Franciscan Family Care Center,

“Based on review of the clinical records, review of agency policies and interview with agency personnel, for three of fourteen patients (Patients #5, #8 and #10) in the survey sample, the agency Registered Nurse (RN) failed to supervise the care provided by a Licensed Practical Nurse (LPN) and failed to perform the necessary assessments in accordance with the agency’s policy. The findings include: a. Patient #5 elected the hospice benefit on 08/01/2024 with diagnoses that included cerebral atherosclerosis, Alzheimers disease, an unstageable pressure ulceration to the left heel, a stage two pressure ulceration to the sacral region, atrial fibrillation, chronic obstructive pulmonary disease, asthma and muscle weakness. The physicians orders for the certification period of 08/01/2024 through 10/29/2024 included nursing services two to three times per week for assessments and wound care, home health aide services three to five times per week, chaplain services one to two times per month, and social work services one to two times per month. b. Patient #8 elected the hospice benefits on 08/06/2024 with diagnoses that included cerebral atherosclerosis, dementia, malnutrition, atrial fibrillation, muscle weakness and falling. The physicians orders for the certification period of 08/06/2024 to 11/03/2024 included nursing services two to three times per week for nursing assessments, home health aide services three to five times per week, chaplain services one to two times per month, and social work services one to two times per month. c. Patient #10 elected the hospice benefits on 03/28/2024 with diagnoses that included cerebral atherosclerosis, dementia, hypertension, dysphagia, anemia, edema and muscle weakness. The physicians orders for the certification period of 08/25/2024 through 10/23/2024 included nursing services three to five times per week for nursing assessments, home health aide services two to three times per week, chaplain services one to two times per month, and social work services one to two times per month. i. Interview and review of Patient #5, #8 and #10s clinical records with the Director of Hospice on 09/12/2024 at 10:20 AM, failed to identify monthly LPN supervisions were conducted by a Registered Nurse (RN) in accordance with the agencys policy to evaluate the care/services provided by the LPN and failed to identify Patient #5’s weekly wound measurements were obtained for the weeks of 08/04/2024, 08/11/2024, 08/18/2024, 08/25/2024 and 09/01/2024. Review of agency Nurse Supervision policy identified the supervising nurse would oversee that patient communication wakes place on a continuous basis. The supervising nurse would ensure that all disciplines were aware of condition changes and evaluations in a timely manner. LPNs would be supervised at least every thirty days by an RN in the patients home with or without the LPN present. Review of the agencys Wound Care Management policy identified wound status, measurements and/or photographs would be documented/taken at a minimum of once a week.”

“Based on review of the clinical records, review of agency policies and interview with agency personnel, for three of fourteen patients (Patients #5, #8 and #10) in the survey sample, the agency Registered Nurse (RN) failed to supervise the care provided by home health aides. The findings include: a. Patient #5 elected the hospice benefit on 08/01/2024 with diagnoses that included cerebral atherosclerosis, Alzheimers disease, an unstageable pressure ulceration to the left heel, a stage two pressure ulceration to the sacral region, atrial fibrillation, chronic obstructive pulmonary disease, asthma and muscle weakness. The physicians orders for the certification period of 08/01/2024 through 10/29/2024 included nursing services two to three times per week for assessments and wound care, home health aide services three to five times per week, chaplain services one to two times per month, and social work services one to two times per month. b. Patient #8 elected the hospice benefit on 08/06/2024 with diagnoses that included cerebral atherosclerosis, dementia, malnutrition, atrial fibrillation, muscle weakness and falling. The physicians orders for the certification period of 08/06/2024 to 11/03/2024 included nursing services two to three times per week for nursing assessments, home health aide services three to five times per week, chaplain services one to two times per month, and social work services one to two times per month. c. Patient #10 elected the hospice benefit on 03/28/2024 with diagnoses that included cerebral atherosclerosis, dementia, hypertension, dysphagia, anemia, edema and muscle weakness. The physicians orders for the certification period of 08/25/2024 through 10/23/2024 included nursing services three to five times per week for nursing assessments, home health aide services two to three times per week, chaplain services one to two times per month, and social work services one to two times per month. i. Interview and review of Patient #5, #8 and #10s clinical records with the Director of Hospice on 09/12/2024 at 10:20 AM, failed to identify home health aide supervisions were conducted at least every fourteen days by an RN in accordance with the agencys policy. Review of agency Nurse Supervision policy identified the supervising nurse would oversee that patient communication wakes place on a continuous basis. The supervising nurse would ensure that all disciplines were aware of condition changes and evaluations in a timely manner. Home health aides would be supervised at least every fourteen days by an RN.”

“Based on review of the clinical record, observations and interview with agency personnel, for one of fourteen patients (Patients #2) in the survey sample, the agency failed to develop and maintain narcotic count records to account for controlled drugs. The findings include: a. Patient #2 elected the hospice benefit on 07/22/2024 with diagnoses of colon cancer, dysphagia, high blood pressure, congestive heart failure and atrial fibrillation. The physicians orders for the certification period of 07/22/2024 through 10/19/2024 included nursing services three times per week for nursing assessments and wound care, chaplain services one to two times per month, and social work services one to two times per month. Registered Nurse (RN) #1 and the surveyor performed a home visit for Patient #2 on 09/11/2024 at 11:30 AM. Patient #2 had Morphine 20 milligrams (mg)/milliliters (ml) oral concentrate to be administered every three hours as needed for pain or shortness of breath and Lorazepam 0.5 mg one tablet every six hours as needed for anxiety or agitation in the home. Patient #2s responsible caregiver had documented the dates, times and doses of Morphine that were administered. The agencys nurses failed to document the amount Morphine and Lorazepam left in the bottles during each visit for the months of July, August and September of 2024. RN #1 identified the hospice agency had not utilized narcotic count records. i. Interview and review of Patient #2s clinical record with the Director of Hospice on 09/11/2024 at 2:30 PM, identified the Patients responsible caregiver was taught by RN #1 how to pre-fill syringes and administer 0.25 ml of Morphine. The Director of Hospice identified the agency had not developed a narcotic count record to ensure controlled drugs were accounted for at each nursing visit. Subsequent to the surveyors inquiry, the hospice agency developed a narcotic count record to account for controlled drugs and would be maintained as a part of the hospice patients clinical record.”

“Based on review of the clinical record, review of agency policies and interview with agency personnel, for one of fourteen patients (Patients #13) in the survey sample, the agency Registered Nurse (RN) failed to dispose of controlled drugs in accordance with the agencys policy. The findings include: a. Patient #13 elected the hospice benefit on 08/10/2023 with diagnoses that included breast cancer, seizures, anxiety, edema and chronic pain. The physicians orders for the certification period of 02/06/2024 through 04/05/2024 included nursing services one to three times per week for assessments, chaplain services one to two times per month, and social work services one to two times per month. i. Interview and review of Patient #13s nursing note dated 03/26/2024 with the Director of Hospice on 09/12/2024 at 09:50 AM, identified the Patient expired and had Morphine 20 milligrams (mg)/ml oral concentrate and Lorazepam 0.5 mg oral tablets in the residential group home, but failed to identify the name and dose of the medication, amount or quantity of the medication remaining and destroyed, the date of disposal and signature of the nurse and witness were documented in the Patients clinical record. Review of the Labeling, Disposing and Storing of Drugs policy identified controlled drugs no longer needed by the patient were disposed of in compliance with state and federal regulations and disposal instructions and activities were documented. A hospice nurse, accompanied by a witness, is responsible for disposing of the patients drugs in a manner consistent with state and federal regulations. At the time of destruction, the following information would be documented in the patients clinical record the name and dose of the medication, amount or quantity of the medication remaining and destroyed, the date of disposal and signature of the nurse and witness were documented in the Patients clinical record.”