Harbor Hospice of South Texas LP

“Observed in Patient Home. In 1 of 1 home visits conducted, the organization failed to maintain a medical record that reflected the patient’s care, treatment, or services. During RRHV#1, the medication profile in the electronic medical record (EMR) had the following discrepancies: medications missing from the EMR list: Phenylephrine nasal spray, Advil PM, Aleve, Promethazine 25 mg tab every 4 hours as needed for nausea, Colace, Vitamin D3, B-12, and Magnesium. Medications that the patient was being administered differently than prescribed (for over a month per the patients wife): Metoprolol 25 mg and Lisinopril 20 mg as needed rather than daily, Janumet 50mg-1000 mg tab, taking 1 tab daily and not 1 tab twice daily, Trazodone 150mg stopped over 1 month ago and Senna 8.6. This was validated with the Director of Nursing present during the visit. 
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“Observed in Patient Home. In 1 of 3 home visits conducted, the organization failed to assess and reassess its patient’s. During a home visit for RRHV#3, the Hospice Nurse Surveyor observed a failed medication assessment. The LVN was asked to perform a medication reconciliation based on policy. He began to look at the bottles but had nothing to compare them to. The Surveyor suggested he check the EMR and he was able to pull it up on his phone. He continued by checking names of the medications but did not double check doses and routes. 

This was discussed and reviewed with the Director of Nursing.”

“Observed in Record Review. In 4 of 14 patient records reviewed, the organization failed to assess and reassess its patient’s. During record review for RRHV#1, RRHV#2, and RRNHV#1, the Hospice Nurse Surveyor observed the assessments not completed as required. 

For example in RRHV#1, the RN did not complete a comprehensive assessment at least every 15 days. During the month of October there was an 18 day period with no RN assessment. 

In RRHV#2, the patient had RN comprehensive assessment dates that were 16 days apart. 


For example in RRNHV#1, the RN did not complete a comprehensive assessment at least every 15 days. During the month of October there was an 16 day period with no RN assessment. 
This was discussed and reviewed with the Director of Nursing.”

“Observed in Record Review. In 5 of 14 patient records reviewed, the organization failed to maintain a complete and accurate patient record. During record review for RRHV#1, RRHV#3, RRNHV#1, RRNHV#2 and RRNHV#5, the Hospice Nurse Surveyor observed inaccurate or confusing documentation. 

For example RRHV#1 had the IDG meeting held on 11/15 and all staff signed off on that date. But the documentation in the IDG showed information of the patient’s bowel movements and newly ordered Lorazepam on 11/25. 

For RRHV#3, the IDG meeting was held on 11/27 and staff signed off on that date. The documentation in the IDG showed information about the patient’s bowel movements for 11/30. 

In RRNHV#1, the IDG meeting was held on 11/15 and staff signed off on that date. The documentation in the IDG showed information about new medication, bowel movement status and PPS for 11/19. 

In RRNHV#2, the IDG meeting was held 12/30/22 and staff signed off on that date. The documentation in the IDG showed information about PPS and bowel movements through 4/10/23. This occurred on several IDG’s for this patient. 

In RRNHV#5, the patient revoked 13 days prior to IDG. The IDG notes stated discharge but the narrative for IDG supported that the patient was still on service. There was no documentation of the patient revoking for continued treatment. 

This was discussed and reviewed with the Director of Nursing.”

“Observed in Record Review. the organization failed to plan the patient’s care. During record review for RRHV#3, the Hospice Nurse Surveyor observed the plan of care was not based on the patient’s goals, time frames, settings or services required. 

For example in RRHV#3, the patient had been tested for a UTI 3 weeks prior to survey and goals had been placed on his Plan of Care. The goals were not resolved or removed when the test came back negative and the patient was no longer on an antibiotic. 

This was discussed and reviewed with the Director of Nursing.”

“Observed in Record Review. In 4 of 14 patient records reviewed, the organization failed to plan the patients care. During record review for RRHV#1, RRHV#2, RRNHV#1, and RRDC#1,the Hospice Nurse Surveyor observed the plan of care did not contain all needed elements. 

For example in RRHV#1, the patient was struggling with pain, constipation, anxiety, and two recent falls but these were not addressed on the plan of care. 

In RRHV#2, the patient had multiple wounds with the only orders stating use Dakins for wound cleanser, let dry and cover with non-adherent dressing. The order did not state which wound this was for. And the nurse was documenting that the caregiver was utilizing betadine and meta-honey for wound care. Also the Plan Of Care did not contain details about the wound care to be provided but the nurse was documenting wound care per plan of care. The SN was also documenting that family was using Zinc-Oxide on redness to the coccyx but there were no orders for this treatment. 

In RRNHV#1, the SN documented edema on several occasions but it was not addressed on the POC. 

In RRDC#1, the patient was struggling with restlessness and sleep disturbance but these were not addressed on the POC. 

This was discussed and reviewed with the Director of Nursing. 

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“Observed in Tracer Activities. The organization failed to document a quality assessment and performance improvement program that demonstrated improvement in the indicators related to improved palliative outcomes and hospice services. There was a corporate wide QAPI plan in place but locally there was no documentation of engagement or implementation of the plan. The hospice surveyor noted the QAPI program did not demonstrate improvement in its palliative outcomes and hospice services as evidenced by the HCO was not able to provide documentation at the time of survey.

This was discussed and reviewed with the Director of Nursing.”

“Observed in Tracer Activities. The organization failed to document that it compiled and analyzed data. During tracer activities for Data Management, the Hospice Nurse Surveyor observed the organization was unable to provide data for 2022 and 2023. And the data collected for the current year was not compiled and compared. 

This was discussed and reviewed with the Director of Nursing. Observed in Tracer Activities. The organization failed to document that it compiled and analyzed data. During tracer activities for Data Management, the Hospice Nurse Surveyor observed the organization was unable to provide data for 2022 and 2023. And the data collected for the current year was not compiled and compared in order to identify improvement opportunities. 

This was discussed and reviewed with the Director of Nursing.”

“Observed in Record Review. In 4 of 5 patient records reviewed, with aide services, the organization failed to supervise effectively. During record review for RRHV#1, RRHV#3, RRNHV#1, and RRNHV#7, the Hospice Nurse Surveyor observed supervision did not take place as required. 

For example in RRHV#1, between the time the patient started aide services and the first supervision was 17 days. The next two supervision visit were completed in 20 day increment not completed every 14 days as required.

In RRHV#3, there were two time periods with extended aide supervision beyond 14 days. 

In RRNHV#1, the patient had 17 days between aide supervision. 

In RRNHV#7, the patient had home health services 3 times over the course of 21 days and there was no documentation of supervision during that time period. 

This was discussed and reviewed with the Director of Nursing.”

“Observed in Patient Home. In 1 of 3 home visits conducted, the organization failed to maintain a medical record that reflected the patient’s care, treatment, or services. During a home visit for RRHV#3, the Hospice Nurse Surveyor observed the LVN do a medication reconciliation. The bottles of medications in the home that the patient was currently taking was not correctly reflected on the medication list in the electronic medical record. The patient was taking Vitamin D3 and B-Complex but these were not on the medical record. The patient had a course of antibiotics the month prior to survey which were completed but it was not removed from the medication list. 

This was discussed and reviewed with the Director of Nursing.”

“Observed in Record Review. In 4 of 4 patient records reviewed, patients who revoked or discharged, the organization failed to send the provider a discharge summary. During record review for RRNHV#4, RRNHV#5, RRDC#1, and RRDC#2, the organization did not follow the required process for discharge. In RRNHV#4, the patient was discharged for extended prognosis but there was no documentation that the discharge summary was sent to the provider. The daughter had not decided on which provider at their office to go with but had decided on a certain provider office. There was no collaboration documented. In RRNHV#5, the patient revoked hospice services one day into her certification so she could continue chemotherapy. There was no collaboration or documentation that a discharge summary was provided to the primary care provider, as required by organizational policy. In RRDC#1, the patient revoked hospice services to seek aggressive treatment, revocation was signed but documentation of a discharge summary being sent did not occur. In RRDC#2, the patient revoked hospice services to seek aggressive treatment, revocation was signed but documentation of a discharge summary being sent did not occur. This was discussed and reviewed with the Director of Nursing.”