Blessed Hands Hospice Inc.

“Observed in Record Review. In 4 of 14 patient records reviewed, it was noted the organization failed to ensure that the hospice plan of care plan includes all services needed for the palliation and management of the terminal illness and related conditions, including medications necessary to meet the patient’s needs. Upon review of the records, several PRN pain medications ordered to be given for pain without specifying which PRN medication should be administered based on specific guidance. For example, HOSRRHV#1 Check Oxygen saturation PRN during SN visits; HOSRRNHV#4 two PRN pain medications: Morphine Sulfate 15mg Immediate-Release Tablet 0.5 tablet PO PRN for pain and sob and Acetaminophen 325mg 2 tablets every 6 hours PRN for pain; HOSRRNHV#5 Acetaminophen 325mg 1 tablet by mouth every 6 hours as needed for pain and Tramadol Hydrochloride 50mg 1Tablet Every 8 Hours As Needed for pain; HOSRRNHV#7 Check Oxygen saturation PRN during SN visits.This finding was discussed and validated by the DPCS.”

“Observed in Record Review. In 7 of 10 patient records with hospice aide services, The organization failed to ensure that the registered nurse, or other appropriate skilled professional responsible for supervising the home health aide, prepared written patient care instructions specifying the aide’s duties. For example, review of record forHOSRRHV#1, HOSRRHV#2, HOSRRHV#3, and HOSRRNHV#5, the patients received oxygen therapy in the home; however, the aide care plans did not include specific oxygen-related instructions or safety precautions. For HOSRRNHV#8 and HOSRRNHV#9, the patients received anticoagulant therapy with Plavix; however, the aide care plans did not include specific instructions or bleeding-risk precautions. For HOSRRNHV#10, the aide care plan directed the hospice aide to check vital signs but did not include parameters to guide when the aide should report findings to the supervisor. This finding was discussed and validated by the DPCS.This finding was discussed with and validated by the DPCS.”

“Observed in Record Review. In 1 of 10 patient records with hospice aide services, the organization failed to ensure that the hospice aide provides services that are ordered by the physician or allowed practitioner in the plan of care, consistent with the aide’s training, and that the aide is permitted to perform under state law. For example, HOSRRNHV#10, the aide care plan required vital signs to be checked at each visit; however, the hospice aide did not check vital signs as evidenced by no vital-sign readings were documented on every aide visit note. This finding was discussed with and validated by the DPCS.”

“Observed in Record Review. In 7 of 10 patient records with hospice aide services, it was noted the organization failed to ensure that hospice aide supervision was conducted at the patient’s home no less than every 14 days as required. For example in HOSRRHV#2, aide supervisory visits were not documented within the required timeframe, with gaps of 17 days from 04/17 to 05/04, 15 days from 05/18 to 06/12, 16 days from 06/16 to 07/02, and 15 days from 07/17 to 08/01. For HOSRRNHV#4, the RN supervisory visit was completed 16 days after the last aide visit on 08/01. For HOSRRNHV#5, each of the five subsequent aide supervisory visits occurred every 15 days rather than every 14 days. For HOSRRNHV#7, there was a 15-day gap between documented aide supervisory visits from 07/23 to 08/07. For HOSRRNHV#8, there was a 20-day gap between documented aide supervisory visits from 06/24 to 07/14, and no evidence of aide supervisory visits during the weeks of 08/09 and 08/23. For HOSRRNHV#9, there was a 19-day gap between documented aide supervisory visits from 06/20 to 07/09. For HOSRRNHV#10, there was a 16-day gap between documented aide supervisory visits from 05/26 to 06/11. In addition, the record contained no evidence of aide supervisory visits during the weeks of 08/02 and 08/16. This finding was discussed and validated by the DPCS.”

“Observed in Record Review. In 1 of 2 live discharge records, the organization failed to ensure that the discharge summary include sufficient information regarding the patient’s stay, including the course of treatment, current symptoms and pain management, response to treatment, medications, and other pertinent clinical information necessary to support continuity and coordination of care following discharge. For example, in record of HOSRRDC#13, the hospice nurse documented that the patient was discharged from services due to revocation of the hospice election; however, the documentation did not provide sufficient detail regarding the circumstances of the revocation or the patient’s condition and care needs at the time of discharge. This finding was discussed and validated by the Administrator.”

“Observed in Patient Home. In 1 of 3 home visits conducted, with home oxygen, the organization failed to address real or potential threats to the health and safety of the patient, others, and property. For example , it was observed in HOSRRHV#2: a total of 13 oxygen cylinders were observed in the home: three for the patient’s husband and 10 for the patient. The cylinders were upright position but were not secured in metal racks. No action was taken by the hospice staff during the home visit. This finding was discussed and validated by the DPCS.”