Harbor Hospice of Central Houston, L.P.

“Observed in Record Review. In 2 of 4 patient records reviewed, During RR# 3 and RR# 4’s patient record review it was noted the organization had not ensured the Interdisciplinary group prepared a written plan of care for each patient. For example: review of RR# 3’s patient record revealed an election of benefit dated approximately 29 days prior to the surveyor review of the record with no documentation of a written plan of care. Review of RR# 4’s patient record revealed an election of benefit dated approximately 22 days prior to the surveyor review of the record with no documentation of a written plan of care. This was reviewed, discussed, and validated with the Adminstratr.”

“Observed in Record Review. In 2 of 3 patient records reviewed with a wound, During RR# 3 and RR# 4’s patient records review it was noted the organization had not ensured staff followed the organization’s policy Wound Care Practice that included if a wound was identified during skin assessment, it would be measured with each assessment. For example RR# 3’s RN initial comprehensive assessment revealed RR# 3 had wound on the coccyx with wound measurements. However, further review of RR# 3’s patient record revealed no documentation of wound measurements for the subsequent three SN visit notes. Review of RR# 4’s RN initial comprehensive assessment revealed RR# 4 had a wound on the coccyx. However, review of the three subsequent SN visit notes revealed no wound measurements of the coccyx. This was reviewed, discussed, and validated with the Administrator.”

“Observed in Record Review. In 3 of 4 patient records reviewed, During RR# 2, RR# 3, and RR# 4’s patient record review it was noted the organization had not ensured the Interdisciplinary Group (IDG) reviewed and revised the plan of care as frequently as the patient’s condition requires, but no less frequently than every 15 days For example: Review of RR# 2’s patient record revealed an IDG/care plan update approximately 19 days prior to the surveyor review of the record. Review of the IDG sign-in sheet and agenda revealed RR# 2 listed to be reviewed, however review of RR# 2’s patient record revealed no documentation of any additional IDG/care plan updates. Review of RR# 3’s patient record revealed the last documented IDG/care plan update approximately 20 days prior to the surveyor review of the record. Review of the IDG sign-in sheet and agenda revealed RR# 3 listed to be reviewed, however review of RR# 3’s patient record revealed no documentation of any additional IDG/care plan update or a plan of care. Review of RR# 4’s patient record revealed RR# 4’s election of benefit was approximately 22 days prior to the surveyor review of the record. Further review of RR# 4’s patient record revealed no documentation of a plan of care or an IDG/care plan update. This was reviewed, discussed, and validated with the Administrator.”

“Observed in Record Review. In 3 of 4 patient records reviewed, During RR# 2, RR# 3, and RR# 4’s patient record review it was noted the organization had not ensured the RN supervised the hospice aide during an on -site visit to the patient’s home no less frequently than every 14 days. For example: review of RR# 2’s patient record revealed the RN had not documented an on-site hospice aide supervisory visit since the hospice aide services were initiated or approximately 28 days. Review of RR# 3’s patient record revealed the RN had not documented an on-site hospice aide supervisory visit since the hospice aide services were initiated or approximately 22 days. Review of RR# 4’s patient record revealed the RN had not documented an on-site hospice aide supervisory visit since the hospice aide services were initiated or approximately 22 days. This was reviewed, discussed, and validated with the Administrator.”

“Observed in Record Review. In 1 of 4 patient records reviewed, During RR# 3’s patient record it was noted the organization had not ensured staff followed the organization policy Entries into the clinical record that included all documentation be completed and in the EMR [electronic medical record] within five day. Review of RR# 3’s patient record revealed no Interdisciplinary Group/care plan update. The Administrator shared it was completed on paper and would need to retrieve it from the patient’s paper record. On further review of RR# 4’s patient record an IDG/care plan update dated 20 days prior to the surveyor review of the record was uploaded to the EMR. this was reviewed, discussed, and validated with the Administrator.”

“Observed in Individual Tracer. In HOSHV#4, 2 Wounds were not measured weekly as required by HCO Ongoing Comprehensive Assessment policy. Examples included the following: The record for HOSHV#4, indicated a Bilateral Medial Dorsal Inner Buttocks Coccyx/Decubitus. During the 2nd and 3rd week of the first certification, there were no measurements completed. During the home visit, the RN did not assess the wound. The RN had documented on their first visit in the 3rd week of the certification that the wound bed was clean. However, no measurements were obtained. During HOSHV#4, the RN removed a dressing from and assessed a right lower leg wound that was not noted on the plan of care. During the visit with the surveyor, the RN stated the leg wound was noted to be a closed blister at the first visit of the week. The family requested additional supplies for the leg wound during the visit with the surveyor present. No orders found in the chart for the right lower leg wound. Nurse Administrator present during the visit and confirmed.”

“Observed in Record Review. During HOSHV#3, the RN did not visit the Hospice patient every 15 days to conduct an assessment. Example #1: RN Revisit made 2 days late . Example #2: RN Revisit made 1 day late. Nursing Administrator confirmed. Observed in Record Review. In HOSNV#8 record review, surveyor noted the RN did not visit the Hospice patient every 15 days. One example included RN Revisit made 2 days late. This was confirmed by the Nurse Administrator. Observed in Record Review. associated with HOSHV1 and HOSHV2 the surveyor observed that the RN had not visited the hospice patient every 15 days to conduct an assessment. The surveyor observed HOSHV1 that RN visited early in the month of December and then exceeded the required 15 day reassessment by 4 days. HOSHV2 the RN made visit in Late December and the following RN assessment was greater than 15 days which exceed regulation and organization policy of RN visit every 15 days. Further in HOSNV1 the surveyor observed that between RN visit completed at the beginning of one month and no other RN visit for 28 days. Organization policy and regulation state RN visits not to exceed 15 days. This issue was discussed and confirmed with organization staff.”

“Observed in Individual Tracer. the surveyor observed on HOSHV2 that the RN had assessed quadriplegic patient without following organization policy as evidenced by assessing the patients tracheostomy, g-tube, and foley catheter without changing gloves or cleaning hands. The surveyor and organization administer observed that the RN assessed patient from one site to the next without changing gloves or cleaning hands. Further the surveyor observed that the RN had not cleaned equipment according to organization policy, the RN placed dirty used equipment in plastic bag and stated he cleaned equipment at car after visit. The issue was discussed and confirmed with organization administrator .”

“Observed in Record Review. During HOSHV#3, Hospice aide supervision not done every 14 days. Example includes the following: RN did not visit the Hospice patient every 15 days to conduct an assessment and therefore failed to complete the Aide Supervisory Visits during these timeframes. The missed Aide Supervisory visits would therefore had been in excess of 14 days. This was confirmed with the Nursing Administrator. Observed in Record Review. In 3 of 7 patient records reviewed, The surveyor found that the hospice aide supervision not been done every 14 days as required by policy and regulation. The surveyor observed on 3 records of patients with CHHA services that the RN had not made at least every 15 day visit, and therefore had also not completed CHHA supervisory visit every 14 days. The RN CHHA supervision had been on the 3 records had been from 2 to 6 days late. This was discussed and confirmed with hospice administrator.”

“Observed in Record Review. In HOSHV#4, the medication profile in the clinical record was inaccurate. The example includes the following: The Medication Profile in the clinical record for HOSHV#4 was noted to have two active Seroquel orders. 1 was for Seroquel 25 mg every night and a second one was for Seroquel 50 mg every night. RN’s last clinical note indicated the receipt of an MD order for Seroquel 25 mg every morning and to continue the 50 mg dose every night, which was being followed in the home by the caregiver. This was confirmed by the Nursing Administrator.”

“Observed in Individual Tracer. In 2 of 2 home visits conducted, of patients receiving oxygen therapy the surveyor observed during home visit 1 that the hospice RN had not taken any action or provided education to patient family when 3 unsecured standing upright oxygen tanks in an extremely cluttered closet was found. Further during second home visit of oxygen patient the family stored the portable tank with multilevels of clothes and other items on top of oxygen tank and again no action had been taken by RN. The issue was discussed and observed by organization administrator.”