Amor Hospice Care, Inc.

“Observed in Record Review. In 4 of 10 patient records reviewed, The organization failed to ensure the update to the comprehensive assessment and reflected plan of care consider changes that have taken place since the initial assessment and include information on the patient’s progress toward desired outcomes and reassessment of the patient response to care. In RRHV#2, RRNHV#9 and RRNHV#10 there was a noted lack of documentation of the patient’s progress toward goals as the plan of care remained the IDG to IDG with no progress toward goals over a 6 month or greater period of time. In RRNHV#7 the lack of documentation of progress to goals was noted over a three month period of time. These observations were reviewed with the DPCS and Administrator.”

“Observed in Record Review. In 3 of 10 patient records reviewed, The organization failed to ensure the plan of care goals were specific, measurable, and time-bound. For example: in RRHV#1 there were goals that were not measurable such as: patient will decrease signs and symptoms of anxiety for the next 2 weeks. In RRHV#3 there were goals such as minimize loss of ROM and patient will minimize episodes of confusion ad alteration of mental status. In RRNHV#6 an example was facilitate bowel elimination and prevent occurrence of constipation. These observations were reviewed with the DPCS and Administrator.”

“Observed in Record Review. In 6 of 10 patient records reviewed, The organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRHV#2 the documentation noted the patient with vaginal itching and medication ordered yet there was not care plan to guide the care. In RRHV#3 the patient had a G-tube yet the tube and its care was not reflected on the care plan. In RRNHV#6 there were minimal care plans established and there was documentation issues with pain, presence of CPaP, documentation of continuous care for respiratory distress yet the issues were not reflected in the plan of care. In RRHV#3, RRNHV#4, RRNHV#6, RRNHV#7 and RRNHV#10 there was documentation that the patient was being seen by Spiritual Care and/or Social Worker yet there were no psychosocial and/or spiritual care plans to guide the care. These observations were reviewed with the DPCS and Administrator.”

“Observed in Patient Home. In 1 of 3 home visits conducted, the organization failed to implement the infection prevention and control activities as planned when cleaning and preforming disinfection of medical supplies and devices. On RRHV#3 home observation the Spiritual Counselor utilized a cell phone to play music for the patient where the phone was placed in the patient bed when music was playing and stored on the floor when not in use yet the clinician did not disinfect the device after use with the patient and returning to her car as required per policy for reusable equipment. This observation was reviewed with the DPCS.”

“Observed in HR File Review. In 2 of 2 HR files reviewed, for Hospice Aide, the organization failed to ensure the supervisor evaluate the required areas of: communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other staff - Reading and recording temperature, pulse, and respirations - Appropriate and safe techniques in personal hygiene and grooming that include bed, sponge, tub, or shower bath; sink, tub, or bed shampoo; nail and skin care; oral hygiene; toileting and elimination - Safe transfer techniques and ambulation - Normal range of motion and positioning, by observing the aide’s performance with a patient or pseudo-patient as part of a simulation. In HR#1 the initial aide competency was documented with an RN yet did not specify how the competency was accomplished but did note that it was not in the patient home setting. In HR#3 the initial aide competency noted that all skills were assessed verbally and not by observation. These observations were reviewed with the DPCS and Administrator.”

“Observed in Patient Home. In 2 of 10 patient records reviewed, the organization failed to ensure the hospice aide provide services ordered by the plan of care. In RRHV#2 from a visit in August the aide assignment did not include incontinence care yet documentation showed that incontinence care was provided. The POC noted a shower and shampoo yet the tasks were not documented as completed nor was there documentation that the task was refused. In RRNHV#10 the aide documentation noted hair care and skin care of apply deodorant and lotion was completed yet the tasks were not assigned. These observations were reviewed with the DPCS.”

“Observed in Record Review. In 1 of 2 patient records reviewed, or live discharge, the organization failed to ensure the discharge summary include all required elements and was provided to other health care professionals who were responsible for providing care and services. On review of RRDC#1 the patient revoked hospice services to seek treatment in the hospital for a g-tube that dislodged. The discharge summary documented the reason for revocation yet lacked the other required elements of: a summary of care, treatment, or services it provided to the patient - The patient’s progress toward goals - A list of community resources or referrals made or provided to the patient. There was also no documentation that the summary of care was offered to the hospital staff receiving the patient. This observation was reviewed with the DPCS.”