Sanctuary Hospice

“Upon patient record review, 2 of 19 (Patient #2,#11) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family’s needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient 2: The plan of care includes a problem of alteration in skin integrity related to a coccyx wound with interventions to assess wound. There is no evidence of documentation of wound assessments by the RN from 9/9/24 to 10/14/24. Patient 11: The plan of care includes an order for wound care to stage III pressure ulcer. There is no evidence of wound assessment documentation by the RN from 8/29 to 10/14.”

“Upon patient record review, 4 of 19 (Patient #2,#3,#9,#13) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 2:The medical record included nursing documentation that the care needs of the patient includes an indwelling foley catheter, dysphagia with risk of aspiration and safety risk with use of Hoyer lift. There is no evidence that the plan of care includes problems, goals and interventions for the management of the foley catheter, risk of aspiration and safety and use of a Hoyer lift. Patient 3:The medical record includes nursing documentation of bilateral nephrostomy tubes. There is no evidence that the plan of care includes problems, goals and interventions for the care and management of nephrostomy tubes. Patient 9:The medical record includes nursing documentation that the patient requires oxygen at 2-4 liters per minute via nasal cannula for shortness of breath and is at risk for aspiration. There is no evidence that the plan of care includes problems, goals and interventions for the safe use and management of oxygen or management of the risk of aspiration. Patient 13:The medial record includes nursing documentation that the patient requires Eliquis for anticoagulation therapy, has had significant weight loss of 25 lbs. in 1 month, has nausea and vomiting requiring medication management and has port-a-cath to right chest. There is no evidence that the plan of care includes problems, goals and interventions for risk of bleeding, nutrition, nausea and vomiting or the management of the port-a-cath.”

“Upon patient record review, 2 of 19 (Patient #2,#14) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 2:The medical record includes nursing documentation of an indwelling foley catheter and the provision of wound care. There is no evidence of an order for an indwelling foley catheter and the order for wound treatment does not include who is to perform care. Patient 14:The medical record includes nursing documentation of a wound to the left lower leg. There is no evidence that the plan of care includes an order for wound care to the left lower leg.”

“Upon patient record review, 2 of 19 (Patient #11,#12) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient 11:The medical record includes nursing documentation of a fungal rash to perineal area requiring nystatin. There is no evidence of an update to the plan of care for management of the active infection. Patient 12:The medical record includes nursing documentation of a urinary tract infection on 9/29 requiring Cipro. There is no evidence of an update to the medical record for the management of an active infection.”

“Upon patient record review, 2 of 19 (Patient #8,#9) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient 8:The patient is at risk for aspiration. The aide plan of care does not include aspiration precautions. Patient 9:The patient is at risk for aspiration and has oxygen ordered as needed for shortness of breath. The aide plan of care does not include aspiration or oxygen precautions.”

“Upon patient record review 3 of 19 (Patient #7,#8,#9) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 7:The aide plan of care includes tasks of shower assigned 1 time per week and and bed bath 1 time per week. The aide documentation notes that the task of bed bath was provided on 9/5 and 9/6. On aide visit 9/12 both a shower and bed bath were provided. Patient 8:The aide plan of care includes task of shampoo hair assigned 1 visit per week. The aide documented that the task was completed on 9/16 and 9/18, 2 visits within the same week. Patient 9:The aide plan of care includes task of shampoo hair assigned 1 visit per week. No evidence that task was performed the week of 9/22 with all documentation noting not required this visit.”