Topkare Hospice Inc.

“Observed in Record Review. In 6 of 10 patient records reviewed, where the patients were actively on service, the organization had not ensured that the plan of care included all services needed for the palliation and management of the terminal illness and related conditions including interventions to manage symptoms. Identified during the record review for RRHV#1, there was no care plan developed to manage the patient’s dysphagia that was identified during the initial comprehensive assessment. Identified in RRHV#3 there was no care plan developed to manage dysphagia despite it being identified as a problem during the initial comprehensive assessment. Identified during the review for RRNHV#3, there was no care plan developed for risks to skin integrity despite the patient being incontinent, mainly chairbound, and having skin tears upon admission. Additionally there was no Psychosocial care plan developed despite there being no funeral/burial plans. Identified in the review of RRNHV#4, there was no Psychosocial care plan developed despite there being no funeral/burial plans and the Medical Social Worker visiting the patient monthly since the start of care five months prior to the survey. Identified during the record review for RRNHV#6, there were no care plans developed for dysphagia and risk for skin integrity despite these problems being identified during the initial comprehensive assessment. Identified during the record review for RRNHV#7 there was no care plan developed for risk to skin integrity despite the patient weighing 64 lbs., being incontinent, chairfast, having a Braden score of 12 and a history of pressure ulcers. There was also no care plan developed for dysphagia/risk for aspiration despite being documented during the initial comprehensive assessment. Additionally there was no psychosocial care plan developed despite no burial/funeral plans, and no spiritual care plan despite the Spiritual Care Coordinator visiting the patient monthly. This was discussed with the Administrator, Director of Patient Care Services, and the CEO following the record review.”

“Observed in Record Review. In 1 of 10 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including drugs and treatment necessary to meet the needs of the patient. Reviewed in the record for RRHV#1, the medication profile listed Norco 5-325, 1 tablet every 6 hours as needed for pain level 1-7, and Tramadol HCl 25 mg, 1 tablet twice daily as needed for pain without indicating a pain level for Tramadol or whether the pain medications can or cannot be given together. This was discussed with the Administrator, Director of Patient Care Services, and the CEO following the record review.”

“Observed in Record Review. In 10 of 10 patient records reviewed, where the patient was active, the hospice had not supervised the hospice aide during on-site visits to the patients’ homes no less frequently than every 14 days. Identified in RRHV#1, the hospice missed 13 opportunities for timely supervision of the hospice aide during the 15 months since the start of care. In RRHV#2, the hospice missed two opportunities for timely supervision of the hospice aide during the three months since the start of care. In RRHV#3 the hospice missed 12 opportunities to supervise the hospice aide timely during the past 20 months since the start of care. In RRNHV#1 the hospice missed one opportunities to supervise the hospice aide timely during the past six weeks since start of care. In RRNHV#2 the hospice missed one opportunity to supervise the hospice aide timely during the past nine weeks since start of care. In RRNHV#3, the hospice missed one opportunity to supervise the hospice aide timely during the past 14 weeks since start of care. In RRNHV#4, the hospice missed one opportunity to supervise the hospice aide timely during the month that the aide provided services, five months prior to the survey date. In RRNHV#5 the hospice missed three opportunities to supervise the hospice aide timely during the past seven months since the start of care. In RRHV#6 the hospice missed two opportunities to supervise the hospice aide timely during the past three months when the patient was receiving aide services. In RRNHV#7 the hospice missed three opportunities to supervise the hospice aide timely during the past nine months since the start of care. This was discussed with the Administrator, Director of Patient Care Services, and CEO following the records reviewed.”

“Observed in Record Review. In 2 of 10 patient records reviewed, the hospice had not included all medications being administered for symptom management and treatments. Observed during the home visit conducted for RRHV#1, the patient’s perineal area was being treated with Equate Diaper Rash ointment with 40% zinc oxide ointment and A&D ointment. These were not included on the hospice medication profile despite the FDA’s classification as human OTC drugs. Identified during the record review for RRNHV#2, A&D ointment was listed as a supply in the patient’s record but not listed on the medication profile. This was discussed with the Administrator, Director of Patient Care Services, and the CEO.”