New England Hospice II, LLC

“Observed in Individual Tracer. In 7 of 14 patient records reviewed, The surveyor noted that (RRHV#4) that there was no evidence in the medical record that the severity of the patient’s diabetes was assessed. The patient was prescribed Metformin and daily insulin and the facility was monitoring the patient’s blood sugar; however, there was no assessment of the diabetes, insulin use or blood glucose results. Also, (RRNHV#5), the patient was diabetic and prescribed routine insulin. There was no assessment of the diabetes, insulin use or blood glucose monitoring. Also, the chaplain’s spiritual assessment indicated that he would complete the assessment with the health care proxy; however, it had not been completed as of four weeks later. In (RRNHV#6), (RRNHV#7), (RRNHV#8) and (RRNHV#9), there was no assessment of the patients’ diabetes, insulin and hypoglycemic use or blood glucose monitoring. In (RRNHV#11) the chaplain had not completed the spiritual assessment as indicated to follow-up with the health care proxy/POA. This was confirmed with the clinical services director.”

“Observed in Individual Tracer. In 5 of 14 patient records reviewed, The surveyor noted (RRHV#4) that the patient was diabetic and prescribed insulin and Metformin. The facility was monitoring the patient’s blood sugar; however, it was not identified on the plan of care. In (RRNHV#6), the patient was diabetic and prescribed Metformin and Jardiance; however the diabetes management was not identified in the plan of care. In (RRNHV#7), the patient was diabetic and prescribed sliding scale insulin; however, it was not identified on the plan of care. Also, the patient admission assessment indicated that the patient had a vulva lesion that was treated with daily wound care; however, it was not addressed on the plan of care until 2 months after admission and did not include the actual treatment that was ordered. In (RRNHV#8), the patient assessment indicated a diagnosis on Diabetes Type 2 and was prescribed insulin. Also, the patient had a diabetic foot ulcer; however, it was not addressed on the plan of care. In (RRNHV#9), the assessment indicated that the patient was dysphasic, had homonymous hemianopsia and that his primary language was Spanish; however, a communication plan and management of his limitations was not address on the plan of care. This was confirmed with the clinical services director.”

“Observed in Record Review. In 4 of 14 patient records reviewed, The surveyor noted (RRNHV#5) that the plan of care was incomplete and did not include the patient’s medications. until 12 days after the admission. In (RRNHV#9) the plan of care did not include the wound care treatment that was ordered: cleanse wound with normal saline, pat dry, apply collagen to wound bed and cover with DSD daily. The care plan was a care coordination plan with the skilled nursing facility and only stated that the facility nurse was to perform daily wound care. In (RRNHV#12) the hospice/SNF plan of care did not include oxygen orders and the written physician order: Oxygen 4LPM NC ( on file in the hospice EMR) did not indicate the frequency for oxygen use (patient on 4lpm NC continuous). Also, the care plan for wound care did not include the treatment that was ordered for the coccyx and heel wounds , and simply indicated that facility staff to perform wound care as ordered. In (RRNHV#13), the plan of care did not include the oxygen orders and the physician order in the hospice EMR did not indicate a frequency of use (Oxygen 2lpm NC). This was confirmed with the director of clinical services.”

“Observed in Individual Tracer. In 3 of 14 patient records reviewed, The surveyor noted that (RRHV#2) the plan of care was not updated when volunteer services was provided. A volunteer was not available for a period of four months (July-October) ;however, the plan of care included orders for volunteer 2-3 x a month, for that time period. In (RRHV#4) the plan of care was not revised when the patient was treated for a leg wound in May, one week after the patient was admitted. The care was being provided by the skilled nursing facility and not included on the coordinated care plan. Also, in (RRNHV#9), the wound care plan was not updated to include new wound care orders for April and again in May. The care was provided by the skilled nursing facility and not updated in the coordinated care plan. The care plan only indicated that the daily wound care was to be performed by the facility staff and evaluated every 14 days by the hospice nurse. This was confirmed with the clinical services director.”