Alive Hospice Inc.

“Observed in Record Review. In 2 of 4 patient records reviewed, for inpatient facility records, the organization failed to conduct and document a patient-specific comprehensive assessment and reassessment that identified the patient’s need for hospice care and services. On review of RRIPU#2 there was documentation of a surgical wound and pressure injury yet no documentation of a comprehensive assessment of the wounds to include details such as size, color, character, drainage, and odor. The patient had a urostomy, nephrostomy, and an abdominal drain yet documentation of assessment of the ostomy and drain sites. There was documentation of giving Intravenous (IV) and/or Subcutaneous (SQ) medications yet no assessment of the site where the meds were being administered. In RRIPU#3 there was documentation of a Left Hip surgical wound but no documentation of an assessment of the size of the wound. There was also no documentation of the IV and/or SQ infusion therapy site(s). These observations were reviewed with the VP of Quality and Compliance.”

“Observed in Record Review. In 2 of 4 patient records reviewed, for inpatient records, the organization failed to ensure the plan of care reflect the patient and family goals that were specific, measurable and time bound. On review of the inpatient records there were goals established that were not specific and measurable such as in RRIPU#2 Caregiver will consult with staff as needed for support and in RRIPU#4 Management and control of anxiety/agitation level during admission to the Residence. These observations were reviewed with the VP of Quality and Compliance. Observed in Record Review. In 12 of 20 patient records reviewed, the organization failed to ensure the plan of care reflect the patient and family goals that were specific, measurable and time bound. Throughout the records reviewed there were goals established that were not individualized and were not specific, measurable and time bound. In RRNHV#1 a goal that was non-specific was Caregiver will receive adequate support from team for patient care. An example in RRNHV#2 was Patient will maintain optimum bowel functioning consistent with food intake and stage of disease process. Further, in RRNHV#2 there was an intervention for volunteer service, yet no goal established. In RRNHV#3 an example of non-specific not measurable goal was patient will maintain optimum level of functioning appropriate for stage of disease process. In RRHV#1 an example was patient will maintain optimal coping through hospice care. In RRNHV#5 there were issues documented with respiratory and oxygen in the home, yet no goals established to guide care. The patient was a fall risk but the goal established for fall safety of patient/caregiver verbalizes plan for evacuation in the event of an emergency did not address the issue. Further examples could be seen in RRNHV#6. These observations were reviewed with the VP of Quality and Compliance. Observed in Record Review. the plan of care goal was not measurable. For example: RRNHV#8, RRNHV#10, RRNHV#12, RRNHV#14 patient goal was Patient / Caregiver will demonstrate necessary behaviors to maintain good safety aware ness and minimize the risk of falls and/or injury. RRHNV#9: Patient receives level of care appropriate to patient care needs. RRNHV#13 Continuity of care will be maintained as appropriate to patient/primary caregiver needs and Patient maintains highest level of mobility possible. This was discussed with the VP of Quality/Compliance.”

“Observed in Record Review. In 6 of 20 patient records reviewed, for active home patient records, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. On review of RRNHV#1 there was documentation in the comprehensive assessment of issues with dysphagia with a failed swallow study in the comprehensive assessment and certificate of terminal illness yet there was no care plan established to address the swallowing risks. There was also documentation of lower extremity edema but no care plan that specifically addressed the increased edema. In RRHV#1 the patient was diabetic with insulin order on admission that was later discontinued yet no care plan to guide the diabetic care. There were multiple adjustments to the pain medication regimen yet the changes were not reflected in the care plan. In RRNHV#3 there was documentation of chronic pain with scheduled and PRN pain medication yet no care plan specific to pain. In RRNHV#4 the patient was receiving tube feeding via NG tube but no orders for the feeds nor NG tube maintenance noted on record or reflected in the care plan. In RRNHV#5 there was documentation of issues with pain and increased anxiety but there were no care plans to guide the care. In RRNHV#6 there was documentation of dysphagia/eating difficulty yet the issue was not reflected in the plan of care. These observations were reviewed with the Educator and VP of Quality and Compliance. Observed in Record Review. In 2 of 4 patient records reviewed, for inpatient hospice, the organization failed to ensure the plan of care included all services needed for the palliation and management of the terminal illness and related conditions. On review of RRIPU#2 the was documentation of the patient having a urostomy, nephrostomy and a abdominal drain yet there were no care plans to guide the care of the drains. In RRIPU#3 the patient was admitted to GIP for pain control but there was no care plan established specific to pain. There was also documentation of continuous oxygen use yet no care plan to address oxygen safety nor the patient’s specific respiratory issue. These observations were reviewed with the VP of Quality and Compliance.”

“Observed in Record Review. for active home patients, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. On review of RRHV#2 the patient was utilizing pressure support, and cough assist yet there were no specific physician orders to address the usage and settings of the devices. The child was receiving tube feeds via G-Tube yet no order for G-Tube site noted on the plan of care. These observations were reviewed with the Educator and VP of Quality and Compliance. Observed in Record Review. In 11 of 20 patient records reviewed, for active home care patients, the plan of care did not include all services needed for the palliation and management of the patients terminal illness. For example: RRHV#4, RRHV#5, RRHV#6, RRNHV#8, RRNHV#9, RRNHV#10, RRNHV#12, RRNHV#13, RRHNV#14: the plan of care orders included May insert foley catheter, but no indication for when may insert foley catheter, nor size of foley catheter to be inserted. RRHV#6 the plan of care did not specify when as needed was appropriate for an order of Meloxicam 7.5mg tablet; take 1 tablet by mouth twice daily as needed. RRHV#3-the plan of care did not include individualize goals and intervention; specifically related to patient taking Eliquis 2.5mg tablet; take 1 tab by mouth twice daily and Novolin R Regular U-100 insulin; 100u/ml injection solution; inject per sliding scale before meals and at bedtime. This was reviewed with the VP of Quality and Compliance and the COO. Observed in Record Review. In 4 of 4 patient records reviewed, for in-patient facility records, the organization failed to ensure the plan of care include all drugs and treatment necessary to meet the needs of the patient. On review of all the inpatient facility records reviewed there were Range orders such as: Hydromorphone 2mg/ml injection solution Admin 0.5 mg to 2 mg IV or SQ every hour as needed for pain/sob and Haloperidol 5mg/ml injection solution Administer 5 - 10 mg IV or SQ every 2 hours as needed for anxiety/agitation. There were no specific instructions to guide the clinician as to when to administer which dose of medication in what situation. Similar range orders were noted on all inpatient records. In RRIPU#3 there was documentation that a foley catheter was inserted on admission. There was an order on admission that simply stated may insert foley catheter as needed yet the order was incomplete. It failed to specify what type and size of catheter and how often to change. Further, the catheter was later noted to be removed yet there was no physicians order to discontinue. These observations were reviewed with the VP of Quality and Compliance.”

“Observed in Record Review. In 3 of 20 patient records reviewed, for active patient records, the organization failed to ensure the care services were provided in accordance with the plan of care. On review of RRNHV#1 the skilled nursing was ordered a frequency of 2 week 2, then 1 week 10. On the second week of the order there was only documentation of one nursing visit. In RRNHV#2 there was a volunteer frequency of 1 week 9 yet there was no volunteer visit documented for week 2, the last week of July. There was no documentation to explain the missed visits. In RRNHV#6 the nurse was ordered a frequency on 1 time a week yet there was no documented visit on the 1st week of June with no documentation to explain the missed visit noted on the record. These observations were reviewed with the VP of Quality and Compliance and Educator.”

“Observed in Tracer Activities. The organization failed to obtain, store, prepare, distribute, and serve all food under sanitary conditions. On tour of the inpatient care unit (IPU) kitchen there was cinnamon bread noted to be stored in the refrigerator that was labeled with an open/use by date in July that was past by 28 days. The policy per the kitchen staff to label with a dating guide to use by today +6 days. There two loves of white bread (one opened, one whole) that were not labeled as required by policy. The kitchen staff noted they should be labeled when placed into the refrigerator and additionally labeled when the bread was opened. This observation was reviewed with the Kitchen Staff and the VP of Hospice Clinical Practice.”