Aadi Home Health and Hospice

“Observed in Record Review. In 14 of 14 patient records reviewed, the organization failed to established individualized, measurable goals with appropriate timeframes to achieve the goals. For example, in RRHV #1 the goals stated, the goal for (patient name) is to have a peaceful passing within 0-24 hrs. Peaceful passing is subjective; another goal stated, maintain pt safety by implementing interventions listed within 0-24 hours, and maintain proper functioning colostomy by implementing interventions listed within 0-24 hrs. 0-24 hrs to achieve the goals is unrealistic for the patient/caregivers. In RRHV #2, the goal stated, SN will instruct pt and cg on proper respiratory management as per Hospice philosophy during certification period and within 0-24 hrs and RRHV #3 the goal stated, SN will instruct pt and cg on proper pain management as per hospice philosophy during certification period and within 0-24 hrs, SN will instruct pt and cg on proper respiratory management as per hospice philosophy during certification period and within 24 hrs, SN will instruct pt and cg on proper management of GI system as per hospice philosophy during certification period and within 24 hrs, the nutrition, GU goals are also the same. There are also similar findings in RRDC #1, RRDC #2, RRBR #1 and #2, and RRNHV #1,2,3,4,5,6, and 7. This was reviewed with the Hospice Care Coordinator and the President.”

“Observed in Record Review. In 8 of 14 patient records reviewed, the organization failed to differentiate the use of PRN medications used for the same symptom. For example, in RRHV #2 on the medication list provided to the Surveyor naproxen oral tablet 250 mg 1 tablet by mouth twice a day PRN pain (take with food), acetaminophen ER Oral tablet extended release 650 mg 1 tablet by mouth every 6 hours PRN pain/fever, and tramadol HCL oral tablet 50 mg 1 tablet by mouth every 6 hours as needed for pain were indicated. In RRHV #3 tramadol HCL Oral tablet 50 mg 1 tablet by mouth every 8 hours as needed for pain and morphine sulfate oral solution 20 mg/ml 0.25 ml to 1 ml by mouth/SL every 2 hrs. as needed for SOB or pain (may repeat 0.25 ml every 15 min up to 1 ml if pain or dyspnea persist), in RRNHV #1, tramadol HCL oral tablet 50 mg 1 tab PO q8hrs PRN pain, acetaminophen oral tablet 500 mg 1 tab by mouth every 4-6 hours as needed for pain/fever, morphine sulfate oral solution 100 mg/5ml 0.25 ml as needed for pain/SOB, in RRNHV #2, tramadol HCL Oral tablet 50 mg 1 tablet by mouth 2x a day PRN pain, acetaminophen oral tablet chewable 80 mg 4 tabs every 8 hours for fever/pain as directed, morphine sulfate (concentrate) oral solution 100 mg/5ml 0.25 mg as needed for SOB/pain, in RRNHV #3, Acetaminophen ER Oral Tablet Extended Release 650mg/LS, Tramadol HCL Oral tablet 50 mg 1 tabs every 6 hours as directed, morphine sulfate (concentrate) oral solution 100 mg/5ml (LS) 0.25 mls every 2 hours as needed for SOB/pain, in RRNHV #4, Tramadol, HCL oral Tablet 50 mg 1 tablet by mouth every 6 hrs as needed for pain and Tylenol 8 hour Oral Tablet Extended Release 650 mg (LS) 1 tablet by mouth every 8 hrs as needed for pain; in RRNHV #5, Acetaminophen Rectal Suppository 650 mg 1 suppository rectally every 6 hrs as needed for fever or pain, Tylenol 8 hour arthritis pain oral tablet extended release 650 mg by mouth every 6 hrs as needed for pain/fever (may administer suppository if pt unable to swallow), and morphine sulfate (concentrate) oral solution 20 mg/ml 0.25 ml by mouth/SL every 2 hrs as needed for pain or dyspnea (may repeat up to 1 ML as needed), in RRNHV #6, Acetainophen Oral Capsule 325 mg (LS) 2 caps by mouth 3x a day as needed for pain (limit total Acetaminophen intake to 3,000 mg/day), Oxycodone-Acetaminophen Oral Tablet 10-325mg (LS) 1 tablet by mouth every 6 hrs as needed for pain, and morphine sulfate (concentrate) oral solution 20 mg/ml 0.5 ml PO/SL every 2 hrs as needed for pain/dyspnea (may repeat 0.25ml every 15 min if s/s persist), and RRNHV #7 Acetaminophen Oral Solution 160 mg/5ML take 5 ml by mouth every 6 hours as needed for pain and Morphine Sulfate (Concentrate) Oral Solution 100 mg/5ML 0.25 ml may take 0.25 ML by mouth every 2 hours as needed for pain/SOB were indicated but did not indicate rather the pain medications should be taken for mild, moderate, or severe pain levels. This was validated and reviewed with the Administrator and the Hospice Care Coordinator. Observed in Patient Home. In 1 of 3 home visits conducted, the organization failed to discontinue medications on the plan of care. For example, in RRHV #2 the family stated, the Hospice Nurse was notified one month prior to the Surveyor’s visit megestrol acetate oral tablet 40 mg 1 tablet by mouth daily was discontinued. This was validated and reviewed with the Administrator.”

“Observed in Record Review. In 14 of 14 patient records reviewed, the organization failed to document IDG/IDT discussions and collaborations to reflect the review and revision of the patient’s care, treatment, or services in the clinical records. The only documentation found in the clinical record was POC reviewed as documented by the Skilled Nurse. For example, in RRHV #1, RRHV #2, RRHV #3, RRDC #1, RRDC #2, RRBR #1, RRBR #2, RRNHV #1,2,3,4,5,6, and 7 there was no evidence of documented IDG/IDT discussions between the interdisciplinary team. The Surveyor also spoke with a Skilled Nurse and the Hospice Care Coordinator who stated, they were both present at all IDG/IDT meetings and there has never been any required documentation of IDT/IDG discussions and collaborations of the interdisciplinary team in the clinical record but instead, only a sign in sheet and an agenda was present at each IDG/IDT meeting. This was reviewed with the Hospice Care Coordinator.”

“Observed in Record Review. In 14 of 14 patient records reviewed, the organization failed to follow the plan of care. For example, in RRHV #2, the goal, SN will instruct pt and cg on proper respiratory management as per Hospice philosophy during certification period and within 24 hrs. In RRHV #1, the goal is to have a peaceful passing within 0-24 hrs. There is no documented evidence in the clinical record that the plan of care was revised and or the Physician was notified of the goal not being met by the target date to meet the patient’s needs. The Skilled Nurse continued the same goals with the same target dates for several benefit periods. There are similar findings in RRHV #3, RRDC #1 and 2, RRBR #1 and 2, RRNHV #1,2,3,4,5,6, and 7. This was reviewed with the Hospice Care Coordinator.”

“Observed in Patient Home. In 3 of 3 home visits conducted, the organization failed to provide the patient and family with an accurate medication list. The pill bottle and the medication list provided to the Surveyor were different. For example, in RRHV #1 the medication list indicated, Imodium A-D oral tablet 2 mg every 8 hours but the pill bottle indicated PRN use, Lorazepam Oral concentrate 2 mg/ml 0.5 ml every 4 hours was listed on the medication list but was every 4 hours PRN on the pill bottle, Hyoscyamine Sulfate Oral Tablet 0.125mg take 1 tablet by mouth every 4 hours as needed for secretions was on the medication list but 1 tablet every 6 hours as needed was indicated on the pill bottle, and metronidazole 500 mg crush and sprinkle 1 tablet over the wound 1-2 times daily x 2 weeks was started 13 days prior to the Surveyors visit but was not on the medication list provided to the Surveyor. There were similar findings in RRHV #2 and RRHV #3. This was validated and reviewed with the Administrator. Observed in Record Review. In 1 of 14 patient records reviewed, the organization failed to complete the Skilled Nurse live discharge visit note. For example, in RRDC #2 the entire Skilled Nursing visit note was left blank except for documentation which read, see transfer note. In further review of the clinical record there was also no documentation of a transfer note. This was validated and reviewed with the Hospice Care Coordinator.”

“Observed in Record Review. In 14 of 14 patient records reviewed, the organization failed to educate the patient/families on the risk of oxygen use in the home. For example, in RRHV #2 the daughters stated, there had been no education provided other than no smoking with use of the oxygen. In reviewing the materials from the organization in the patient’s home folder with the patient’s daughters the family also denied having the materials reviewed with them over the past year the patient had been on services. There was also no documentation in the clinical record to support education had been provided. There was similar findings of no documentation to support education being provided for the risk of oxygen use in the home in RRHV #1 and #3, RRNHV #1, 2, 3, 4, 5, 6, and 7, RRDC #1 and 2, and RRBR #1 and 2. This was validated and reviewed with the Administrator and the Hospice Care Coordinator.”