Ryder Memorial Hospice Program

“Observed in Record Review. The hospice nurse surveyor noted that for HOSRRHV#2, HOSRRHV#3, HORRNHV#1, HOSRRNHV#2, HOSRRNHV#3, HOSRRNHV#4 the need for volunteer services to offer support or respite to the patient or family was not being assessed. The hospice did not have any volunteers available to provide services since 2021, and therefore had not been assessing the need for volunteer services. This was verified by the Hospice Coordinator. Observed in Record Review. In 14 of 14 patient records reviewed, It was noted by the nurse surveyor that the need for volunteer services was not assessed for HOSRRHV#1, HOSRRNHV#5, HOSRRNHV#6, HOSRRNHV#7, HOSRRDC#1, HOSRRDC#2, HOSRRBR#1, and HOSRRBR#2 as the agency did not have a hospice volunteer since 2021 to provide support or services. Finding was discussed with the Hospice Coordinator.”

“Observed in Record Review. In 4 of 14 patient records reviewed, the goal time frames were not being updated based on the current individualized assessments. HOSRRNHV#1 included nursing goals with target dates of more than 2 weeks prior to survey. HOSRRNHV#2 included nursing and chaplain goal target dates in the past. HOSRRNHV#3 included a nursing constipation goal date in July more than 2 months prior to survey. HOSRRNHV#4 included a goal related to a urinary infection with a target date of more than a month prior to survey and social work goals with target dates in the past. This was reviewed with the Hospice Coordinator during record review.”

“Observed in Record Review. The hospice surveyor noted from record review that the frequency of visits planned did not include the duration of services necessary to meet the patient needs. HOSRRHV#2, HOSRRHV#3, HOSRRNHV#1, HOSRRNHV#2, HOSRRNHV#3, and HOSRRNHV#4 included a plan for frequency for all disciplines, nursing, social work, chaplain, medical director, and hospice aide without any duration included for the planned frequency for any discipline. This was confirmed with the Hospice Coordinator. Observed in Record Review. In 14 of 14 patient records reviewed, it was noted by the nurse surveyor that for HOSRRHV#1, HOSRRNHV#5, HOSRRNHV#6, HOSRRNHV#7, HOSRRDC#1, HOSRRDC#2, HOSRRBR#1, and HOSRRBR#2 the visit frequency as established by the IDG (interdisciplinary group) did not include a duration for services. Finding was discussed with the Hospice Coordinator.”

“Observed in Record Review. In 2 of 14 patient records reviewed, it was noted by the nurse surveyor that care was not being provided care per the hospice plan of care. For HOSRRHV#1, the order for oxygen was for 5 liters BNC continuously, during the home visit it was noted that the oxygen concentrator was set on 4 liters. Additionally, there was an order that the oxygen could be increased to 10 liters BNC for acute episodes of shortness of breath, however, in the home it was being provided by mask. Findings were validated by the Hospice Coordinator who was present on the Home Visit. Observed in Record Review. The hospice nurse surveyor noted that for HOSRRNHV#3 the plan for aide frequency of visits was not followed. The frequency of aide visits was included in the plan as 3x a week and after the second week of aide care when the patient refused further aide services the plan was not updated, there was no evidence in the record that the interdisciplinary team was informed of the change in services. This was confirmed by the Hospice Coordinator during record review.”

“Observed in Patient Home. In 2 of 2 home visits conducted, where equipment disinfection was observed, the surveyor noted the organization had not implemented its infection prevention and control activities when cleaning and performing disinfection of medical supplies and devices. For example HOSRRHV#2 and HOSRRHV#3 the nurses placed the dirty equipment on the clean barrier. After the equipment was cleaned it was placed back on the area where the dirty equipment was placed. In addition, during HOSRRHV#2 the nurse wrapped the blood pressure cuff as soon as she wiped it with the disinfectant wipe without leaving it open to allow for the manufacturer required 1 minute wet time. During HOSRRHV#3 the nurse cleaned the equipment with the same gloves used to check the patient’s skin, which included removing the patient’s adult disposable brief and checking the peri area for skin breakdown. This was reviewed with the Hospice Coordinator who accompanied the surveyor on the visits.”

“Observed in Tracer Activities. It was noted by the nurse surveyor that the hospice did not have an organized bereavement program. There was a bereavement coordinator in place (their social worker) visited each family at time of death. At that time, the family was asked if they wanted bereavement follow-up (comfort/condolence support). If the family said no, (which they all did), no further follow-up was provided. The hospice did not have any standardized mailing program or set time frames for follow-up with the bereaved if they should want bereavement follow-up (comfort/condolence support). Finding was discussed with the Hospice Coordinator. 
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“Observed in Record Review. In 3 of 3 patient records reviewed, with the Hospice Aide, it was noted by the nurse surveyor that the hospice aide care plan did not include all of the information for the hospice aide to effectively provide care. For HOSRRHV#1, the patient was on continuous oxygen and there were no instructions to indicate if the patient’s oxygen could be removed for her bed bath. Additionally, there were no instructions as to when to notify the nurse, resuscitation status, or incontinence care. HOSRRNHV#7, the patient was on continuous oxygen and there were no instructions to indicate if the patient’s oxygen could be removed for her bed bath. Additionally, there were no instructions as to when to notify the nurse, resuscitation status, incontinence care, or what to do regarding a necrotic hand wound. Findings were discussed with the Hospice Coordinator. Observed in Record Review. The hospice nurse surveyor noted for HOSRRNV#3 that the aide care plan did not include all of the necessary written patient care instructions. The aide care plan did not include for example the patient’s resuscitation status, incontinence management instructions, what to do with the oxygen, or when to notify the nurse. This was reviewed with the Hospice Coordinator.”