Angel Wings Hospice Services LLC

“Observed in Record Review. The HCO failed to conduct and document a patient-specific comprehensive assessment as evidenced by in RR#6 there was no assessment for aspiration risk for a mechanical soft diet for a CVA patient, this was validated and discussed with Assistant Director of Nursing and Administer Observed in Record Review. In 2 of 12 patient records reviewed, The surveyor noted (ARR#10) that the initial social worker assessment indicated that the primary caregiver was experiencing burnout; however, it did not indicate the severity of the stress or an assessment of the need for a different level of care/respite. This was confirmed with the administrator.”

“Observed in Record Review. In 3 of 12 patient records reviewed, The HCO failed to provide education and training to the patient caregiver based on the patient’s assessed needs as identified in RRHV#2 , patients spouse informed the surveyor that when needed the patients son provides wound care and in chart review there was no education provided to son or identified on plan of care that son would do the wound care. In RR#6 and RR#8, orders were present for Oxygen 2-4 litres via N/C PRN but no education was provided to family on how to dose oxygen. This was discussed and validated with Assistant Director of Nursing and Administrator.”

“Observed in Record Review. In 4 of 12 patient records reviewed, The HCO failed to implement an individualized plan of care based on problems identified as in RR #4 aggression and hallucinations identified at SOC but there was no goals for managing symptoms. RR#5 IDG note identified disturbance in sleep patterns, but no goals identified. In RR #6, patient had orders for mechanical soft diet for a CVA patient, but no goal identified for aspiration precautions and in RR#7 patient had nausea 8/10 as identified in the Palliative scale and no goals for assessment or improvement of symptoms. This was discussed and validated with Assistant Director of Nursing and Administrator Observed in Record Review. The surveyor noted (ARR#10) that the plan of care goals on the initial plan of care did not include reasonable time frames for achieving outcomes. All goals were to be met at the end of the certification period. This was confirmed with the administrator.”

“Observed in Record Review. The surveyor noted (ARR#10) that there were no interventions to manage the goal: caregiver emotional challenges. The plan of care issue was identified; however, there were no intervention for assisting the caregiver to manage burnout and exhaustion as indicated in the assessment. There were no outcome expectation or time frames for managing the caregiver stress. The goal was to provide support throughout the benefit period. The frequency for the social worker was monthly, as it was for everyone. This was confirmed with the administrator. Observed in Record Review. In 5 of 12 patient records reviewed, The HCO failed to implement the plan of care to include all services needed for the palliation and management of the terminal illness and related conditions as seen in RRHV#2 the SN to prefill the medication box weekly was not on the plan of care. RRHV#2 when HHA was getting the patient out of bed to bathe, the surveyor observed a dressing on patients lt upper buttock, when asked the HHA stated that she would change the dressing following the patients shower, in record review there was no order for wound care. In RRHV#3 there was no instructions on the care plan as to who was administering the pre filled medication in the syringes. In RR#5 patient had a g-tube but there was no order for g-tube site care or what measures to take if g-tube falls out. RR#7 orders for oxygen was 3 liter’s via N/C continuous or PRN, no indication identified. This was discussed and validated with Assistant Director of Nursing and Administrator”

“Observed in Individual Tracer. In 5 of 12 patient records reviewed, The HCO failed to implement measurable outcomes anticipated from implementing and coordinating the plan of care as identified in record review. In RRHV#1 goals for pain was to remain at a tolerable level and no timeframe identified. RRHV#3 constipation was identified goal was for elimination needs to be at an acceptable level and the goal for the wound had an appropriate measure but not a reasonable time frame as documented: will decrease in size by 50% by end of cert. An additional goal identified in RR#3: anxiety but measure was to inform of reduced symptoms. In RR #9 initial plan of care, pain and dyspnea was identified as a symptom but time frames were for end of cert.This was discussed and validated with Assistant Director of Nursing and Administrator”

“Observed in Individual Tracer. In 3 of 3 home visits conducted, The HCO failed to implement the infection prevention and control activities: to perform hand hygiene consistent with policy as evidenced during HV #1 it was observed that the Chaplain did not perform hand hygiene during the home visit, minimally at start and end of visit. During HV#2 the HHA used a bar of soap that was in the bathroom, she turned off the faucet with her hands and did not have any paper towels to dry her hands. During HV#3 the RN did not use hand sanitizer when entering her medical bag after performing vital signs and assessment. This was validated with the Assistant Director of Nursing who was also present for both visits.”