Illuminate Hospice Care, Inc.

“Observed in Record Review. In 14 of 14 patient records reviewed, the organization failed to assess and reassess its patient’s. During record review for all patients, the Hospice Nurse Surveyor observed the comprehensive assessment did not include measurable progress towards goals or revisions to the plan of care when needed. For example in HOSRRNHV#7, the comprehensive assessment stated that the pain teachings goal was completed but the Plan of Care was not updated to reflect that. Upon conversation with the DPCS, she stated that the progress being documented was just continuous teaching and not measurable progress towards specific goals. This was discussed and reviewed with the DPCS/ Owner.”

“Observed in Record Review. In 14 of 14 patient records reviewed, the organization failed to plan the patient’s care. During record review for HOSRRHV#1, HOSRRNHV#1, HOSRRDC#1, HOSRRDC#2, HOSRRHV#2, HOSRRNHV#2, HOSRRHV#3, HOSRRNHV#3, HOSRRNHV#4, the Hospice Nurse Surveyor observed the plan of care not based on the patient’s goals, and time frames, settings and services to meet those goals. In HOSRRHV#1, the patient had a goal of pain will be controlled within 24-48 hrs of initial assessment with no indication of what controlled meant. The patient also had a goal of patients agitation at manageable level during care which was not measurable and had no individualized timeframe. In HOSRRNHV#1, the patients goal timeframes were not individualized to meet their needs. The patient had a goal of Pain will be managed throughout care and PCG will verbalize understanding of medication and treatment during care. There were no measurable timeframes to meet those needs. In HOSRRDC#1, the patient had a goal of pain will be managed throughout care. This was not individualized or measurable. In HOSRRDC#2, the patient had a goal of nausea and vomiting will be controlled during care. This goal did not include an individualized timeframe to achieve the goal and the goal was not measurable. In HOSRRHV#2, the patient had a goal of PCG will verbalize understanding of medications and treatment during care. This goal did not have an individualized timeframe to achieve the goal. In HOSRRNHV#2, the patient had a stage 4 pressure ulcer but there were no goals related to wound healing. The only goal was to maintain skin integrity. The interventions did reflect current wound care orders. In HOSRRHV#3, the patient had a goal of pt pain will remain at a comfortable level but there had been multiple medication changes related to pain management but the goal was not updated. The patient also had a goal of patient will maintain skin integrity during care but had stage II pressure ulcer and the goal did not address wound healing. In HOSRRNHV#3, the patient had a goal of patient will maintain skin integrity during care but had an active wound to left hand. In HOSRRNHV#4, the patient had a goal of CG will demonstrate ability to cope with patients altered mental status during care with no goal timeframe and the goal had been in place 1 year prior to survey.In HOSRRNHV#5, the patient developed insomnia 5 days prior to survey and had new orders but this was not addressed on the plan of care. In HOSRRNHV#6, the patient had a goal for functional mobility stating the patient was chair bound but the patient was recently noted to be bed bound with new orders and this was not updated on the plan of care. In HOSRRNHV#7, the patient had a goal of patient will be free from infection related to Covid and Flu which had been in place for 8 months but the patient did not have issues with Covid or Flu and there was no timeframe for the goal to be achieved. This was discussed and reviewed with the DPCS/ Owner.”

“Observed in Record Review. In 9 of 14 patient records reviewed, the organization failed to plan the patient’s care. During record review for HOSRRHV#1, HOSRRHV#3, HOSRRNHV#1, HOSRRDC#1, HOSRRDC#2, HOSRRNHV#2, HOSRRNHV#4, HOSRRNHV#5, and HOSRRNHV#7, the Hospice Nurse Surveyor observed not all necessary items were included on the Plan of Care. For example in HOSRRHV#1, the patient had Advil and Hydromorphone PRN for pain with no indication on the Plan of care of when to take which medication. In HOSRRNHV#1,HOSRRDC#1, HOSRRHV#2, and HOSRRNHV#2, HOSRRNHV#4, HOSRRNHV#5, and HOSRRNHV#7, the patient had orders for Roxanol and Tylenol PRN for pain with no indication of when to take which medication. For HOSRRDC#2, the patient had orders for tramadol PRN every 6, Roxanol every 6 prn and ,Tylenol every 4 PRN for pain with no indication when to take which drug. In HOSRRHV#3, the patient had orders for PRN Tylenol, tramadol, and Roxanol for pain with no indication when to use which one. This was discussed and reviewed with the Hospice DPCS/ Owner.”

“Observed in Record Review. In 2 of 2 patient records reviewed, the organization failed to plan the patient’s care. During record review for HOSRRBR#1 and HOSRRBR#2, the Hospice Nurse Surveyor observed the organization failed to document a specific bereavement care plan. For example, in both records the bereavement coordinator documented a risk level but did not document how often outreach would be based on that risk. The documentation did not include the services to be offered or the frequency of services. During conversation with the DPCS it was noted that the org keeps a log of all of the needed letters but there was no documented individualized bereavement care plan for each patient. This was discussed and reviewed with the DPCS/ Owner.”

“Observed in Record Review. In 8 of 8 patient records reviewed, with aide services ordered, the organization failed to plan the patient’s care. During record review for HOSRRDC#1, HOSRRDC#2, HOSRRHV#2, HOSRRNHV#2, HOSRRHV#3, HOSRRNHV#3, and HOSRRNHV#4, the aide plan of care was not complete. For example in HOSRRDC#1, the patient was a high risk of fall, was on PRN oxygen, and had aspiration precautions but these were not addressed on the aide plan of care. In HOSRRDC#2, the patient was a high risk for fall and was on PRN oxygen but this was not addressed on the aide plan of care. In HOSRRHV#2, the patient was a high risk for fall and was on PRN oxygen but it was not addressed on the aide plan of care. In HOSRRNHV#2, the aide care plan did not contain precautions for oxygen, fall or thickened liquid diet. In HOSRRHV#3, the patient had a recent fall but did not have fall precautions on the aide care plan. In HOSRRNHV#3, the patient was a high risk of fall and had oxygen PRN but neither were addressed on the aide plan of care. In HOSRRNHV#4, the patient was a bleeding and fall risk but it was not addressed on the aide plan of care. In HOSRRNHV#7, the patient was a high risk of fall and had oxygen but it was not addressed on the aide plan of care. This was discussed and reviewed with the DPCS/ Owner.”