Silverado Hospice- Austin

“Observed in Record Review. In 10 of 19 patient records reviewed, the nurse surveyor observed that the organization failed to plan the patient’s care by entering care plans specific to their care in the plan of care. In HOSRRHV #1 the patient documented in IDT that the patient had dysphagia and had lost 14 lbs., she was a fall risk, she was on 4 medications for constipation, and she was on 2 medications prophylactically for urinary tract infections. No care plans were entered for these problems noted. in HOSRRHV #4 the patient was on an anticoagulant and the nursing plan of care did not include a care plan. In HOSRRNHV #1 the patient had dysphagia and there was no care plan entered on aspiration risk. In HOSRRNHV #3 the patient has a diagnosis of depression and also on an antidepressant and there was no care plan entered for depression. In HOSRRNHV #4 the patient was assessed for pain, and had diagnosis and taking medications for seizures and depression and there were no care plans entered into the plan of care. In HOSRRNHV #8 the patient was on an anticoagulant and there was no bleeding care plan entered. In HOSRRNHV #9 the patient was on 2 liters of continuous oxygen and there was no oxygen safety care plan entered. In HOSRRNHV #10 in IDT it was noted that the patient was being treated for depression and anxiety and had aspiration issues and there were no care plans addressing these issues in the plan of care. In HOSRRBRV #1 the patient had a urinary tract infection while on service and was on an anticoagulant and there was no care plan addressing the infection or bleeding precautions. In HOSRRBRV #3 the patient had an upper respiratory infection, and eye infection and a urinary tract infection and placed on new medications for each and none included a care plan on the POC. This was reviewed and validated with the QAPI Manager. Observed in Patient Home. In 2 of 19 patient records reviewed, the nurse surveyor observed that the medication list had duplicate and as needed medications without a clear indication when to take one over the other. In HOSRRHV #1 the patient had two orders for Quetiapine Fumarate . One order stated for the patient to take 50mg 1/2 tablet twice a day and the other order stated 50 mg 1 tablet once a day. It was not clear if the patient could take both of the medications for 75 mg. In talking with the medication aide at the facility, the 1/2 tablet is taken in the morning and at noon and the full tablet is taken at bedtime. This patient also had a duplicate order for pain medication. The patient had an order for Morphine Sulfate 20 mg /ml every 2 hours as needed for pain, and Ibuprofen 200 mg one tablet every 6 hours as needed for pain. It is not clear when the patient should take one over the other for pain. In HOSRRNHV #3 the patient had an order for Acetaminophen 325 mg one tablet every 6 hours for mild to moderate pain and Tramadol 50 mg one tablet every 6 hours for mild to moderate pain. It is not clear when the patient should take one medications over the other for pain. This was reviewed and validated with the DCPS.”

“Observed in Record Review. In 12 of 19 patient records reviewed, the organization failed to notify the provider or IDG of missed visits. In HOSRRHV #1 on one visit in June and one visit in July were missed by the HHA. In HOSRRHV #2 there were 3 missed visits since start of care. In HOSRRHV #3 there were 3 missed visit one each for May, June and July. In HOSRRHV #4 there was one missed visit in April and one in May. In HOSRRNHV #1 there were a total of 3 missed visits one each for April, May, and July. In HOSRRNHV #3 there was 1 missed HHA visit in May and 2 in July. In HOSRRNHV #6 there was a missed HHA visit in December, January, and May. In HOSRRNHV #7 there were 23 missed visits from April to August for the HHA. In HOSRRNHV #8 there were 2 missed visits in May and one in July for the HHA. In HOSRRNHV #9 there were 10 missed visits for the HHA from May to July. In HOSRRBRV #2 there were 3 visits missed in where patient was unavailable and 1 visit was missed due to the observance of the holiday. In HOSRRBRV #3 there were 2 missed visited as patient refused and one holiday observation visit that was missed. This was reviewed and validated with the QAPI Manager.”

“Observed in Record Review. In 8 of 19 patient records reviewed, where home health aide services were provided the HOS surveyor noted that the aide assignment did not include specific precautions. In HOSRRHV #1 the patient had a diagnosis of seizures, she was on medications for the diagnosis and the home health aide assignment did not include this as a precaution. In HOSRRHV #2 the patient had a diagnosis of seizures and had a wound and there were not precautions entered into the aide assignment nor were there instructions as to what to do with the wound when bathing the patient. In HOSRRHV #4 the patient was on an anticoagulant and 2 liters of Oxygen continuous. There were no bleeding precautions entered into the assignment and there were no instructions of what the aide should do with the oxygen when showering the patient. In HOSRRNHV #1 the aide assignment was inaccurate, it included bleeding precautions and the patient was not on an anticoagulant. In HOSRRNHV #2 the patient was an aspiration risk and this was not in the aide assignment as a precaution. In HOSRRNHV #5 the patient was a fall and seizure precaution and these were not entered into the aide assignment. In HOSRRNHV #8 the patient was on an anticoagulant and the aide assignment did not include bleeding precautions. In HOSRRBRV #1 the patient was on an anticoagulant and the aide assignment did not include the bleeding precaution. This was reviewed and validated with the QAPI Manager.”

“Observed in Patient Home. In 1 of 4 home visits conducted, the surveyor observed that the medication list was found to be inaccurate. In HOSRRHV #4 the patient had the following medications on the medication list that she was no longer taking; Diclofenac Sodium 1% gel one inch as needed for edema, Chloroseptic spray 1.4% one spray every 2 hours as needed, and Estradiol 1% vaginal cream three times a week. The following medications were inaccurate: Hydroxyzine 10 mg tablet one time a day, the patient is getting this three times a day, Hydrocodone Acetaminophen 7.5-325 mg one tablet three times a day but patient is taking it four times a day for pain. This was reviewed and validated with the DCPS.”