Every finding on record at Kaiser Foundation Hospital Home Health - Hayward

The following reflects the findings of the California Department of Public Health during a Recertification survey conducted from 6/6/23 through 6/8/23. Representing the Department: Health Facilities Evaluator Nurses: 40638 and 32717 The unduplicated census was 2,408. Sample size was 17. There were two deficiencies. (See Tags G0578 and G1012).

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on interview and record review, for one of 17 sampled patients (Patient 14), the agency failed to ensure a blood draw (procedure of taking blood from a vein for laboratory testing) was performed per physician’s order. This failure had the potential to result in delayed treatment. Review of Patient 14’s Home Health Certification And Plan of Care indicated Patient 14 was admitted to home health services on 5/26/23 with diagnoses that included a fracture of the vertebra (backbone), hypertension (increased blood pressure) and thrombophilia (blood disorder that makes your blood more likely to from a clot). [Reference: https://medical-dictionary.com]. During a concurrent interview and record review with Registered Nurse (RN) 1, on 6/6/23 at 12 noon, RN 1 stated there was a supplemental order for a blood draw on 5/24/23 that was missed. RN 2 found out about the missed blood draw during a home visit on 5/29/31. Patient 14’s order dated 5/24/23 indicated for the agency to do a CBC (complete blood count that measures parts and features of your blood, including red blood cells, which carry oxygen and white blood cells) and Chem 7 (Chemistry 7 measures seven blood markers including sodium, potassium and glucose) in three days. Review of Patient 14’s Visit Notes dated 5/27/23 (three days after discharge from hospital) did not indicate any blood draws were done. Review of Patient 14’s Visit Notes dated 5/29/23 indicated, “Patient has referral order to repeat CBC and Chem 7 in 3 days upon discharge from hospital on 5/24/23 but we missed it." Review of the agency’s policy and procedure titled, “Physician/Authorizing Provider Participation in Plan of Care,” last reviewed 10/29/20, indicated care will be provided in compliance with the physician’s therapeutic and diagnostic orders.

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on interview and record review, for one of 17 sampled patients (Patient 13), the agency failed to ensure the wound assessments included the current pressure ulcer (bedsore) stage of development. This failure had the potential to result in the lack of coordination of care among clinicians. Review of Patient 13’s Home Health Certification And Plan of Care indicated Patient 13 was admitted to home health services on 1/11/23 with diagnoses that included pressure ulcer (areas of damaged skin caused by being in one position for too long, often on a bony prominence) on the right hip, right buttock and right heel. During a concurrent interview and record review with Registered Nurse (RN) 1, on 6/8/23 at 10:24 a.m., RN 1 stated wound assessments were done on 5/31/23 and 6/5/23, but did not indicate the pressure ulcer stage under the section for wound status. RN 1further stated that indicating the pressure ulcer stage should be a part of the wound assessment and documented in the clinical record. The policy and procedure titled, "Documenting Wounds,” last revised January 2023, indicated information that should be entered in the wound assessment included; dressing/closure status, exudate (drainage) odor, wound edge, surrounding skin, open wound bed appearance and pressure injury stage.