East End Hospice, Inc.

“Observed in Record Review. In 3 of 14 patient records reviewed, The surveyor noted that (RRNHV#5) several components of the psycho-social assessment in the EMR were not completed and were blank, for example, there was no assessment of the patient’s coping mechanisms (RRNHV#10), the areas related to family dynamics, end of life issues, advanced directives and funeral planning and most of the home safety assessment were not completed. In (RRNHV#13), the psycho-social assessment was incomplete and did not assess the discourse in the family related to the patient living arrangements, family dynamics, and the patient’s children, as noted in a visit note. There was no assessment for this 50 year old patient need at end of life issue including, advanced directives, funeral planning, history of addiction (use of lock box in home). Also, there was no assessment of lifestyle assessment including employment, legal, and financial needs. This was confirmed with the president. Observed in Individual Tracer. In 13 of 14 patient records reviewed, The surveyor noted that (RRHV#1) that a spiritual assessment was not completed that considered the spiritual concerns or needs identified by the patient or family, such as despair, suffering, guilt, and forgiveness. The only documentation was the identification of the patient’s religion and that pastoral care was deferred. There was no evidence that the chaplain had attempted to contact/visit the patient or that the patient/cg refused the assessment. In (RRHV#2, RRHV#3, and RRNHV#5-14), the spiritual assessment was limited to confirming/discussing religion and was completed by either the nurse or social worker and there was no evidence that the chaplain attempted to contact the patients or that the patient’s refused a visit from the chaplain. In discussion with the president, it was confirmed that it was not the organizations practice to include a pastoral assessment by the chaplain, and the chaplain only visits when it is requested.”

“Observed in Record Review. In 4 of 14 patient records reviewed, The surveyor noted (RRHV#1) that the patient had an indwelling Foley catheter, developed a UTI and had a wound; however a temperature was not assessed. In (RRNHV#5), there was no assessment of the severity of the patient’s agitation. In (RRNHV#8) there was no assessment of the severity of diarrhea related to C-Diff, also in (RRNHV#13) there was no assessment of the patient’s G-tube feeding tolerance and risk for aspiration, and there was no assess of patient’s goal for pain management, as required by the pain assessment policy. This was confirmed with the president.”

“Observed in Individual Tracer. In 10 of 14 patient records reviewed, The surveyor noted (RRHV#3) that the plan of care did not include any measurable outcomes. For example the goal for pain was effective ongoing management of chronic pain, verbalized understanding of Ekit medications, adheres to medication plan within two weeks. Others included effective bowel pattern maintained, progressive healing of wound within two weeks ,address issues of sadness and anxiety will be minimized/controlled. In (RRHV#4), the surveyor noted that the SN and MSW goals did not include measurable outcomes for goals including role stress (patient receives safe/appropriate care within two weeks, caregivers needs are not compromised throughout care. The assessment indicated the CG need for emotional support, Health care advocacy and understanding of disease process and anticipatory grief, however, there were no interventions to address the needs. In 13 of 14 records the MSW visit freq. was Q other week and did not include individual outcome expectations. ; also, most of the nursing goals did no include outcome measures or time frames for achieving them. For example in (RRNHV#4) the goal was stated effective ongoing management of chronic pain, effective bowel pattern maintained, demonstrate proper aspiration precautions and swallowing methods. In (RRNHV#5-12) there were no measurable outcomes for effective ongoing pain management, reduce evidence of agitation in 72 hours, optimal mobility within disease restrictions and address issues of sadness. In (RRNHV#7) the goal included resumption of baseline bowel pattern in 2 weeks, andoptimal mobility. In (RRNHV#12), there were no goals for sadness, anxiety or agitation. This was confirmed with the president.”

“Observed in Individual Tracer. In 2 of 4 home visits conducted, The surveyor noted that (RRHV#1) that the nurse used a spray bottle of Sanizide to disinfect equipment after use; however, did not follow the manufacturer’s guideline to spray surface and maintain visibly wet for three minutes. Also, the product was only to be used on non-porous surfaces and it was used to clean both the plastic stethoscope and the fabric blood pressure cuff. The equipment was non sprayed to be visible wet. Also, in (RRHV#2), the nurse sprayed the product lightly onto a paper towel then used the paper towel to wipe down the equipment and thus was not visibly wet. This was confirmed with the president. Observed in Individual Tracer. In 1 of 4 home visits conducted, The surveyor noted (RRHV#3) that the aide did not carry hand hygiene supplies with her into the home, and depended on the patient to provide her with soap and paper towels. The bag policy indicated that staff should carry soap, paper towels and hand sanitizer. This was confirmed with the president.”