Hospice & Palliative Care Palmetto Region- Greenville County

“Upon patient record review, 2 of 25 (Patient #11, 13) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable state law. Patient 11: The patient consent forms for admission to hospice services was signed by a person identified as the patients step-mother. The patients father was present for the admission, the signature does not follow the company policies as indicated by regulations of the State of South Carolina. Patient 13: The patient consent forms for admission to hospice services was signed by a person identified as the patients daughter-in-laww. The patients son was present for the admission, the signature does not follow the company policies as indicated by regulations of the State of South Carolina.”

“Upon patient record review, 2 of 25 (Patient #11, 13) did not have evidence that the hospice obtained the patient’s or representative’s signature confirming that they received a copy of the Patient’s Rights and Responsibilities. Patient 11: The Patient Rights and Responsibilities forms for admission to hospice services was signed by a person identified as the patients step-mother. The patients father was present for the admission, the signature does not follow the company policies as indicated by regulations of the State of South Carolina. Patient 13: The Patient Rights and Responsibilities forms for admission to hospice services was signed by a person identified as the patients daughter-in-law. The patients son was present for the admission, the signature does not follow the company policies as indicated by regulations of the State of South Carolina.”

“Upon patient record review, 2 of 25 (Patient #11, 13) did not have evidence that if a state court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with state law may exercise the patient’s rights to the extent allowed by state law. Patient 11: The Patient Rights and Responsibilities forms for admission to hospice services was signed by a person identified as the patients step-mother. The patients father was present for the admission, the signature does not follow the company policies or the regulations of the State of South Carolina. Patient 13: The Patient Rights and Responsibilities forms for admission to hospice services was signed by a person identified as the patients daughter-in-law. The patients son was present for the admission, the signature does not follow the company policies or the regulations of the State of South Carolina.”

“Upon patient record review, 2 of 25 (Patient #11, 13) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient 11: The patient consent forms for admission to hospice services was signed by a person identified as the patients step-mother. The patients father was present for the admission, the signature does not follow the company policies as indicated by regulations of the State of South Carolina. Patient 13: The patient consent forms for admission to hospice services was signed by a person identified as the patients daughter-in-law. The patients son was present for the admission, the signature does not follow the company policies as indicated by regulations of the State of South Carolina.”

“Upon patient record review, 2 of 25 (Patient #11, 13) did not have evidence of the appropriate documentation for release of confidential information. Patient 11: The patient consent forms for admission to hospice services was signed by a person identified as the patients step-mother. The patients father was present for the admission, the signature does not follow the company policies as indicated by regulations of the State of South Carolina. Patient 13: The patient consent forms for admission to hospice services was signed by a person identified as the patients daughter-in-law. The patients son was present for the admission, the signature does not follow the company policies as indicated by regulations of the State of South Carolina.”

“Upon patient record review, 1 of 25 (Patient #13) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient 13: The medication profile includes Polyethylene Glycol 3350 17G powder, one dose daily for constipation. It does not include a diluent or mixing instructions.”

“Upon patient record review, 1 of 25 (Patient #23) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient 23: The patient was admitted on 6/14/24, the record does not include an initial bereavement risk assessment.”

“Upon patient record review, 2 of 25 (Patient #13, 15) 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 13: The medication orders on 1/6/25 for Polyethylene Glycol 3350 17G powder, one dose daily for constipation, does not include a diluent or mixing instructions. Patient 15: The patient record includes documentation on 3/28/25 that wound care was provided to the sacrum and right heel due to stage II and stage III wounds, the record does not include wound care orders.”

“Upon client record review, 3 of 25 (Patient #4, 14, 24) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 04: The plan of care includes orders for Spiritual Care services 1 x per month, there are no visits made in the month of March. Patient 14: The plan of care includes orders for Spiritual Care services 1 x per month, there are no visits made in the month of March. Patient 24: Documentation on 2/14/25 states “RN placed foley catheter in pt.” The plan of care does not include MD orders for foley placement.”

“Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient 02: Upon home visit, it was observed that the RN obtained an electronic blood pressure cuff from the facility nurse that was positioned on a medication cart and placed it up on the patients left and right wrist without having performed a cleaning on the device. The RN was observed performing a physical assessment, reaching into her nursing bag, cleaning a wound to a toe on the right foot (including extracting serosanguinous fluid and puss) and then applying iodine to the wound, while wearing the same pair of gloves. The nurse also cleaned her nursing tools ie; stethoscope and pulse oximeter, and placed them immediately into her nursing bag without allowing for drying time.”

“Upon patient record review 5 of 25 (Patient #2, 5, 6, 10, 24) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient’s needs. Patient 02: An aide supervisory visit was performed on 2/27/25, the record does not include a supervisory aide visit since that time. Patient 05: An aide supervisory visit was performed on 3/13/25, the subsequent supervisory visit was performed on 4/3/25, day 21. Patient 06: An aide supervisory visit was performed on 2/28/25, the subsequent supervisory visit was performed on 4/1/25, day 32. Patient 10: An aide supervisory visit was performed on 3/10/25, the record does not include a supervisory aide visit since that time. Patient 24: An aide supervisory visit was performed on 1/27/25, the record does not include a subsequent supervisory visit performed leading up to the time of death on 2/15/25, 19 days.”

“Upon patient client record review, 2 of 25 (Patient #11, 13) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient 11: The patient consent forms for admission to hospice services was signed by a person identified as the patients step-mother. The patients father was present for the admission, the signature does not follow the company policies as indicated by regulations of the State of South Carolina. Patient 13: The patient consent forms for admission to hospice services was signed by a person identified as the patients daughter-in-law. The patients son was present for the admission, the signature does not follow the company policies as indicated by regulations of the State of South Carolina.”

“Upon client record review, 1 of 25 (Patient #13) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 13: The patient record includes documentation and orders on 1/15/25 that the patient was started on Cipro 500 mg, 1 tab daily for infection. The medication order was changed on 1/17/25 to Cephalexin 500 mg every 6 hours due to drug interaction, the plan of care was not updated to include interventions and goals for the infection management. The patient record includes documentation on 1/8/2025 and 1/20/25 indicating the patient has a deep tissue injury to the left heel, the skilled nursing facility is treating this with sure prep. The plan of care is not updated to include interventions and goals for the wound/injury.”

“Upon observation, there was no evidence the electrical of a facility is provided consistent with the 2012 editions of the LSC of the National Fire Protection Association and NFPA 99. The provisions of the adopted edition of the Life Safety Code do not apply in a State if CMS finds that a fire and safety code imposed by State law adequately protects patients in hospices. New and existing Construction Upon review of NFPA 99, 2012 with regard to Type 2 and 3 systems, Section 6.6 on Type 3 EES (essential electrical systems, i.e. - generator systems) code 6.4.2.2.3.2: The life safety branch shall supply power for lighting, receptacles, and equipment as follows: (1) Illumination of means of egress in accordance with NFPA 101, Life Safety Code (2) Exit signs and exit directional signs in accordance with NFPA 101, Life Safety Code (3)*Hospital communications systems, where used for issuing instruction during emergency conditions (4) Generator set location as follows: (a) Task illumination (b) Battery charger for emergency battery-powered lighting unit(s) (c) Select receptacles at the generator set location and essential electrical system transfer switch locations (5) Elevator cab lighting, control, communications, and signal systems (6) Electrically powered doors used for building egress (7) Fire alarms and auxiliary functions of fire alarm combination systems complying with NFPA 72, National Fire Alarm and Signaling Code The emergency power system at Hospice of Laurens County, Inpatient was non-functional for a period exceeding one month, from 9/27/24 to 1/10/25. On 9/27/24, during a severe weather event the facility lost power and did also encountered a failure of the alternate source of power, the facility appropriately evacuated patients when the generator failed. However, patients were returned to the facility on 9/28/24 once the main power systems were restored, but before the emergency power system was fully restored. Due to the events of the catastrophic weather that occurred with Hurricane Heleen and Hurricane Irene, the agency was unable to obtain an inspection of the unit, or a replacement in a timely manner. Upon inspection on 10/31/24, it was found that the alternate back up power (generator) was non-functional and beyond repair. A back up source of power was not established until 1/10/2025 with the use of a rental generator. The facility did not have a documented risk assessment or contingency plan in place to ensure patient safety during the outage.”