPCS.”

“Observed in Record Review. In 3 of 12 patient records reviewed, the Surveyor noted care not provided according to the patient plan of care (POC). For example, in RRHV#3, the patient had orders for nursing visits 2 times per week; however, there had only been 1 visits per week documented over the past 9 weeks. In RRNHV#4, the POC had orders for an RN to visit 2 times per week; however, there had not been an RN visit documented during the patients time on service from March. All visits made had been completed by the LVN. In RRNHV#5, there had been no visit documented by the LVN or RN in the 2nd week of February even though visits had been ordered. This was validated with the DOPCS.”