Every finding on record at 7 Angeles Hospice Inc.

Upon patient record review, 5 of 5 (Patient 1,2,3,4,5) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient 1-5: Imminence of death is not documented in the comprehensive assessment as the admitting nurse did not complete this area on admission form.

Upon personnel record review, 1 of 13 (Personnel 9 ) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel 9: Personnel file for aide (CHHA) did not contain evidence of competency being done with a patient or pseudo- patient. All skills were marked off as "verbal" as the method of competency validation by the DPCS/Admin.

Upon patient record review, 1 of 5 (Patient #2) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: Patient #2: The medication profile contains Novolog Flexpen 100units/ml inject 10 units daily. The POC contains order that the injection is 3 times daily. Corrected on site.

Upon patient record review, 2 of 5 (Patient #2,3) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. Patient #2: The POC contains a diagnosis of Type II Diabetes, Pt is on insulin 3 times a day and there is no evidence of an endocrine care plan. Patient #3: The comprehensive assessment 9-21-22 contains a pain assessment that patient is having aching pain to their back causing grimacing and guarding, rates 3/10 and the worst it gets is 6/10. Acceptable pain level is 0-1. The next SN visit on 9-28-22 contains a pain assessment that the nurse documents patient is having aching pain to their back and both knees causing grimacing and guarding, patient rating 3-4/10, relieved to a 0 after med/Tx. Missing evidence interventions and goals for pain.

Upon patient client record review, 4 of 5 (Patient #1,2,3,5) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Patient #1: The clinical note on 9-27-22 contains a pain assessment that the nurse documents patient has back, bilateral knee intermittent pain rating 3-4/10. The nurse then documents pain is relieved to a 0/10 using med/tx. The nurse then documents "No pain noted using abbey". Pt has dementia diagnosis and is documented at alert and oriented times 2 to person and place. The Abbey scale is for use in non-verbal dementia patients. Patient #2: The comprehensive assessment on 9-30-22 contains documentation by the nurse "Insulin dose frequency, Novolog flex pen 10 units daily." The dose is incorrect per the POC which states insulin is given 3 times a day. The RN documents in the comprehensive assessment that patient's diabetes is oral controlled with metformin. There is no evidence patient is on metformin. Patient #3: The comprehensive assessment 9-21-22 contains a pain assessment that patient is having aching pain to their back causing grimacing and guarding, rates 3/10 and the worst it gets is 6/10. Acceptable pain level is 0-1. The next SN visit on 9-28-22 contains a pain assessment that the nurse documents patient is having aching pain to their back and both knees causing grimacing and guarding, patient rating 3-4/10, relieved to a 0 after med/Tx. "No pain noted using Abbey". Pt is alert and oriented to person and place. The Abbey scale is for use in non-verbal dementia patients. Patient #5: The IDG note on 5-20-22 contains documentation "Patient revoked today 5-23-20." Additionally, the clinical note on 5-17-22 contains a pain assessment that the nurse documents patient has abdominal pain rating 3-4/10. The nurse then documents pain is relieved to a 0/10 using med/tx. The nurse then documents "No pain noted using abbey". Pt has no dementia diagnosis and is documented at alert and oriented times 3. The Abbey scale is for use in non-verbal dementia patients.