Traditions Hospice of Blue Springs, LLC

“Observed in Patient Home. In 2 of 2 home visits conducted, visits in single family homes, the organization failed to inform the patient of and provide the patient with written information about its policies on advance directives, including a description of any state law concerning the advance directives. During home visits for RRHV#2 and RRHV#3, the Hospice Nurse Surveyor observed the patients had organizational folders in the home which did not contain all required elements provided to the patients. Specifically neither patient received information about advance directives. 

This was discussed and reviewed with the Hospice Team.”

“Observed in Record Review. In 14 of 21 patient records reviewed, the organization failed to plan the patient’s care. During record review for RRNHV#1, RRNHV#2, RRHV#1, RRHV#2, RRHV#3, RRHV#4, RRNHV#3, RRNHV#4, RRNHV#5, RRNHV#6,RRNHV#7, RRNHV#8, RRNHV#9, and RRNHV#10, The Hospice Nurse Surveyor observed the timeframes to achieve goals were absent or were not updated and measurable. 

For example in RRNHV#1, the patient had a goal of caregiver will verbalize/ demonstrate measures to prevent/manager yeast infection by adjusting anti-fungal cream to powder and add barrier cream to buttocks by 2/22 and that date had passed. The patient also had a goal of Pt/ CG verbalize and demonstrate understanding of how to correct safety hazards in the home started 7/13/22 at SOC with no goal timeframe and almost two years later had not been updated. In RRNHV#2, the patient had a goal of pt/CG will demonstrate ability to administer meds via planner device with no goal timeframe. In RRHV#1, the patient had a goal of pt/ CG verablize understanding to report any altered mental status or incidence of confusion with no goal timeframe. In RRHV#2 had a goal of pt/cg verbalize demonstrate understanding of oxygen safety with no goal timeframe and the start date was 1 1/2 years prior to survey. In RRHV#3 the patient had a goal of pt/ CG verbalizes/ demonstrates understanding of how to correct safety hazards in the home with no goal timeframe. In RRHV#4 the patient had a goal of pt/cg verbalizes/ demonstrates understanding of proper safety measures related to fall prevention started 7/21 with no goal timeframe. In RRNHV#3, the patient had a goal of pt/ CG verbalized/ demonstrates understanding of how to correct safety hazards in the home which had a start date 8 months prior to survey and no goal timeframe. In RRNHV#4, the patient had a goal of patient/ cg verbalize/ demonstrate understanding of oxygen safety with a begin date 3 months prior to survey and no goal timeframe. For RRNHV#5 and RRNHV#6, the patients had a goal of CG/ facility will be knowledgeable and involved in hospice plan of care for patient by (enter date) and the target date was never entered. In RRNHV#7, the patient had a goal of pt/ CG verbalizes/ demonstrates understanding of applicable safety measures with no goal timeframe and it had been started 2 years earlier at SOC. In RRNHV#8, the MSW had a goal for problems concerning patient’s personal affairs would be identified and a plan established to resolve issues but there was no goal timeframe and the patient had recently been placed on daily visits. In RRNHV#9, the patient had a goal of facility staff is knowledgeable and involved in hospice plan of care for patient be(enter date) and the goal timeframe was not filled in. In RRNHV#10, the patient had a goal of Pt/CG verbalize understanding of when to utilize PRN medications and to document each use. The goal was started one year prior to survey with no target date. 

This was discussed and reviewed with the Hospice Team.”

“Observed in Record Review. In 10 of 21 patient records reviewed, the organization failed to plan the patient’s care. During record review for RRHV#3, RRNHV#1, RRNHV#2, RRNHV#4, RRNHV#5, RRNHV#6, RRNHV#7, RRNHV#8, RRNHV#9, and RRNHV10, the plan of care did not contain all required elements. 

In RRHV#3, RRNHV#1, RRNHV#2, RRNHV#6, RRNHV#7, the patient had more than one medication for the same symptom, the medication POC orders did not contain an indication for when to use which medication. 

In RRNHV#1, the patient had a urinary tract infection one month prior to survey but it was not addressed on the POC. 

In RRNHV#4, the patient had multiple narrative notes and goals on the POC related to Oxygen but there were no orders for the oxygen including route, dose, etc. 

In RRNHV#5, the patient had a new wound on her upper calf and coccyx with new wound orders and it was not added to the POC. She also had a goal of code status resolved with patient started 7 months prior to survey with no target date but did have documentation in the EMR that a DNR is in place. The goal was never updated. 

In RRNHV#6, the patient had a recent fall but the care plan was not updated to include falls. 

In RRNHV#7, the patient had an order for Acetaminophen PRN with no reason when to take it. The patient also had a recent fall with skin tear and wound care orders related to the skin tear that was not addressed on the POC. 

In RRNHV#8, the patient had a recent diagnosis of cellulitis with antibiotic ordered but the POC was not updated. 

In RRNHV#9, the patient had a recent PRN visit with medication changes for anxiety but the POC was not updated. 

In RRNHV#10, the patient had a new order for nectar thick diet but it was not added to the POC. 

This was discussed and reviewed with the Hospice Team.”

“Observed in Patient Home. In 2 of 21 patient records reviewed, the patient record did not reflect the patient’s care, treatment, or services. During record reviews for RRHV#2 and RRNHV#4, the Hospice Nurse Surveyor observed the medication orders were not correct. For example in RRHV#2, Carafate and Protonix were listed as sub-lingual but the patient was taking the medications orally and the pharmacy sent oral. For RRNHV#4, the patient meds (acetaminophen, albuterol, calcium, praluent, calcium carbonate) all had a alternate route listed as sub-lingual which crossed over to the 485/POC as the primary route. 

This was discussed and reviewed with the Hospice Team.”