Harbor Hospice of Plano, L.P.

“Observed in Record Review. In 2 of 10 patient records reviewed, for active patients it was noted by the nurse surveyor that the comprehensive assessment was not completed within five calendar days of the election of the hospice benefit. For RRHV#1, the spiritual counselor completed his initial spiritual assessment six days after the patient had been admitted. For RRNHV#5, the spiritual counselor and social worker both completed their initial assessments thirteen days after admission. There was no documentation in the electronic medical record to indicate why the visits were not completed. Findings were discussed and verified with the Nurse Administrator and the Director of Nursing.”

“Observed in Record Review. In 10 of 10 patient records reviewed, for all active records, the nurse surveyor noted that the goals were not measurable or individualized. For example, “Patient’s left hip DTI will continue healing process as evidenced by decreased need for dressing changes and wound bed decreasing in size throughout current cert period,” and “Patient will be able to make his needs known and verbalize communication during this cert period”. There were no short-term goals at start of care to address issues of immediate needs such as understanding medication management, symptom management, pain management, or safety. Additionally, time frames for completion were either at the end of the certification period or none at all. Finding was verified by the Nurse Administrator and the Director of Nursing.”

“Observed in Record Review. In 1 of 10 patient records reviewed, for active patients it was noted by the nurse surveyor that the patient’s plan of care did not include all needed services. For RRHV#1, the patient developed an additional sacral decubitus. The medical director verbal order for the change of wound care was not documented by the nurse and the plan of care was not updated to include the new orders. Finding was verified by the Nurse Administrator and the Director of Nursing. Observed in Record Review. In 1 of 10 patient records reviewed, for active patients it was noted by the nurse surveyor that the patient’s plan of care did not include all needed services. For RRHV#1, the patient developed an additional sacral decubitus. The medical director order for the change of wound care and the plan of care was was not updated to include the new orders. Finding was verified by the Nurse Administrator and the Director of Nursing.”

“Observed in Patient Home. In 3 of 3 home visits conducted, it was noted by the nurse surveyor that the staff failed to follow acceptable practice and agency policy when performing patient care. During RRHV#1, the hospice aide washed her hands in the patient’s sink then dried her hands on a cloth hand towel hanging on a rack by the sink. Later after using hand sanitizer, she double gloved so she could remove a pair after applying lotion to the patient. Additionally, her nails were beyond the recommended length for patient care staff per supervisor and the Dress and Appearance policy. During RRHV#2, the registered nurse washed her hands with soap and water, then set up her barriers, nursing bag and equipment, then gloved without hand sanitizing. During RRHV#3, the social worker held the patient’s hands in prayer and in providing presence several times during the visit and did not hand sanitize prior to leaving the patient’s room. Findings were verified by the Director of Nursing who was present on the visits.”

“Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the nurse surveyor that the hospice aide care plan did not contain all the necessary or current information. For RRHV#1, the patient had coccyx wound and a hip wound, however there was not anything on the hospice aide care plan regarding the hospice aide’s responsibility or what she should report regarding the wound and the dressings. Additionally, the hospice aide care plan had not been updated in over a year and now she is no longer getting into the shower two times a week but getting a bed bath five times a week instead of three times a week. For RRHV#2, the patient was on continuous oxygen when the patient was admitted, she is now on PRN oxygen, however, the hospice aide care plan did not have any information regarding what the hospice aide was supposed to do with the oxygen during the bath. Findings were discussed with the Director of Nursing.”

“Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the surveyor that the electronic medical record (EMR) medication profile was inaccurate. During RRHV#2, it was noted that the patient’s family had started giving her Calcium/Magnesium/Zinc/D3/K2 as a supplement po 1/1 daily, yet the medication profile in the medical record had not updated. Also, Desitin and Dyna-shield Skin Barrier Cream were used to prevent skin breakdown and were not on the EMR medication profile. Findings were reviewed with the Director of Nursing who was present on the home visits.”

“Observed in Record Review. In 1 of 1 patient records reviewed, for extended progress it was noted by the nurse surveyor that the Hospice did not have a process in place to ensure that a Notice of Medicare Non-Coverage (NOMNC) was signed by the patient or patient’s representative at least two days prior to a planned discharge as required. For RRDC#1 the patient did not have a signed NOMNC. The Director of Nursing was not aware that a NOMNC was needed for a discharge for extended prognosis. Lack of a process was discussed with the Director of Nursing and verified by the Nurse Administrator.”