Accent Care Hospice and Palliative Care of WI

“Observed in Record Review. On 2 of 16 active patient records reviewed, wound assessments were not completed per policy. Agency wound assessment policy states that wounds will be assessed at least once per week. On RRNHV #9 it was noted that patient had multiple wounds that were not being assessed weekly per policy. In particular a heel wound that was not assessed weekly over a 2-month period. On RRNHV #10 it was noted on admit nearly 2 months ago that patient had a wound but there has been no assessment since day two on service. This issue was discussed was discussed with Hospice leaders.”

“Observed in Record Review. In 3 of 16 active patient records reviewed, the organization did not ensure the care and services necessary to meet the needs identified in the comprehensive assessment were specified on the patient’s plan of care. For example, RRHV #1, it was noted that the comprehensive assessment identified that the patient was at risk for skin breakdown and had recent pressure ulcers but the patient’s plan of care did not include goals and interventions to maintain the integrity of the skin. On RRIP #2, it was noted that the patient had been started on methadone but no goals developed for this medication. On RRNHV #6, it was noted that patient is incontinent using incontinent briefs but there was not goals addressing the incontinence or the skin breakdown risk associated with incontinence. This was reviewed with hospice leadership.”

“Observed in Record Review. In 8 of 16 active patient records reviewed, the hospice nurse surveyor noted medication orders were not clear and accurate. On RRHV # 1 and RRHV #4, it was noted that the plan of cares had duplicate PRN constipation drugs of Senna and Bisacodyl with no indication when to use duplicate therapy. On RRHV #2 and RRNHV #7 it was noted that the plan of cares had duplicate PRN constipation drugs of Milk of Magnesia and Bisacodyl with no indication of how to handle each duplicate therapy. On RRHV #3 it was noted that the plan of care had duplicate PRN constipation drugs of Milk of Magnesia, docusate and Bisacodyl with no indication of how to handle each duplicate therapy. On RRNHV #1, it was noted that patient had multiple PRN pain medications of Morphine, Oxycodone, and extra strength Tylenol with no indication how to handle duplicate therapy. On RRNHV #4, it was noted that patient had multiple PRN constipation medications of Magnesium Hydroxide and Bisacodyl with no indication when to use the duplicate therapy. On RRNHV #5, it was noted that patient had multiple PRN pain medications of Morphine, Tylenol supp and Tylenol PO with no indication how to handle duplicate therapy. This finding was discussed with Hospice leadership.”

“Observed in Record Review. In 2 of 16 active patient records reviewed, the plan of care did not include medical supplies and appliances necessary to meet the patient’s needs. On RRHV #2, it was noted that the plan of care did not include all equipment need to care for the patient including the walker, wheelchair and hospital bed. On RRHV #3 it was noted that the plan of care did not include all equipment needed to care for the patient including, air mattress, hospital bed, and Hoyer lift. This finding was reviewed with Hospice leadership.”

“Observed in Record Review. In 2 out of 4 home visits conducted that had ordered aide services, the Aide Care Plan did not have specific instructions for the aide. During the home visit for RRHV #1, the assigned tasks did not include specific instructions for care of the patient. For example, the patient is bedbound and told me that when the aide comes she is placed in a Hoyer lift to transfer. In addition patient states that she is transferred from bed to a chair but there was no instructions for this on the aide plan of care. On RRHV #3 it was noted that the patient was incontinent and the aide is using incontinence briefs and this should be noted on the aide plan of care. This finding was reviewed with Hospice leadership. .”

“Observed in Building Tour. It was observed above the ceiling outside the soiled utility room that there were several data cables supported by the fire main piping. This was verified by the Director of Plant Operations. This finding was observed during survey activity, but corrected onsite prior to the surveyor’s departure. The corrective action taken needs to be included in the organization’s Evidence of Standards Compliance submission. Observed in Building Tour. It was observed in the med room which was one hour rated that there was an unsealed penetration in the fire barrier. This was verified by the Director of Plant Operations. This finding was observed during survey activity, but corrected onsite prior to the surveyor’s departure. The corrective action taken needs to be included in the organization’s Evidence of Standards Compliance submission. Observed in Building Tour. It was observed that the Hospice med room was one hour rated and the door label fire rating had been painted over and could not be read. This was verified by the Director of Plant Operations. The surveyor discussed the Life Safety deficiency with the organization, and it was determined that the following ILSMs will be implemented until the deficiency has been resolved and according to the organization’s ILSM policy: Observed in Building Tour. It was observed that the fire pump room door which was in a one hour fire barrier did not have a fire rating label. This was verified by the Director of Plant Operations. The surveyor discussed the Life Safety deficiency with the organization, and it was determined that the following ILSMs will be implemented until the deficiency has been resolved and according to the organization’s ILSM policy: Observed in Building Tour. It was observed in the kitchen that the gas cooking equipment was equipped with tethers, but they had been disconnected. This was verified by the Director of Plant Operations. The surveyor discussed the Life Safety deficiency with the organization, and it was determined that the following ILSMs will be implemented until the deficiency has been resolved and according to the organization’s ILSM policy:”