Caring One Hospice

“Upon patient record review, 3 of 5 (Patients #2, #3, #5) 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: Upon admission, nurse charts that patient has noted dyspnea and dysphagia on a mechanical soft diet, there are no problems, goals, or interventions to manage findings. Patient 3: Upon admission, nurse charts that patient needs to be on aspiration precautions, there are no problems, goals, or interventions to manage findings. Patient 5: Upon admission, nurse charts in the narrative that patient has pain rating 6/10, in the pain section of the assessment, it is charted that patient has no pain. There are no problems, goals, or interventions to manage findings.”

“Upon patient record review, 3 of 5 (Patients #1, #3, #5) 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 1: Nurse charts in admission assessment that patient is using supplemental oxygen, there is no order for oxygen. Patient 3: Nurse charts in admission assessment that patient is using supplemental oxygen, there is no order for oxygen. Patient 5: Nurse charts in admission narrative that patient has Norco 5 on order for pain management, there is no order written for Norco.”

“Upon patient record review, 4 of 5 (Patients #1, #3, #4, #5) 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 equipment and supply needs. Patient 1: Patient has oxygen concentrator, nebulizer, and walker in home, there are no orders for listed medical equipment. Patient 3: Patient has air mattress, oxygen concentrator and Emergency tanks, there are no orders for listed medical equipment. Patient 4: Patient has walker and oxygen concentrator there are no orders for listed medical equipment. Patient 5: Patient has nebulizer, oxygen concentrator, and walker there are no orders listed for medical equipment.”

“Upon personnel record review, 1 of 11 (Personnel # 5) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel #5: There is no evidence of personnel having direct supervision performing tasks with a patient or pseudo patient.”