Vhs Hospice Services of New Jersey

“Based on observations, staff interview, and review of facility documents, it was determined that the facility failed to ensure an individualized emergency preparedness plan was available in one of two patient homes visited (Patient (P)2). Findings include: Facility Policy titled, “;Natural Disasters/Emergencies states, “;...Policy: All patients will receive information on emergency preparedness booklet on the initial home visit. Clinical staff will provide specific, individualized information to each home care patient regarding the following: 1. Emergency phone numbers 2. Emergency supplies 3. Understanding disasters. The patients understanding of the above will be assessed on an ongoing basis. Procedure: 1. Upon admission patients will be assessed as to their emergency preparedness plan for their home and special needs ...” On 7/9/24, a home visit for P2 was conducted from 1:00 PM to 1:35 PM. At 1:20 PM, upon review of P2’s admission folder, a blank emergency plan was observed. In an interview with P2s caregiver, it was stated that he/she never needed to look in the folder and did not know where the emergency plan was located. P2s caregiver stated that this might be the second admission folder and the emergency preparedness paper might be in the first folder. In an interview with Staff (S) 16, the Nurse Case Manager, it was stated that emergency preparedness plans are to be completed upon admission to hospice and he/she was unsure why the plan was blank in the folder. S16 reported that he/she would ensure P2’s family got an emergency plan.”

“Based on medical record review, staff interviews, and review of facility documents, it was determined that the facility failed to ensure patients received the number of Home Health Aide visits ordered by the Hospice physician in six of the 23 medical records reviewed, (Patients (P) 5, 15, 16, 17, 18, and 21). Findings include: On 7/11/24, Staff (S) 1, Nurse Manager and S5, Staff Development / Nurse Case Manager, provided assistance with medical record review. P16 was admitted to hospice services on 1/25/24, for Senile Degeneration of the brain (mental deterioration associated with aging). For the period of 6/16/24 to 7/10/24, P16 was ordered Home Health Aide (HHA) visits seven days a week. A review of the medical record revealed a missed HHA visit on 6/29/24. The missed HHA visit was confirmed by S1. The medical record contained evidence that the doctor was notified of the missed HHA visit. P17 began hospice services on 11/10/23, for Hypertensive Heart Disease (heart condition that can develop over many years in people with chronic high blood pressure) with Heart Failure (condition that happens when your heart can’t pump blood well enough to give your body a normal supply). For the period of 5/12/24 to 6/1/24, P17 was ordered HHA visits seven days a week. A review of the medical record revealed missed HHA visits on 5/12/24 and 5/27/24. S5 confirmed the missed visits. The medical record contained evidence that the doctor was notified of both missed HHA visits. P18 began hospice services on 12/10/22, for Alzheimers Dementia (a progressive disease that destroys memory and other important mental functions). For the period of 1/7/24 to 1/27/24, P18 was ordered HHA visits five days a week. A review of the medical record revealed a missed HHA visit on 1/15/24. S5 confirmed the missed visit. The medical record contained evidence that the doctor was notified of the missed HHA visit. P21 was admitted to hospice services on 5/30/24 for seizures and a Glioblastoma (a malignant tumor affecting the brain or spine). For the period of 6/16/24 to 7/6/24, P21 was ordered HHA visits seven days a week. A review of the medical record revealed missed visits on the following dates: 6/16/24, 6/30/24, and 7/4/24. S1 and S5 confirmed the missed visits. The medical record contained evidence that the doctor was notified of the missed visits on 6/30/24 and 7/4/24. The notification on 6/16/24 was just addressed to the RN Case Manager. S1 acknowledged that the doctor was not notified of the missed visit and explained that the doctor should be notified of all missed visits. Facility Policy titled, “The Plan of Care” states, “...Procedure...7. Content of the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: ... A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs/goals...” Cross-Reference State Regulations: NJAC 8:42C-6.3(a)(6) Findings include: On 7/9/24 and 7/10/24, a review of medical records was conducted with Staff (S) 14, Nurse Staff Development, and S17, Registered Nurse (RN). P5 was admitted to hospice services on 3/11/24, for sequelae of cerebrovascular disease (complications from a lack of blood flow to the brain). For the period of 6/6/24 to 9/6/24, P5 was ordered Home Health Aide (HHA) visits seven days a week. A review of the medical record revealed missed home visits on 6/29/24, 7/4/24, and 7/6/24. The missed HHA visits were confirmed by S14. On 7/1/24, the physician was informed of the missed visit for 6/29/24. On 7/8/24, the physician was informed of the missed visit for 7/4/24. On 7/6/24, the physician was notified of the missed visit for 7/4/24. The medical record lacked evidence of notification of the missed visits within the 24-hour documentation timeframe. P15 was admitted to hospice services on 4/21/23, for malignant neoplasm of lower lobe of right lung (lung cancer). For the period of 6/16/24 to 8/12/24, P15 was ordered HHA visits five days a week. A review of the medical record revealed a missed home visit on 7/4/24. The missed HHA visit was confirmed by S14. On 7/8/24, the physician was notified of the missed visit for 7/4/24. The medical record lacked evidence of notification of the missed visit within the 24-hour documentation timeframe. An interview was conducted on 7/11/24 at 1:45 PM with S2, Director regarding the policy on missed visits. S2 was made aware of the missed HHA visits. S2 confirmed that staffing is decreased on holidays and that “the visit string should be altered on holidays”. When questioned if missed visits could be made up a different day that week, S2 stated, “we have done that in the past.” The facility was unable to provide additional documentation of attempts to reschedule the HHA missed visits. Facility policy titled, “Entries into the Clinical Record”, last revised May 2023, states, “...a written, signed, and dated notation in the medical record by the practitioner providing care and the patient’s response to it will be completed within 24 hours of care provision....” Findings include: Facility Policy titled, “The Plan of Care” states, “...Procedure...7. Content of the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: ... A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs/goals...” Facility policy titled, “Entries into the Clinical Record”, last revised May 2023, states, “...a written, signed, and dated notation in the medical record by the practitioner providing care and the patient’s response to it will be completed within 24 hours of care provision....” On 7/10/24 and 7/11/24, a review of medical records was conducted with Staff (S) 1, Nurse Manager, S5, Staff Development / Nurse Case Manager, S14, Nurse Staff Development, and S17, Registered Nurse (RN). The following was identified: P5 was admitted to hospice services on 3/11/24, for sequelae of cerebrovascular disease (complications from a lack of blood flow to the brain). For the certification period 6/6/24 to 9/6/24, P5 was ordered Home Health Aide (HHA) visits seven days a week. A review of the medical record revealed missed home visits on 6/29/24, 7/4/24, and 7/6/24. The missed HHA visits were confirmed by S14. A review of the Nurse’s Notes revealed that the missed visit for 6/29/24 was not communicated with the physician until 7/1/24 (two days later). The missed visit on 7/4/24 was not communicated with the physician until 7/6/24 (two days later). The missed visit for 7/6/24 was not communicated to the physician until 7/8/24 (two days later). The medical record lacked evidence of notification of the missed visits within the 24-hour documentation timeframe. P15 was admitted to hospice services on 4/21/23, for malignant neoplasm of lower lobe of right lung (lung cancer). For the period of 6/16/24 to 8/12/24, P15 was ordered HHA visits five days a week. A review of the medical record revealed a missed home visit on 7/4/24. The missed HHA visit was confirmed by S14. The missed visit for 7/4/24 was not communicated to the physician until 7/8/24 (four days later). The medical record lacked evidence of notification of the missed visit within the 24-hour documentation timeframe. P16 was admitted to hospice services on 1/25/24, for Senile Degeneration of the brain (mental deterioration associated with aging). For the period of 6/16/24 to 7/10/24, P16 was ordered Home Health Aide (HHA) visits seven days a week. A review of the medical record revealed a missed HHA visit on 6/29/24. The missed HHA visit was confirmed by S1. The medical record contained evidence that the doctor was notified of the missed HHA visit. P17 began hospice services on 11/10/23, for Hypertensive Heart Disease (heart condition that can develop over many years in people with chronic high blood pressure) with Heart Failure (condition that happens when your heart can’t pump blood well enough to give your body a normal supply). For the period of 5/12/24 to 6/1/24, P17 was ordered HHA visits seven days a week. A review of the medical record revealed missed HHA visits on 5/12/24 and 5/27/24. S5 confirmed the missed visits. The medical record contained evidence that the doctor was notified of both missed HHA visits. P21 was admitted to hospice services on 5/30/24 for seizures and a Glioblastoma (a malignant tumor affecting the brain or spine). For the period of 6/16/24 to 7/6/24, P21 was ordered HHA visits seven days a week. A review of the medical record revealed missed visits on the following dates: 6/16/24, 6/30/24, and 7/4/24. S1 and S5 confirmed the missed visits. Documented evidence of the missed visit on 6/16/24 was a notification to the RN Case Manager. Upon interview, S1 acknowledged that the doctor was not notified of the missed visit and stated that the doctor should be notified of all missed visits. An interview was conducted on 7/11/24 at 1:45 PM with S2, the Director, regarding the policy on missed visits. S2 was made aware of the missed HHA visits. S2 confirmed that staffing is decreased on holidays and that “the visit string should be altered on holidays.” When questioned if missed visits could be made up on a different day that week, S2 stated, “We have done that in the past.” Upon request, the facility was unable to provide additional documentation of attempts to reschedule the HHA missed visits. NJAC 8:42C-6.3(a)(6)”

“Based on observation, staff interviews, and a review of facility documents it was determined the facility failed to ensure that accepted standards of practice were followed to prevent the transmission of infections and communicable diseases during 1.) care of an in-dwelling urinary catheter for one of two patients (P5), and 2.) cleaning of blood pressure cuffs for two out of six patients (P1 and P4) per policies and procedures. On 7/10/24 at 10:00 AM, S11, a home health aide (HHA), began providing care for P5. S11 greeted P5 and family and waited for P5 to finish breakfast before providing care. At 10:10 AM, S11 donned gloves and began to give P5 a bed bath using two gray, plastic wash basins. At 10:25 AM, bed bath is completed and S11 doffed gloves, applied hand sanitizer, and donned a new pair of gloves before changing P5s sheet, pad, and diaper. At 10:40 AM, S11 finished changing the sheet, pad, and diaper. S11 began draining the urine from the in-dwelling urinary catheter into one of the empty gray, plastic wash basins used during the bed bath. At 10:42 AM, S11 emptied the urine from the wash basin in the bathroom. S11 rinsed the gray, plastic wash basin used to empty the urine with water for eight seconds, then placed the wash basin on top of a stack of five identical gray, plastic wash basins on the bathroom floor to air dry. The wash basin used to empty the urine from the in-dwelling urinary catheter was not labeled or marked to distinguish it from the other wash basins. S11 doffed gloves and washed hands for five seconds. At 10:43 AM, S11 donned a new pair of gloves and began cleaning P5s oxygen tubing and tray table. S11 then placed the oxygen tubing back in P5’s nostrils. On 7/11/24 at 2:13 PM, an interview was conducted with S15, Manager Clinical Practice of HHAs. S15 stated that urinary catheter care is not covered during orientation with HHAs unless the new employee identifies the need for urinary catheter care training on their orientation checklist. S15 stated that urinary catheter care is covered during monthly in-services. When asked what type of container the HHAs should use to empty urinary catheters, S15 stated that “the HHA should ask the patient’s family which container should be used to empty the urinary catheter.” S15 was not sure if there should be a label on the container used to empty the urinary catheter. S15 stated that a wash basin would not be an appropriate container to use for emptying a urinary catheter. Facility policy titled “;Urinary Catheter/GU Management” states “; ... C. Procedure/Protocol: ... IV. Maintenance: ... Empty the bag when at least 2/3 full or often as indicated by the patients condition. Use a separate clean labeled (patients initials and type of excrement) container for each type of patients waste and drain.” Facility policy titled “Hand Washing and Hand Hygiene” states “ ... Procedure: ... A. Hand Washing Method: ... 6. Scrub the hands for at least 15 seconds.” On 7/9/24 at 12:50 PM, S18, a Registered Nurse (RN), began providing care for P1. S18 spoke with P1’s family members to discuss any changes with P1’s health. At 12:58 PM, S18 hand sanitized and put on gloves. S18 set up barrier on P1’s couch for equipment and his/her computer. At 1:01 PM, S18 took P1’s vital signs, including blood pressure, pulse oxygenation, temperature, and heart rate. S18 placed vital sign equipment on barrier. At 1:02 PM, S18 entered P1’s vital signs into his/her computer with dirty gloves on. At 1:08 PM, S18 performed a skin check and examined patient’s lower extremities for peripheral pulses and edema. At 1:09 PM, S18 entered skin assessment and lower extremity assessment into his/her computer with dirty gloves on. At 1:17 PM, S18 doffed dirty gloves, hand sanitized, and put on new gloves At 1:21 PM, S18 assessed and measured patient’s blister and documented wound assessment on his/her computer with dirty gloves on. At 2:01 PM, S18 sanitized his/her hands and put on new gloves. At 2:06 PM, S18 used “Sani Wipes” to wipe down his/her blood pressure cuff and then immediately rolled blood pressure cuff up and placed in bag. S18’s stethoscope and pulse oximetry sensor were wiped down thoroughly with Sani Wipes and allowed to dry before being placed in S18’s bag. An interview was performed with S18 at 2:10 PM and S18 stated that the dwell time for “sani cloths” is two minutes. On 7/10/24 at 10:02 AM, during a home visit with P4, S7, RN, was observed cleaning/disinfecting the used blood pressure cuff with a Sani-Cloth Wipe and then immediately rolled up the cuff, not allowing the disinfectant to dry on the surface for the recommended time. Manufacturer instructions for use (IFU) the Sani-Cloth Germicidal Disposable Wipes, located on the package, states, “;... use a wipe to remove visible soil prior to disinfecting. Unfold a clean wipe and thoroughly wet surface. Allow surface to remain wet for two (2) minutes. Let air dry...” Findings include: 1. Facility policy titled “;Urinary Catheter/GU Management” states “; ... C. Procedure/Protocol: ... IV. Maintenance: ... Empty the bag when at least 2/3 full or often as indicated by the patients condition. Use a separate clean labeled (patient’s initials and type of excrement) container for each type of patients waste and drain.” Facility policy titled “Hand Washing and Hand Hygiene” states “ ... Procedure: ... A. Hand Washing Method: ... 6. Scrub the hands for at least 15 seconds.” On 7/10/24 at 10:00 AM, during a Home Health Aide (HHA) home visit for P5, the following was observed: At 10:10 AM, Staff(S) 11, HHA, donned gloves and began to perform a bed bath using two gray, plastic wash basins. At 10:40 AM, upon completion of the bed bath, S11 began draining the urine from the in-dwelling urinary catheter into one of the empty, gray, plastic wash basins used during the bed bath. At 10:42 AM, S11 emptied the urine from the wash basin in the bathroom and proceeded to rinse the basin with water for eight seconds. The wash basin was then placed on top of a stack of five other identical gray, plastic wash basins on the bathroom floor. The wash basin used to empty the urine from the in-dwelling urinary catheter was not labeled or marked to distinguish it from the other wash basins. S11 doffed their gloves and washed their hands for five seconds. At 10:43 AM, S11 donned a new pair of gloves and began cleaning P5s oxygen tubing and tray table. S11 then placed the oxygen tubing back in P5’s nostrils. On 7/11/24 at 2:13 PM, an interview was conducted with S15, Manager Clinical Practice of HHAs. S15 stated that urinary catheter care is not covered during orientation with HHAs unless the new employee identifies the need for urinary catheter care training on their orientation checklist. S15 stated that urinary catheter care is covered during monthly in-services. When asked what type of container the HHAs should use to empty urinary catheters, S15 stated “The HHA should ask the patient’s family which container should be used to empty the urinary catheter.” S15 was unsure if there should be a label on the container used to empty the urinary catheter. S15 stated that a wash basin would not be an appropriate container to use for emptying a urinary catheter. 2. On 7/9/24 at 12:50 PM, during a home visit for P1 with Staff (S)18, a Registered Nurse (RN), the following was observed: At 12:58 PM, S18 hand sanitized and put on gloves. S18 set up a barrier on P1’s couch for equipment and his/her computer. At 1:01 PM, S18 took P1’s vital signs, including blood pressure, pulse oxygenation, temperature, and heart rate. S18 placed vital sign equipment on the barrier. S18 then proceeded to provide care to the patient. At 2:06 PM, S18 used “Sani Wipes” to wipe down his/her blood pressure cuff and then immediately rolled the blood pressure cuff up and placed it in the bag. S18’s stethoscope and pulse oximetry sensor were wiped down thoroughly with Sani Wipes and allowed to dry before being placed in S18’s bag. An interview was conducted with S18 at 2:10 PM and S18 stated that the dwell time for “sani cloths” was two minutes. On 7/10/24 at 10:02 AM, during a home visit with P4, S7, RN, was observed cleaning/disinfecting the used blood pressure cuff with a Sani-Cloth Wipe and then immediately rolled up the cuff, not allowing the disinfectant to dry on the surface for the recommended time. Manufacturer instructions for use (IFU) the Sani-Cloth Germicidal Disposable Wipes, located on the package, states, “;... use a wipe to remove visible soil prior to disinfecting. Unfold a clean wipe and thoroughly wet surface. Allow surface to remain wet for two (2) minutes. Let air dry...” NJAC 8:42C-10.2(b) NJAC 8:42C-10.3(a)(1) NJAC 8:42C-10.3(a)(4)”