Hospice of Cincinnati, Inc.

“Observed in Record Review. During a review of 1 of 23 patient records, it was noted that the organization did not ensure the comprehensive assessment update included all required information. For example, a review of the medical record for RRHV#1, revealed that the comprehensive pain assessment for benefit period #12, did not include the following information location, character, frequency, duration, and exacerbating factors. This observation was reviewed with the leadership team. Observed in Record Review. In 1 of 23 patient records reviewed, the patient assessment did not include the patient’s needs for care. In the chart for RRNHV#2, the initial comprehensive assessment did not include the presence of the patient’s colostomy and the CPAP use. This was discussed with the Clinical Support Specialist.”

“Observed in Record Review. In 2 of 23 patient records reviewed, it was noted that the organization did not ensure the plan of care goals included outcome measures for specific care activities. For example, a review of the medical record for HosInpt#3, revealed that the patient’s terminal illness diagnosis was Alzheimer’s disease. The plan of care did not include a goal statement to evaluate the response to care, treatment, and services related to Alzheimer’s disease interventions. Example#2: A review of the medical record for RRHV#6, revealed that the patient’s terminal illness diagnosis was Protein Calorie Malnutrition, unspecified severity. The plan of care did not include a goal statement to evaluate the response to care, treatment, and services related to Protein Calorie Malnutrition. This observation was reviewed with the leadership team.”

“Observed in Record Review. In 1 of 23 patient records reviewed, the plan of care did not include interventions to manage pain and symptoms. In the chart for RRNHV#3, the patient had respite stays, however the plan of care was not updated to reflect the change in level of care required. Additionally, the patient’s oxygen order was non-specific and read 2-10 liters per minute without clarification about how to use the range. The oxygen order was not included on the plan of care. This was discussed with the Clinical Support Specialist. Observed in Record Review. In 1 of 23 patient records reviewed, the plan of care did not include interventions to manage pain and symptoms. In the chart for RRNHV#4, the patient had GIP and respite stays, however the plan of care was not updated to reflect the changes in level of care required. This was discussed with the Clinical Support Specialist. Observed in Record Review. In 2 of 23 patient’s records reviewed, it was noted that plan of care did not include interventions based on the problems identified in the comprehensive assessment. For example, a review of the medical record for HosInpt#3, revealed that the patient’s terminal illness diagnosis was Alzheimer’s disease. The plan of care did not include interventions related to Alzheimer’s disease. This observation was reviewed with the leadership team.Example #2: A review of the medical record for RRHV#6, revealed that the patient’s terminal illness diagnosis was Protein Calorie Malnutrition. The plan of care did not include interventions related to Protein Calorie Malnutrition. This observation was reviewed with the leadership team.”

“Observed in Record Review. In 1 of 23 patient records reviewed, the plan of care (POC) did not include all services needed for the palliation and management of the terminal illness and related conditions, including the following: A statement of the scope and frequency of the services necessary to meet the patient’s and family’s needs. In the chart for RRNHV#3, the POC included ranged visits for aide services such as 2-4 visits/7 days (for the remainder of the number of days in the benefit period) without any further clarification as to when visits were to be made at the lower or higher visit count and who was to make the decision about what the actual visit frequency should be. This was discussed with the Clinical Support Specialist. Observed in Record Review. In 2 of 23 patient records reviewed, the plan of care (POC) did not include all services needed for the palliation and management of the terminal illness and related conditions, including the following: A statement of the scope and frequency of the services necessary to meet the patient’s and family’s needs. In the chart for RRNHV#5 and RRNHV#6, the POC included ranged visits for aide services such as 2-4 visits/7 days (for the remainder of the number of days in the benefit period) without any further clarification as to when visits were to be made at the lower or higher visit count and who was to make the decision about what the actual visit frequency should be. This was discussed with the Clinical Support Specialist. Observed in Record Review. In 1 of 23 patient records reviewed, the plan of care (POC) did not include all services needed for the palliation and management of the terminal illness and related conditions, including the following: A statement of the scope and frequency of the services necessary to meet the patient’s and family’s needs. In the chart for RRNHV#7 the POC included ranged visits for aide services such as 1-3 visits/7 days (for the remainder of the number of days in the benefit period) without any further clarification as to when visits were to be made at the lower or higher visit count and who was to make the decision about what the actual visit frequency should be. This was discussed with the Clinical Support Specialist. Observed in Record Review. In 1 of 23 patient records reviewed, the plan of care (POC) did not include all services needed for the palliation and management of the terminal illness and related conditions, including the following: A statement of the scope and frequency of the services necessary to meet the patient’s and family’s needs. In the chart for RRNHV#2, the POC included ranged visits for aide services such as 2-4 visits/7 days (for the remainder of the number of days in the benefit period) without any further clarification as to when visits were to be made at the lower or higher visit count and who was to make the decision about what the actual visit frequency should be. This was discussed with the Clinical Support Specialist.”

“Observed in Record Review. In 1 of 23 patient records reviewed, the plan of care did not include all services necessary to meet the patient’s needs. In the chart for RRNHV#1, the plan of care did not include the oxygen liter flow. This was discussed with the Clinical Support Specialist. Observed in Record Review. In 1 of 23 patient records reviewed, the plan of care did not include all treatments required by the patient. In the chart for RRNHV#5, there was no order for oxygen on the patient’s plan of care. This was discussed with the Clinical Support Specialist. Observed in Record Review. In 1 of 23 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions. In the chart for RRNHV#7, the Oxygen order was not on the POC. This was discussed with the Clinical Support Specialist. Observed in Record Review. In 1 of 23 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions. In the chart for RRNHV#2, the plan of care did not include the order for the Foley catheter. There was no order to routinely change the catheter which the RN did complete during a home visit. This was discussed with the Clinical Support Specialist.”

“Observed in Record Review. In 1 of 23 patient records reviewed, the interdisciplinary group, in collaboration with the patient’s attending physician, if any, reviews and revises the plan of care as frequently as the patient’s condition requires, but no less frequently than every 15 calendar days. In the chart for RRNHV#3, the patient chose an attending physician other than a hospice physician. There was no documentation in the record that the attending physician had reviewed or revised the plan of care. All orders and reviews were documented by the hospice physicians. This was discussed with the Clinical Support Specialist. Observed in Record Review. In 1 of 23 patient records reviewed, the interdisciplinary group, in collaboration with the patient’s attending physician, if any, reviews and revises the plan of care as frequently as the patient’s condition requires, but no less frequently than every 15 calendar days. In the chart for RRNHV#1, the patient chose an attending physician other than a hospice physician. There was no documentation in the record that the attending physician had reviewed or revised the plan of care. All orders and reviews were documented by the hospice physicians. This was discussed with the Clinical Support Specialist. Observed in Record Review. In 1 of 23 patient records reviewed, the interdisciplinary group, in collaboration with the patient’s attending physician, if any, reviews and revises the plan of care as frequently as the patient’s condition requires, but no less frequently than every 15 calendar days. In the chart for RRNHV#2, the patient chose an attending physician other than a hospice physician. There was no documentation in the record that the attending physician had reviewed or revised the plan of care. All orders and reviews were documented by the hospice physicians. This was discussed with the Clinical Support Specialist.”

“Observed in Record Review. In 1 of 23 patient records reviewed, the organization had not provided the patient with care according to the patient’s individualized plan of care. In the chart for RRNHV#3, the aide did not follow the visit frequency on the plan of care and had documented 4 missed visits without any documentation that the IDT had been informed. This was discussed with the Clinical Support Specialist. Observed in Record Review. In 2 of 23 patient records reviewed, the organization had not provided the patient with care according to the patient’s individualized plan of care. In the chart for RRNHV#5, the aide did not follow the visit frequency on the plan of care. Aide visits were ordered on the plan of care as 2-4 visits/7 days; 3x/week in the aide assignment, yet in the first 7 days, 2 visits were documented; in the second 7 days, 1 visit was documented. No missed visits were documented. In the chart for RRNHV#6, there were no aide visits provided in weeks 1, 2 and 3 of the benefit period. Visits were to be provided 2-4 times per week. This was discussed with the Clinical Support Specialist.”

“Observed in Record Review. In 1 of 23 patient records reviewed, the patient assessment did not include the patient’s needs for care. In the chart for RRNHV#8, the initial comprehensive assessment did not include an assessment of the patient’s and family’s spiritual needs. There was no spiritual care assessment documented. This was discussed with the Clinical Support Specialist. Observed in Record Review. In 1 of 23 patient records reviewed, the patient assessment did not include the patient’s needs for care. In the chart for RRNHV#2, the initial comprehensive assessment did not include an assessment of the patient’s and family’s spiritual needs. There was no spiritual care assessment documented. This was discussed with the Clinical Support Specialist.”

“Observed in Record Review. In 2 of 5 patient records reviewed, for whom aide services were ordered, the organization had not effectively supervised the aide to ensure that services meet the patient’s needs. In the chart for RRNHV#5, the RN documented supervisory visits at the required frequency, however failed to recognize that the aide had not provided the visits at the frequency ordered. In the chart for RRNHV#6, Aide services were not provided in weeks 1,2,3. The RN documented aide supervision including that the aide was following the plan of care, yet failed to recognize that the aide had not provided the visits as ordered, nor that multiple interventions had not been provided on multiple visits. This was discussed with the Clinical Support Specialist.”

“Observed in Record Review. In 1 of 3 applicable individual tracers, it was noted that the organization did not ensure the medication list included accurate information. For example, individual tracer activities for RRHV#1, revealed that the plan of care did not include an accurate description of the medication’s the patient was currently taking. The medication list included the following information: 1) Eliquis 2.5mg take 1 tablet by mouth 2 times daily; 2) Metformin 500mg take 1 tablet by mouth daily; 3) Ferrous Sulfate 325mg take 1 tablet by mouth at bedtime; 4) Florastor 250mg take 1 capsule by mouth every morning. The patient was currently taking Eliquis 5mg 1 tablet by mouth 2 times daily; and Metformin 500mg 1 tablet by mouth 2 times per day. The patient was no longer taking Ferrous Sulfate and Florastor. This observation was reviewed with the leadership team. Observed in Record Review. In 1 of 23 patient records reviewed, the patient record did not contain the following clinical information: Any medications administered, including dose. In the chart for RRNHV#4, the nurse documented Haldol given at this time, however did not document the dose or route. This was discussed with the Clinical Support Specialist.”

“Observed in Record Review. In 1 of 23 patient records reviewed, the patient record was not accurately documented. In the chart for RRNHV#3, the admission plan of care (POC) indicated the start date was effective 6 days after the admission of the patient. It was confirmed by the Hospice Surveyor with the Clinical Support Specialist that this was a data entry error by the clinician who created and/or edited the POC and should have started on the day of admission. Additionally, the plan of care included interventions and goals for OT and PT, however there were no OT nor PT visits or interventions ordered. This also was a documentation error as confirmed with the Clinical Support Specialist. Observed in Record Review. In 1 of 23 patient records reviewed, the patient record was not accurately documented. In the chart for RRNHV#7, the admission plan of care (POC) indicated the start date was effective 7 days after the admission of the patient. It was confirmed by the Hospice Surveyor with the Clinical Support Specialist that this was a data entry error by the clinician who created and/or edited the POC and should have started on the day of admission. Additionally, the plan of care included interventions and goals for OT and PT, however there were no OT nor PT visits or interventions ordered. This also was a documentation error as confirmed with the Clinical Support Specialist.”

“Observed in Building Tour. There was spray on fire proofing missing from the structural beam in the Main Fire Alarm Control Panel Room. This was confirmed by the Maintenance Technician & Facility Manager. The surveyor discussed the Life Safety deficiency with the organization, and it was determined that the following ILSMs will be implemented until the deficiency has been resolved and according to the organization’s ILSM policy: Observed in Building Tour. During the building tour, two (2) penetrations were found above the acoustical ceiling tile (ACT) in the one (1) hour fire barriers at the following stairwells. The locations were:*Communications Stairwell near the elevator & cafe’. Hole measure approximately four (4) inches by four (4) inches around & thru the 3/4 metal conduit*Stairwell near the Chapel around the & thru the 3/4 conduit & MC CablingThis was confirmed by the Maintenance Technician. This finding was observed during survey activity, but corrected onsite prior to the surveyor’s departure. The corrective action taken needs to be included in the organization’s Evidence of Standards Compliance submission. Observed in Building Tour. Penetrations were noted in the smoke barrier wall in the conference room that also served as a corridor wall. Room was protected with a smoke detector & sprinkler protection. Penetrations were also sealed with various fire caulks. This was confirmed by the Facilities Manager. This finding was observed during survey activity, but corrected onsite prior to the surveyor’s departure. The corrective action taken needs to be included in the organization’s Evidence of Standards Compliance submission.”

“Observed in Document Review. During the document review session t was noted that EP 3 (Duct / Heat / Smoke / Manual Fire Alarm Boxes) & EP 4 (Notification Devices (audible & visual) & door-releasing devices) did not state what year & sections the items were inspected too. This was confirmed by the Maintenance Technician. Observed in Document Review. During the document review session t was noted that EP 16 (Portable Fire Extinguishers Maintained Annually) did not state what year & sections the item was inspected too. This was confirmed by the Maintenance Technician.”