Activate Care Hospice, Inc.

“Observed in Patient Home. In 1 of 2 home visits conducted, it was noted that the LVN failed to perform an effective medication assessment. For example, during RRHV#2 the LVN did not recognize that Lorazepam liquid was not refrigerated as indicated on all the packaging. 
The LVN completed the medication assessment at the beginning of the visit and at the end of the visit the surveyor requested to see where the medications were being stored. They were in a kitchen cabinet. Discussed storage for Lorazepam liquid and reviewed the packaging with the LVN who was surprised to discover the medication required refrigeration. This was discussed with the QI/QA RN present.
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“Observed in Record Review. In 3 of 10 patient records reviewed, it was noted that the comprehensive assessment was not completed no less frequently than every 15 days. For example in record RRHV#1, RRNHV#1, and RRHV#2 an RN did not visit the hospice patient every 15 days to conduct an assessment. RRHV#1 there were 29 days between documented RN assessment visits and RRHV#2 there were 20 days between documented RN assessment visits. In record RRNHV#1 there were 18 days between documented RN assessment visits. This was discussed with the QI/QA RN present.
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“Observed in Record Review. In 10 of 10 patient records reviewed, it was noted that the plans of care did not contain individualized time framed goals. For example, all POC goals time frames in all 10 records indicated were all ‘by the next IDG’ and target dated for the next IDG. For example, all 10 records included Patient will remain free from fall and injury throughout certification period-Patient/Family/PCG will verbalize understanding of increased risk of fall by next IDG for patient’s assessed with low, moderate and high fall risk. This was discussed with the QI/QA RN present.”

“Observed in Record Review. In 5 of 10 patient records reviewed, it was noted that care was not provided according to hospice plan of care. For example in RRNHV#5 the POC stated the skilled nurse was to visit the patient 2 times a week and there was 1 visit a week documented for 6 of 6 weeks of care. In RRNHV#4 the POC stated the skilled nurse was to visit the patient 3 times a week and there was 1 visit a week documented for 6 of 6 weeks of care. In RRNHV#2 the POC stated the skilled nurse was to visit the patient 2 times a week and there was 1 visit a week documented for 19 of 19 weeks of care. In RRHV#2 the POC stated that the aide was to visit the patient 1 time a week and there were no visits documented 20 weeks. In RRNHV#1 the POC stated the skilled nurse was to visit the patient 2 times a week and there was 1 visit a week documented for 23 of 23 weeks of care. This was discussed with the QA/QI RN present.”

“Observed in Patient Home. In 10 of 10 patient records reviewed, it was noted that the organization did not provide the patient with an individualized emergency plan. For example, in RRHV#1, RRHV#2 and RRHV#3 there was no individualized emergency plan in the patient home record and the caregivers could not speak to a plan having been provided. For example, in RRHV#1-3, RRBR#1-2 and RRNHV#1-5 there was no individualized emergency plan documented in the patient record. The QA/QI RN showed the surveyor a document she had developed, however it was not being utilized. This was discussed with the QI/QA RN present. 
 Observed in Patient Home. In 1 of 2 home visits conducted, that included medication assessment it was noted that information on the safe and effective use of medications was not provided. For example, during home visit RRHV#2 the record did not include education related to proper medication storage specifically Lorazepam liquid. The organization policy Medication Management Medication Profile Policy No 3-002.1 stated 6. Each patient and /or family/caregiver will receive appropriate written teaching materials for specific medication he/she is receiving. The material should contain …. and any special instructions . This was discussed with the QA/QI RN present. 
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