Comforting Hands Hospice, LLC

“Observed in Record Review. it was noted the organization failed to ensure that the patient was informed in advance about the expected outcomes of care and services. For example in review of record of HOSRRDC#18, the notice of Medicare non-coverage (NOMNC) was signed by the patient 11 days late from the date patient was discharged from hospice services. In HOSRRDC#20, there was no evidence that patient had received NOMNC from the date patient was discharged from hospice services. This finding was discussed and validated by the hospice Administrator and Patient Care Coordinator (PCC).”

“Observed in Record Review. In 14 of 14 active patient records, it was noted the organization had failed to ensure that the written plan of care was developed in accordance with the patient’s identified goals with defined timeframes for achieving those goals. For example, HOSRRHV#1: MSW: Patient will maintain optimal coping through hospice care. HOSRRHV#2: SN Patient will pain free or verbalize an acceptable pain level with current pain management regimen. HOSRRHV#3: SN: Measured arm circumference will not decrease by more than 1 cm per month. HOSRRHV#4: MSW: Patient will demonstrate ability to cope with limitation. HOSRRNHV#5: HOSRRNHV#6: SC: Patient/Caregiver will feel needs are being met as they have defined; SN: Anxiety/agitation controlled through course of care. HOSRRNHV#7: Patient/Caregiver will verbalize appropriate interventions for stress/anxiety management. HOSRRNHV#8, HOSRRNHV#9: SC: Family/Caregiver will minimize effects of abnormal grief.(SN): Skin will remain intact. HOSRRNHV#10: Maintenance of respiratory baseline as evidenced by breathing at optimal level within disease parameters. HOSRRNHV#11: Aide: Patient’s personal care needs will be met. HOSRRNHV#12: SN: Family/caregiver maintain and modify environment according to patient’s cognitive and comfort status. HOSRRNHV#13: SC: Patient/Caregiver will feel needs are being met as they have defined. HOSRRNHV#14: SN: Patient/Caregiver will verbalize understanding of falls/injury prevention and home safety measures. This finding was discussed and validated by the Hospice Administrator and Patient Care Coordinator.”

“Observed in Record Review. In 2 of 14 active patient records reviewed, it was noted the organization failed to ensure that the hospice plan of care plan includes all services needed for the palliation and management of the terminal illness and related conditions, including medications and treatment necessary to meet the patient’s needs. For example, on review of record HOSRRHV#2, SN was ordered to perform wound care/dressing change. apply thin layer of barrier cream. However, it did not indicate how often the wound dressing change and what kind of wound barrier cream; In record of HOSRRHV#4, an order for Oxygen 3 LPM via NC to maintain oxygen saturation above 90% and comfort, however, it did not specify frequency (continuously or intermittent). This finding was discussed and validated by the hospice Administrator and patient care coordinator (PCC).”

“Observed in Record Review. In 14 of 14 active hospice patient records reviewed, it was noted the organization failed to ensure that a revised plan of care must include information from the patient’s updated comprehensive assessment and must note the patient’s progress toward outcomes and goals specified in the plan of care. For example on review of records HOSRRHV#1, HOSRRHV#2, HOSRRHV#3, HOSRRHV#4, HOSRRNHV#5,HOSRRNHV#6,HOSRRNHV#7,HOSRRNHV#8,HOSRRNHV#9,HOSRRNHV#10,HOSRRNHV#11,HOSRRNHV#12,HOSRRNHV#13,HOSRRNHV#14, The plan of care goals and interventions remained the same and not updated from admission and continued IDT to IDT meeting. This finding was discussed and validated by the Administrator and Patient Care Coordinator.”

“Observed in Record Review. In 14 of 14 active patient records with hospice aide services, it was noted the organization had failed to ensure that the written patient care instructions for a hospice aide must be prepared by a registered nurse who is responsible for the supervision of a hospice aide. For example, HOSRRHV#1, HOSRRHV#2, HOSRRHV#3, HOSRRHV#4, HOSRRNHV#5,HOSRRNHV#6,HOSRRNHV#7,HOSRRNHV#8,HOSRRNHV#9,HOSRRNHV#10,HOSRRNHV#11,HOSRRNHV#12,HOSRRNHV#13,HOSRRNHV#14, the aide care plan did not include a frequency for each of the task assigned. Also noted in other records, HOSRRNHV#5 Patient takes Aspirin 81 mg 1 tablet PO once a day. No instructions related to bleeding precaution or not use razor blade when shaving. This finding was discussed with and validated by the Administrator and Patient Care Coordinator.”

“Observed in Record Review. In 2 of 14 active patient records with hospice aide services reviewed, it was noted the organization failed to ensure that hospice aide supervision was conducted at the patient’s home no less than every 14 days as required. For example in HOSRRHV#4, there was a gap of 15 days hospice aide supervision between the 2nd week and 4rth week of March (certification benefit period 1). Another example, in HOSRRHV#8, there was a gap of 15 days hospice aide supervision between 2nd week and 4rth week of March and also noted between the 1st and 3rd week of April (certification benefit period 4). This finding was discussed and validated by the hospice administrator and patient care coordinator (PCC).”

“Observed in Patient Home. In 1 of 1 hospice patient with home oxygen observed, it was noted the organization failed to provide patient education and training related to storage, handling, and access of home oxygen. For example, during home visit of HHRRHV#4 , the hospice nurse surveyor had noticed 1 oxygen cylinder stored in the living room, although in upright position, but unsecured and also found another oxygen cylinder stored in the garage. The clinical staff had not re-educated patient the proper storage and safety nor taking action during the entire home visit. This finding was discussed and validated by hospice Administrator (RN), who was present during the visit.”

“Observed in Record Review. In 1 of 5 patient records reviewed, the plan of care failed to include all services needed for the palliation and management of the terminal illness and related conditions, including treatments necessary to meet the patient’s needs. For RRNHV #3 who had been admitted to the hospice program 9 weeks ago the initial assessment documented a pressure ulcer to the patient’s coccyx, and left ankle but there were no physician orders for wound care in the medical record. On subsequent visits the nursing staff documented measurements of the ankle wound and reported that the wound bed had granulating tissue and also documented performing dressing changes to the left outer ankle however there was no evidence of physician orders for wound care. The Administrator and Patient Care Coordinator confirmed that an physician order for wound care had not been obtained.”

“Observed in Record Review. In 3 of 5 patient records reviewed, all problems identified on assessments were not included on the plan of care. Examples include: MR 1: the plan of care did not include the heart disease primary problem, pain or caregiver for moderate risk assessment during bereavement; MR 2: no plan of care for the HHA providing services, heart disease/edema (CHF was primary diagnosis) or fall risk; MR 5 plan of care did not include an update when the patient was placed on oxygen, which was noted on the IDT note. This was verified by the Administrator and PCC.”

“Observed in Record Review. In 5 of 5 patient records reviewed, the organization did not develop plans of care that were based on patient’s goals and the time frames, settings, and services required to meet those goals. In every record reviewed goals were not specific, measurable, and individualized. For example: Personal care needs will be met; respirations will not be labored as evidenced by respirations will be at or below 24 at each visit; patients personal care needs will be met as evidenced by skin clean, dry, intact and free from odors; patient achieves feelings of spiritual comfort by evidence of face expressions or body movement; patient will complete oral antibiotics as disease will allow as evidence by patient able to swallow medication. This RFI was confirmed by the Administrator and Patient Care Coordinator.”

“Observed in Record Review. In 5 of 5 patient records reviewed, the organization did not ensure that the plan of care included all services needed for the palliation and management of the terminal illness and related conditions, including the scope and frequency of the services necessary to meet the patient’s and family’s needs. For example, in comprehensive assessments and re-assessments of RRNHV#1 it was identified that the patient was at risk for skin breakdown; had sluggish perfusion; was saturating at 91% at 4 lpm of oxygen without dyspnea or shortness of breath; had an indwelling foley catheter; bowel incontinence; and a high risk for falls. None of these problems were addressed in the plan of care. Similar omissions were found in the records of RRHV#1, RRNHV#2, RRBR#1, and RRBR#2. This RFI was confirmed by the Administrator and Patient Care Coordinator.
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“Observed in Record Review. In 5 of 5 patient records reviewed, the organization did not ensure that written certifications documented primary terminal conditions, and current subjective and objective medical findings. In the record of RRHV#1 the terminal diagnosis was identified as chronic respiratory failure in some CTIs and COPD in other CTIs. These were intermingled and there was nothing in the record to indicate that the terminal diagnosis was changed. In the records of RRHV#1, RRNHV#1, RRNHV#2, RRBR#1, and RRBR#2 subjective and objective documentation to support on-going appropriateness for hospice services was minimal or absent. This RFI was confirmed by the Administrator and Patient Care Coordinator.”