Aurora at Home

“Observed in Patient Home. In 2 of 4 Home visits conducted with medication reconciliation, During HOSRRHV# 1 and HOSRRHV# 4’s home observation and patient record review it was noted the organization had not ensured it assessed and reassessed its patients. For example: during HOSRRHV# 1’s home observation’s medication reconciliation it was noted the biscodyl supposities had expired in May 2025. During HOSRRHV# 6’s home observation the RN completed a medication reconciliation with the Skilled Nursing Facility (SNF) that revealed Oxycodone immediate release 100mg/ml 30ml was not present on the current month’s medication administration record and not present in the narcotic drawer. The organization Leadership was notified and it was determined the Oxycodone had been delivered to the SNF on July 30th and the SNF was investigating why the medication did not make it to the medication cart narcotic box. Review of four Skilled Nurse visits completed after the mediation was ordered revealed documentation that the medications were reviewed and no issues noted. This was observed, discussed, and validated with the RN and the Clinical Manager and reviewed, discussed, and validated with the Director of Education and Clinical Practice.”

“Observed in Record Review. In 23 of 26 patient records reviewed, During 23/26 patient records reviewed it was noted the organization had not ensured the written plan of care was based on the patient’s goals. For example: review of the 23/26 patient records revealed the pain goal Patient will remain at or below the patient’s identified pain goal with no documentation of what the identified pain goal was. Review of 23/26 patient records revealed documentation of patient identified pain goals from 0/10 to 4/10 or with no documented pain goal due to the patient being unable to verbalize a pain goal. This was reviewed, discussed and validated with the Director of Education and Clinical Practice.”

“Observed in Record Review. In 23 of 26 patient records reviewed, During 23/26 patient records reviewed it was noted the organization used standing orders that were not consistent with assessed clinical needs. For example: review of 23/26 patient records revealed the same as needed interventions to include a Macy catheter for rectal administration of medication, an indwelling urinary catheter with a size range of 14-18 Fr., and oxygen 1-5 lpm as needed for patient comfort. Review of HOSRRHV# 1’s start of care plan of care dated approximately 7 months prior to the surveyor review of the record and recertification plans of care included the intervention of a Macy Catheter as needed for rectal administration of medications when the patient was no longer able to swallow. Review of HOSRRHV# 1’s patient record revealed no documentation HOSRRHV# 1 was unable to take medications orally. Further review of the start of are plan of care and recertification plans of care revealed the intervention for an indwelling urinary catheter prn with a size range of 14-18 Fr, and oxygen 1-5 lpm as needed and with documentation of oxygen 1-5 lpm as needed on the medication profile. Review of HOSRRHV# 2’s start of care plan of care dated approximately 17 months prior to the surveyor review of the record and subsequent recertification plans of care revealed the intervention of a Macy Catheter as needed for rectal administration of medications and indwelling urinary catheter prn with a size range of 14-18 Fr., and oxygen 1-5 lpm as needed for patient comfort with no oxygen in the home. This was reviewed, and discussed and validated with the Director of Education and Clinical Practice.”

“Observed in Record Review. In 2 of 26 patient records reviewed, During HOSRRHV# 2 and HOSRRHV# 3’s patient records review it was noted the organization had not ensured the registered nurse prepared complete patient care instructions for the hospice aide. For example: review of HOSRRHV# 2’s plan of care revealed the hospice aide patient written care instructions with the task of indwelling catheter care beginning at the start of care approximately 15 months prior to the surveyor review of the record. Further review of HOSRRHV# 2’s patient record revealed HOSRRHV# 2 did not have an indwelling catheter at start of care and an indwelling catheter had not been implemented. In addition, the plan of care has the interventions for the SN or Hospice aide to apply zinc to the peri-area and tubi-grips to the bilateral lower extremities, however, the hospice aide written instructions did not have this tasks and the hospice aide was observed providing those tasks during the home observation. Review of HOSRRHV# 3’s hospice aide patient written care instructions revealed the task of applying a condom catheter at night and PRN as needed and the task of caring for the condom catheter. However, there were not specific directions as to determine PRN by the hospice aide. This was reviewed, discussed, and validated with the Director of Education and Clinical Practice.”

“Observed in Patient Home. In 3 of 4 Home visits conducted with medication reconciliation, During HOSRRHV# 4, HOSRRHV# 5, AND HOSRRHV# 6’s home observation it was noted the organization had not ensured the patient record contained information that reflected the patient’s care, treatment, or services. For example: during HOSRRHV# 4’s medication reconciliation it was noted on the Skilled Nursing Facility (SNF) medication administration record (MAR) the HOSRRHV# 4 was taking Lasix 40mg tablet, one tablet three times a week. However, the organization medication profile had Lasix 20mg tablet, take one tablet three times a week. During HOSRRHV# 5’s home observation review of the SNF MAR revealed acetaminophen 500mg tablet take 1,000 mg three times a day. However, the organization’s medication profile revealed acetaminophen 500mg take 1,000mg every 6 hours for pain. During HOSRRHV# 6’s home observation it was noted HOSRRHV# 6 was taking Rosuvastatin 40 mg daily for approximately the last nine months per HOSRRHV# 6. However, review of HOSRRHV# 6’s medication profile revealed no documentation of Rosuvastatin. This was observed, discussed, and validated with the Clinical Manager.”