QA Investigation Results

Pennsylvania Department of Health
CONSTELLATION HOSPICE PA, LLC
Health Inspection Results
CONSTELLATION HOSPICE PA, LLC
Health Inspection Results For:


There are  9 surveys for this facility. Please select a date to view the survey results.

Surveys don't appear on this website until at least 41 days have elapsed since the exit date of the survey.



Initial Comments:


Based on the findings of an onsite unannounced state re-licensure survey conducted on May 1, 2024 through May 3, 2024 and concluded on May 6, 2024, Constellation Hospice of PA, LLC was found to be in compliance with the requirements of 42 CFR, Part 418.113,Subpart D, Conditions of Participation: Hospice Care-Emergency Preparedness.





Plan of Correction:




Initial Comments:


Based on the findings of an onsite unannounced state re-licensure survey conducted on May 1, 2024 through May 3, 2024 and concluded on May 6, 2024, Constellation Hospice of PA, LLC was found not to be in compliance with the requirements of 42 CFR, Part 418, Subparts A, C, and D, Conditions of Participation: Hospice Care.






Plan of Correction:




418.64(b)(1) STANDARD
NURSING SERVICES

Name - Component - 00
§418.64(b) Standard: Nursing services

§418.64(b)(1) The hospice must provide nursing care and services by or under the supervision of a registered nurse. Nursing services must ensure that the nursing needs of the patient are met as identified in the patient’s initial assessment, comprehensive assessment, and updated assessments.

Observations:

Based on review of agency policies, clinical record (CR), and staff interviews the hospice nurses failed to ensure the nursing needs of the patient were met for four (4) of nineteen (19) clinical records reviewed (CR# 4, 6, 8 & 9).

Findings included:

Review of agency policy was conducted on May 6, 2024 at approximately 12:00 PM and revealed the following.

Review of agency policy titled, "Ongoing Assessments" stated, "During each home visit, the case manager or other discipline will evaluate the patient according to the problems identified during the initial assessment and thereafter the comprehensive assessment. The nurse will assessment each patient on each visit for: pain..., secondary symptoms related to the terminal illness..., factors that alleviate or exacerbate physical symptoms, current treatment related to the identified symptoms and the patient's response, vital signs appropriate for the patient's condition, breath sounds, skin integrity, bowel sounds, elimination, mental status...nutritional status, functional status and safety/home environment."

Review of agency document titled, "Job Title/Position: Licensed Practical Nurse (also known as LPN)" stated, "Licensed practical nurse is responsible for providing direct patient care under the direction and supervision of a registered nurse. These services include visits or continuous care. Responsibilities include following the plan of care established by physician...Essential job responsibilities: assess and provide patient and family/caregiver education and information pertinent to diagnosis and plan of care..."


A review of clinical records was conducted on May 1, 2024 at approximately 1:00PM, May 2, 2024 at approximately 9:30 AM . and May 6, 2024 at approximately 9:30 AM and revealed the following:


CR# 4. Start of Care: 4/2/2024. The certification period reviewed: 4/2/2024-6/30/2024. Orders included the following for Skilled Nursing (SN): once weekly for one week then one to two times weekly for 11 weeks and 6 PRN (as needed) visits. Hospice plan of care for the certification period from 4/2/2024-6/30/2024 stated, "SN (skilled nurse) to assess for cognitive status...speech and communication deficits...urinary function...monitor vital signs..safety: fall precautions..."

The patient's primary diagnosis was cerebral atherosclerosis (a disease that occurs when the arteries in the brain become hard, thick, and narrow due to the buildup of plaque (fatty deposits) inside the artery walls). Skilled Nursing documentation by LPN (PF #2) for a LPN revisit on 4/24/2024 contained no Nursing Assessments for the following areas: HEENT (head, ears, eyes, nose, and throat examination), Pressure Ulcer risk assessment, Cardiovascular, Endocrine/Metabolic, Emotional/Behavioral, Functional assessment and Fall risk assessment.

CR# 6. Start of Care: 1/25/2024. The certification period reviewed: 4/24/2024-7/22/2024. Orders included the following for Skilled Nursing (SN): once weekly for one week, then one to two times weekly for 12 weeks, and 6 PRN (as needed) visits. Hospice plan of care for the certification period from 4/24/2024-7/22/2024 stated, "SN (skilled nurse) assess for: behavioral disturbances... signs/symptoms skin infection...overall condition of lips, mouth and oropharnyx...respiratory status, skin integrity..."

The patient's primary diagnosis was cerebral atherosclerosis (a disease that occurs when the arteries in the brain become hard, thick, and narrow due to the buildup of plaque (fatty deposits) inside the artery walls). Skilled Nursing documentation by LPN (PF #2) for a LPN revisit on 4/29/2024 contained no Nursing Assessments for the following areas: HEENT (head, ears, eyes, nose, and throat examination), Pressure Ulcer risk assessment, Endocrine/Metabolic, Emotional/Behavioral, Functional assessment, and Fall risk assessment.

CR# 8. Start of Care: 3/16/24. The certification period reviewed: 3/16/2024-6/13/2024. Orders included the following for Skilled Nursing (SN): one to two times per week for 13 weeks and 6 PRN (as needed) visits. Hospice plan of care for the certification period from 3/16/2024-6/13/2024 stated, "SN (skilled nurse) to assess for cognitive limitations, impairments, behavioral disturbances, mobility impairment..."

The patient's primary diagnosis was senile degeneration of brain (mental deterioration (loss of intellectual ability) that is associated with or the characteristics of old age) not elsewhere classified. Skilled Nursing documentation by LPN (PF #2) for a LPN revisit on 4/23/2024 contained no Nursing Assessments for the following areas: HEENT (head, ears, eyes, nose, and throat examination), Pressure Ulcer risk assessment, Endocrine/Metabolic, Emotional/Behavioral, Functional assessment, and Fall risk assessment. Skilled Nursing documentation by LPN (PF #2) for a LPN revisit on 4/26/2024 contained no Nursing Assessments for the following areas: HEENT (head, ears, eyes, nose, and throat examination), Integumentary (skin) assessment, Pressure Ulcer risk assessment, Endocrine/Metabolic, Emotional/Behavioral, Functional assessment, and Fall risk assessment.


CR#9. Start of Care: 2/3/2024. The certification period reviewed: 4/3/24-6/1/24. Orders included the following for Skilled Nursing (SN): once weekly for one week then one to two times weekly for 8 weeks and 6 PRN (as needed) visits. Hospice plan of care for the certification period from 4/3/2024-6/1/2024 stated, "SN (skilled nurse) to assess for musculoskeletal deficits...neurosensory deficits...mental status/orientation, musculoskeletal status...overall condition of skin...functional status...risk for falls..."

The patient's primary diagnosis was senile degeneration of brain (mental deterioration (loss of intellectual ability) that is associated with or the characteristics of old age) not elsewhere classified. Skilled Nursing documentation by LPN (PF #2) for a LPN revisit on 4/12/24 contained no Nursing Assessment for the following areas: HEENT (head, ears, eyes, nose, and throat examination), Pressure Ulcer risk assessment, Endocrine/Metabolic, Emotional/Behavioral, Functional assessment and Fall risk assessment.



Interview with administator on May 6, 2024 at approximatley 2:00 PM confirmed above findings.








Plan of Correction:

Mandatory Staff Education with review of Comprehensive, Initial and Ongoing policy, including hospice documentation will be completed on or before 06/3/2024. Administrator will conduct 10% patient chart audit reviews for accurate & complete documentation of nursing visits including comprehensive, initial and ongoing nursing visits until 100% accuracy has been reached.


Initial Comments:


Based on the findings of an onsite unannounced state re-licensure survey conducted on May 1, 2024 through May 3, 2024 and concluded on May 6, 2024 , Constellation Hospice Pa, LLC., was found to be in compliance with the requirements of 28 Pa. Code, Health Facilities, Part IV, Chapter 51, Subpart A.





Plan of Correction:




Initial Comments:


Based on the findings of an onsite unannounced state re-licensure survey conducted on May 1, 2024 through May 3, 2024 and concluded on May 6, 2024, Constellation Hospice of PA, LLC was found to be in compliance with the requirements of 35 P.S. 448.809 (b).





Plan of Correction: