Luminos Hospice, LLC

“Observed in Patient Home. In 3 of 3 home visits conducted, the organization had not provided the patient/family with written information about its policies on advance directives, including a description of any state law concerning advance directives. In review of the home folder for RRHV #1 although the organization had included information on advance directives in the home folder they had not provided a description of Missouri State law for example, information on the Missouri’s Advance Health Care Directives Registry. This also was observed for RRHV #2 and RRHV #3. This was discussed with the Clinical Supervisor.”

“Observed in Patient Home. In 2 of 2 home visits conducted, with nursing staff, the organization failed to assess for potential medication-related problems in accordance with their policy. For RRHV #1 the RN completed the skilled nursing visit without reconciling the medications in accordance with the organization’s policy #7003 Medication Management Policy which states; the patient’s medications are reviewed and assessed during each skilled visit. The RN reported that she reviews the medications every few weeks and at the time of re-certification. Also, for RRHV #2 although the RN did provide an updated medication list and asked the patient’s husband who was the primary caregiver if there were any changes or problems with medications the RN did not reconcile all of the patient’s 22 medications in accordance with the organization’s policy. This was discussed with the Clinical Director.”

“Observed in Record Review. In 10 of 10 patient records reviewed, the written plan of care did not include measurable goals and the time frames and services required to meet those goals. For example; in review of the medical record for RRHV #2 the plan of care included a problem of pain with a goal that pt/pcg verbalizes pain is controlled within their desired comfort level within 48 hours of intervention.. The goals did not have measurable outcomes such as a pain rating that the patient/family would like to achieve. The surveyor noted the same problem and goals were written in the medical records for RRHV #1, RRHV #3, RRNHV #1, RRNHV #2, RRNHV #3, RRNHV #4, RRNHV #5, RRNHV #6 and RRNHV #7 and the plans of care were not individualized according for each patient. This was verified with the Clinical Director. 
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“Observed in Record Review. In 1 of 10 patient records reviewed, the organization did not provide care, treatment or services according to the patient’s individualized plan of care. In review of the medical record for RRHV #1 the spiritual counselor did not visit the patient once a month in accordance with the plan of care. The surveyor noted that during the second and third month of care there was documentation of a telephone call to schedule a visit however there was no answer and no evidence of follow up by the spiritual counselor to schedule and complete the visits as planned. This was discussed with the Clinical Director.”

“Observed in Patient Home. In 1 of 3 home visits conducted, staff failed to follow the organization’s policy # 4006 Hand Hygiene. For RRHV #2 the RN failed to perform hand hygiene upon entering the home and having contact with the patient. Additionally, the surveyor observed the RN then perform hand hygiene, glove and the perform the assessment of the patient however failed to perform hand hygiene after removing gloves. Finally, the surveyor observed the RN perform hand hygiene, glove and then inspect the patient’s buttocks, then remove gloves and proceed with visit by picking up his cell phone, putting away medical equipment without performing hand hygiene. This was discussed with the Clinical Director.”

“Observed in HR File Review. In 1 of 7 HR files reviewed, the organization had not defined the competencies it requires of social workers. In review of the personnel file for HR #3 who was a social worker the surveyor noted that the competencies that were assessed were related to infection control, bag technique, security awareness, ergonomics for health care workers however there were no competencies specific to the role of the social worker such as conducting a psychosocial assessment of clients to determine their psychological, social, emotional, and spiritual needs. This was validated with the Clinical Director. 
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“Observed in Record Review. In 1 of 1 home visits conducted, to patient’s who resided in a Skilled Nursing Facility (SNF), the organization had not provided the SNF with required information and documents in accordance with the organization’s policy #9122A Provding Hospice Car for Patient/Resident of Contracted Facility. In review of the facility record for RRHV #3 who resided in a SNF the record did not contain the hospice medication list, hospice physician orders and a complete plan of care since the patient’s admission 14 months ago. This was validated by the hospice social worker and discussed with the Clinical Director.”