Every finding on record at Abc Hospice Care, Inc

Based on interviews and record reviews, the hospice agency (HA) failed to follow their own policy on rights and responsibilities to inform patients representatives of any changes in the plan of care for three out of eight sampled patients (Patient 6, 8 and 10). This deficient practice had the potential for misinformation, misunderstanding and miscommunication for Patient's 6, 8 and 9's plan of care and services rendered. Findings: a. A review of Patient 6's face sheet indicated Patient 6, an 78-year-old female, with a start of care (SOC) of 2/6/202, a certification period on 6/5/2022 to 8/3/2022 was admitted with a medical diagnoses including Alzheimer's disease (is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life) and chronic pain syndrome (when people have symptoms beyond pain alone, like depression and anxiety, which interfere with their daily lives). A review of Patient 6's Plan of Care (POC) dated 7/27/2022 indicated the patient has self-care deficits (inability to perform toileting, transferring from bed to chair, dressing, feeding and bathing), is a fall risk, and impaired skin integrity due to decrease in mobility. Patient 6's KPS (Karnofsky Performance Scale is an assessment tool for predicting of length of survival in terminally ill patients) of 40 percent which means unable to care for self; requires equivalent of institutional or hospital care; disease may be progressing rapidly; requires special care and assistance. A PPS (Palliative Performance Scale is an assessment tool to assess patients' functional status and collaboratively establish palliative care plans) of 50 percent indicating patient mainly sits/lies in bed, unable to do any work and shows extensive disease. Registered Nurse visits every 28 days for LVN and every 14 days for home health aide (HHA) and update on comprehensive assessment every 14 days before interdisciplinary group (IDG) meeting. Licensed Vocational Nurse (LVN) visit once a week, HHA visits twice per week, chaplain visit once a month and as needed. During a phone interview on 7/28/2022 at 12;36 p.m., with Patient 6's DPOA (Durable Power of Attorney- is a document that authorizes your agent (a person you choose) to manage your financial affairs if you become unable (or unwilling) to manage them yourself.), when he was asked if he was informed of the patients' rights and responsibilities by the HA, the DPOA stated, "They didn't really tell me much of anything. I received an email from one of their staff saying, "Hi, please sign this paper and send it back to me." DPOA further stated, "They didn't even introduce themselves; they just sent the forms to me. I asked them several times and they don't really communicate." DPOA also stated "There was no discussion that the prognosis was 6 months or less." During a phone interview on 7/28/2022 at 2:23 p.m., the Clinical Manager (CM) stated, "there is communication with the DPOA through email and he replies when he can. CM stated the HA sends DPOA a message when emergency and he calls or replies to the message is sent. CM also confirmed that consent forms were sent to DPOA through email and was sent back to the HA. b. During a review of Patient 8's face sheet indicated the patient is a 97-year-old male with an SOC of 2/9/2022 with a certification period on 5/10/2022 to 8/7/2022 with medical diagnoses including heart failure (is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body's needs for blood) and hypertension (A condition in which the force of the blood against the artery walls is too high). A review of Patient 8's Plan of Care (POC) dated 7/28/2022 indicated the patient has self-care deficits (inability to perform toileting, transferring from bed to chair, dressing, feeding and bathing), is a fall risk and had periods of restlessness and agitation. Patient 8's KPS (Karnofsky Performance Scale is an assessment tool for predicting of length of survival in terminally ill patients) of 40 percent which means unable to care for self; requires equivalent of institutional or hospital care; disease may be progressing rapidly; requires special care and assistance. A PPS (Palliative Performance Scale is an assessment tool to assess patients' functional status and collaboratively establish palliative care plans) of 40 percent indicating patient is mainly in bed, requires complete assistance, unable to do work, confused and extensive disease progression. Skilled Nurse visits twice a week, supervisory visits every 28th day for SN and every 14 days for home health aide (HHA) and update on comprehensive assessment every 14 days before IDG (Interdisciplinary group) meeting and HHA visits twice per week. During a phone interview with Patient 8's DPOA on 7/29/2022 at 9:50 a.m., DPOA stated "No one called me when they extended hospice care. It was the board and care that I was in constant communication with. They keep me in the loop with everything." c. During a review of Patient 10's face sheet indicated patient is an 93-year-old female with an SOC of 2/23/2022 with a certification period on 5/24/2022 to 8/21/2022 with a medical diagnosis of Alzheimer's disease (is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life) and chronic pain syndrome (when people have symptoms beyond pain alone, like depression and anxiety, which interfere with their daily lives). A review of Patient 10's Plan of Care (POC) dated 7/27/2022 indicated that patient has self-care deficits (inability to perform toileting, transferring from bed to chair, dressing, feeding, and bathing), is a fall risk, impaired skin integrity due to decrease in mobility. Patient 6's KPS (Karnofsky Performance Scale is an assessment tool for predicting of length of survival in terminally ill patients) of 40 percent which means unable to care for self; requires equivalent of institutional or hospital care; disease may be progressing rapidly; requires special care and assistance. A PPS (Palliative Performance Scale is an assessment tool to assess patients' functional status and collaboratively establish palliative care plans) of 40 percent indicating patient is mainly in bed, requires complete assistance, unable to do work, confused and extensive disease progression. Registered Nurse visits every 28 days for LVN and every 14 days for HHA and update on comprehensive assessment every 14 days before interdisciplinary group (IDG) meeting. Licensed Vocational (LVN) visit twice a week, home health aide (HHA) visit was declined. During a phone interview with the DPOA on 7/29/2022 at 9:00 a.m., DPOA stated, "No one called me for updates every time they extended her care. The communication with the HA isn't that great. I have never spoken to the hospice doctor, not even once. I had a total of 3 calls from them and I initiated it." During an interview with the CM on 8/1/2022 at 10:45 a.m., CM stated, "The nurses should call the family, communicate verbal or email for consents before they are admitted for hospice." A review of the communication logs for Patient 6, Patient 8 and Patient 10 indicated there was no documented evidence on the electronic medical records for any communication as to whom the staff spoke to, no date and no time recorded. A review of the HA's policy no. 1-001.1 titled, "Rights and Responsibilities" indicated to assist with fully understanding patients' rights and responsibilities, all policies are available to organization personnel, the patient, and his/her representatives as well as other organizations and the interested public. Patient and family/caregiver responsibilities will be explained upon admission and as needed. The patient and family/caregiver are responsible for: Providing accurate and complete information about the present complaints, past illnesses, hospitalizations, medications, changes in Advanced Directives and other matters relating to the patient's health. Remaining under a doctor's care while receiving hospice services. Being fully informed by a physician of his or her medical condition. Reporting unexpected changes in the patient's conditions. The patient's rights and responsibilities will be explained and distributed to the patient prior to the initiation of organization services. This explanation will be in a language that the patient and manager understand. When a patient's representative signs the patient's rights and responsibilities form, an explanation of that relationship must be documented and kept on file in the clinical record, including a copy of signed Durable Power of Attorney or legal guardianship.

Based on observation, interview, and record review, the hospice agency (HA) failed to conduct accurate comprehensive assessment for one of 7 sampled patients (Patient 6). This deficient practice had the potential for the delay in the progress of Patient 6's delivery of the plan of care. Findings: During a review of Patient 6's face sheet indicated patient is an 78-year-old female with a start of care (SOC) of 2/6/2021 with a certification period on 6/5/2022 to 8/3/2022 with a medical diagnosis of Alzheimer's disease (is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life) and chronic pain syndrome (when people have symptoms beyond pain alone, like depression and anxiety, which interfere with their daily lives). A review of Patient 6's Plan of Care (POC) dated 7/27/2022 indicated that patient has self-care deficits (inability to perform toileting, transferring from bed to chair, dressing, feeding and bathing), is a fall risk, impaired skin integrity due to decrease in mobility. Patient 6's KPS (Karnofsky Performance Scale is an assessment tool for predicting of length of survival in terminally ill patients) of 40 percent which means unable to care for self; requires equivalent of institutional or hospital care; disease may be progressing rapidly; requires special care and assistance. A PPS (Palliative Performance Scale is an assessment tool to assess patients' functional status and collaboratively establish palliative care plans) of 50 percent indicating patient mainly sits/lies in bed, unable to do any work and shows extensive disease. Registered Nurse visits every 28 days for LVN and every 14 days for HHA and update on comprehensive assessment every 14 days before interdisciplinary group (IDG) meeting. Licensed Vocational (LVN) visit once a week, home health aide (HHA) visits twice per week, chaplain visit once a month and as needed. A home visit was conducted on 7/28/2022 at 10:02 a.m., at Patient 6's Assisted Living facility with LVN. LVN stated he conducts his visits once a week at least every Monday. LVN initiated his visit. During observation on 7/28/2022 at 10:28 a.m., Patient 6 is calm and cooperative, awake, sitting on recliner, verbally responsive with "yes or no" answer. Not in any respiratory distress. LVN performed hand washing, reviewed medications, and assessed blood pressure, temperature, listened to patient's stomach, heart rate and lung sounds. LVN was not observed to do skin assessment. On concurrent interview, LVN stated "she does not have skin issues." During an interview with the Clinical Manager (CM) on 7/29/2022 at 2:23 p.m., stated that skilled nursing should perform head to toe assessments which include skin assessments every visit. A review of Patient 6's Plan of Care (POC) dated 7/27/2022 on Integumentary/Skin issue created on 2/6/2021 by Registered Nurse (RN) indicated the risk for impaired skin integrity related to immobility. Braden score (uses a scores from less than or equal to 9 to as high as 23. The lower the number, the higher the risk is for developing an acquired ulcer or injury. 19-23 = no risk. 15-18 = mild risk. 13-14 = moderate risk) is 13. A review of Patient 6's "MD Visit Note" dated 2/4/2022, 4/1/2022 and 6/3/2022 indicated Medical Director (MD) documented "The patient is a 78-year-old female with a PMH significant for advanced Alzheimer`s disease, major depressive disorder, insomnia, hypertension, history of sacral ulcer who is being re-evaluated for hospice care. The patient is unable to answer questions reliably and history is obtained from her caregiver. She has been having issues with her left leg around her knee being especially stiff. She has been having stiffness and causes issues at night sleeping. She is not on any muscle relaxants. She continues to decline cognitively and functionally and requires assistance on all ADL. Her decubitus ulcers have improved with repositioning and wound care. Clinical Findings Summary showed MD documentation of Sacral ulcer stage 2, significantly improved". During an interview with the CM on 7/29/2022 at 9:53 a.m., upon showing the MD face to face notes to the CM stated "No she does not have any wound, it must be a "typo." A review of the HA's policy no. 2-030.1 titled "Comprehensive Assessment" indicated during the comprehensive patient assessment, all baseline data and other relevant information will be documented in the patients clinical record including at least the following information, as relevant: A physical assessment, including blood pressure, temperature, pulse, respiration, skin and other relevant data related to pertinent physical findings and the patient's terminal illness. A review of the HA's policy no. 2-031.1 titled "Ongoing Comprehensive Assessments" indicated the nurse will assess the patient on each visit for: skin integrity.

Based on interview and record review, the hospice agency failed to ensure that all members of the Interdisciplinary Group (IDG) were in attendance for one of 11 patients (Patient 3) IDG meeting. This deficient practice resulted in the Chaplain not contributing to Patient 1's ongoing assessments and care planning process. Findings: A review of Patient 3's clinical record indicated a start of care date (SOC) of 06/13/2022, with diagnoses which included heart failure and atrial fibrillation (irregular, often rapid heart rate that commonly causes poor blood flow). A review of Patient 3's Plan of Care for the certification period of 06/13/2022 to 09/10/2022, indicated that a skilled nurse (SN) and Certified Home Health Aide (CHHA) are scheduled to visit patient two times per week and a Spiritual Counselor (SC) to visit on initial and as needed. A review of Patient 3's IDG note dated 07/07/2022, indicated that there was no signature that the Chaplain attended the meeting. During an interview with the Clinical Manager (CM) on 08/01/2022, at 3:40 p.m., she stated that the IDG meetings are attended by the Medical Director (MD), Registered Nurse (RN), Master of Social Worker (MSW) and Chaplain and they electronically sign to confirm attendance. CM confirmed that Patient 3's IDG meeting for 07/07/2022 did not have the Chaplains signature. A review of the agency's policy and procedure titled, "Interdisciplinary Group Meeting," dated 04/2014, indicated that the interdisciplinary group will meet on a regular basis to discuss patient and family/caregiver changes and progress and updates to the plan of care, deaths and changes in patient and family/caregiver circumstances, referrals, and admission/certification and recertification of patients on the hospice program. The policy and procedure further indicated that members of the interdisciplinary group meeting will sign an attendance form.

Based on observation, interview and record review, the hospice agency failed to ensure the Plan of Care (POC) was accurate and reflected the current status of the patients, for one of 11 patients (Patients 1). The deficient practice had the potential to result in an inconsistent assessment of the patient's status which could lead to inaccurate care. Findings: A review of Patient 1's clinical record indicated a start of care date (SOC) of 12/29//2021, with diagnoses which included heart disease and atrial fibrillation (irregular, often rapid heart rate that commonly causes poor blood flow). A review of Patient 1's Plan of Care for the certification period of 06/27/2022 to 08/25/2022, indicated that a skilled nurse (SN) and Certified Home Health Aide (CHHA) are scheduled to visit patient two times per week. Patient 1's POC further indicated that Integumentary/Skin goal is for patient's pressure ulcer (injuries to the skin and underlying tissue, primarily caused by prolonged pressure on the skin) on the left heel will resolve. On 07/28/2022, at 10:40 p.m., a joint home visit with Licensed Vocational Nurse (LVN 2) was conducted at the Board & Care (B&C) where Patient 1 resides. Patient 1 was observed lying in bed with siderails up. During an observation of LVN 2's skin assessment, it was observed that Patient 1's skin was intact and there was no pressure ulcer to the left heel. During an interview with the Clinical Manager (CM) on 08/02/2022, at 11:28 a.m., she stated Patient 1 had no wounds and that the POC was wrong. A review of the agency's policy and procedure titled, "The Plan of Care," dated 04/2014, indicated that a written individualized patient and family/caregiver plan of care will be established and maintained for each individual admitted to the hospice program. The policy and procedure further indicated that the plan of care will be based on the initial, comprehensive and ongoing comprehensive assessment performed by members of the interdisciplinary group and will be reviewed on a regular basis but no less than every fifteen (15) days.

Based on observation, interview and record review the hospice agency (HA) failed to ensure the Condition of Participation for Infection Control was met as follows: The agency failed to: 1. Develop its policy and procedures to ensure a mitigation (the act of reducing the severity, seriousness of something) process will be followed and implemented in regards to the spread of Coronavirus (COVID-19, a potentially severe respiratory illness caused by a coronavirus and characterized by fever, coughing, and shortness of breath) infection for the 20 staffs employed by the agency who provides care and services to the 39 patients under their care. (Refer to L579) 2. Provide guideline for the mitigation process of exposed (persons who were within six feet of someone who is showing symptoms of COVID-19, for at least 15 minutes, or an infected person who shows no symptoms but later tests positive for the coronavirus), symptomatic (a person who is infected with COVID-19 and has symptoms) and COVID-19 confirmed (tested positive for COVID) staffs and patients. (Refer to L579) 3. Provide a process to ensure standards of infection prevention and control practices are observed by staff to reduce the spread and transmission of COVID-19 virus. (Refer to L579) 4. Provide a process to screen employees for COVID-19 signs and symptoms (like fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, congestion or runny nose, nausea or vomiting diarrhea) of infection prior to reporting the office and prior to providing care and services to their 39 patients. (Refer to L579) 5. Ensure all employees providing direct patient care were fit tested (a test protocol conducted to verify that a respirator is both comfortable and provides the wearer with the expected protection) for N-95 mask, (a respiratory protective device designed to achieve a very close facial fit to form a seal around the nose and mouth to efficiently filter airborne particles). (Refer to L579) On 8/1/22, at 4:07 p.m., an Immediate Jeopardy (IJ, a situation in which the facility's non-compliance with one or more requirements of participation has caused, or is likely to cause serious injury, harm, impairment, or death to a patient) was identified in the presence of the hospice agency's Clinical Supervisor (CM) and Licensed Vocational Nurse (LVN) for the facility's failure to ensure policies and procedures on COVID-19 mitigation plan were developed and implemented including staff that was COVID-19 positive and was symptomatic was placed on isolation/quarantine and was not conducting visits at the patients' homes. On 8/3/22 at 2:08 p.m., in the presence of the CM and LVN, the IJ was removed after the hospice agency submitted an approved IJ removal plan. The survey team verified and confirmed during onsite, the implementation of the removal plan through record reviews and interviews. These deficient practice had the potential to spread COVID-19 infection to its employees, patients and families that could lead to severe respiratory illness, which could be life threatening and can result to prolonged hospitalization and/or death. The cumulative effect of these systemic problems resulted in an Immediate Jeopardy situation and the HA's inability to ensure the provision of a quality health care in a safe environment.

Based on observation, interview and record review, the hospice agency failed to: 1. Develop its policy and procedures to ensure a mitigation (the act of reducing the severity, seriousness of something) process will be followed and implemented in regards to the spread of Coronavirus (COVID-19, a potentially severe respiratory illness caused by a coronavirus and characterized by fever, coughing, and shortness of breath) infection, and ensure standards for infection prevention and control practices are observed to reduce the spread and transmission of COVID-19 virus for the hospice agency's 20 employees who provides care and services to the 39 patients who are under their care. 2. Provide guideline for the mitigation process for exposed (persons who were within six feet of someone who is showing symptoms of COVID-19, for at least 15 minutes, or an infected person who shows no symptoms but later tests positive for the coronavirus), symptomatic (a person who is infected with COVID-19 and has symptoms) and COVID-19 confirmed (tested positive for COVID-19) staff and patients. 3. Provide a process to screen employees for COVID-19 signs and symptoms (like fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, congestion or runny nose, nausea or vomiting diarrhea) of infection prior to reporting the office and prior to providing care and services to their 39 patients. 4. Ensure all employees providing direct patient care were fit tested (a test protocol conducted to verify that a respirator is both comfortable and provides the wearer with the expected protection) for N-95 mask, (a respiratory protective device designed to achieve a very close facial fit to form a seal around the nose and mouth to efficiently filter airborne particles). This deficient practice had the potential to spread COVID-19 infection to its employees, patients and families that could lead to severe respiratory illness, which could be life threatening and can result to prolonged hospitalization and/or death. On 8/1/22, at 4:07 p.m., an Immediate Jeopardy (IJ, a situation in which the facility's non-compliance with one or more requirements of participation has caused, or is likely to cause serious injury, harm, impairment, or death to a patient) was identified in the presence of the hospice agency's Clinical Supervisor (CM) and Licensed Vocational Nurse (LVN) for the facility's failure to ensure policies and procedures on COVID-19 mitigation plan were developed and implemented including staff that was COVID-19 positive and was symptomatic was placed on isolation/quarantine and was not conducting visits at the patients' homes. On 8/3/2022 at 2:08 p.m., the IJ was removed after the agency submitted an IJ Removal Plan in the presence of the CM and LVN. The survey team verified and confirmed during onsite, the implementation of the removal plan, through interviews and record review. The accepted IJ Removal Plan included the following actions: 1. An immediate review and tracking of staffs who were positive of COVID-19 and who were on quarantine and were not visiting patients. 2. The HA immediately started COVID-19 screening for field and office employees. 3. The HA initiated COVID-19 screening of staff and patients by providing antigen tests to exposed patients and staff. 4. The HA initiated an in-service to all staff via zoom (a meeting through video call) for COVID-19 testing and exposure. 5. Develop policies and procedures for employees who have contracted COVID-19, including testing, tracking of exposed staffs and or patients and documentation. Findings: A review of the agency's census during the recertification survey on 7/29/2022 indicated, the hospice agency (HA) was actively caring for 39 patients. During an observation on 7/27/2022 at 11:40 a.m., the agency had no process of screening for COVID -19 signs and symptoms for all its employees upon each arrival and entry at the agency and the employees were observed not wearing masks in the office. During an interview on 7/27/2022 at 12:26 p.m., the Clinical Manager stated the HA did not have a log for COVID-19 screening and that all 20 staff were 100 percent COVID-19 vaccinated (vaccines are used to prepare the body's immune system to protect against COVID-19) and did not require any further screening. During another observation on 8/1/2022 at 10:30 a.m., the agency had no screening process for employees and visitors at the entrance for COVID-19 symptoms. During an interview on 8/1/2022 at 12:02 p.m., the Administrator/Director of Patient Care Services (Admin/DPCS) stated he had been sick. Admin/DPCS stated that on 7/25/2022 and 7/26/2022, he tested positive in an antigen test (COVID-19 virus home test) and had COVID-19 symptoms on 7/23/2022 and 7/25/2022. Admin/ DPCS stated that on 7/25/2022, he performed supervisory visits [visits done by a Registered Nurse to ensure field workers' like home aides adhere to the plan of care (POC) and maintenance of acceptable quality standards of care] to Patient 9 and was not aware if Patient 9 and the board and care (home where patients needing care resides), where Patient 9 resides were notified of the exposure, and state, he also went to the board and care to do Supervisory visit for Patient 8. When asked, Admin/ DPCS stated, he was not aware about line listing (a table that contains key information about each case in an outbreak). During an interview on 8/1/2022 at 1:14 p.m., the CM and the Licensed Vocational Nurse (LVN) both stated the hospice agency did not have policies and procedures to follow for COVID-19 positive patients and employees, exposures, tracking, planning, screening and employees and patients testing. During an interview on 8/2/2022 at 12:20 p.m., the CM stated, the agency did not have N-95 fit testing for its employees. A review of Patient 3's Supervisory Visit notes indicated that Admin conducted an in-person supervisory visit on 7/26/2022. The narrative notes indicated that visit was conducted in the patient's room, bathroom and home with patient and caregiver present. A review of Patient 8's face sheet indicated the patient is a 97-year-old male with a start of care (SOC) of 2/9/2022, a certification period on 5/10/2022 to 8/7/2022 witha medical diagnoses that included heart failure (is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body's needs for blood) and hypertension (A condition in which the force of the blood against the artery walls is too high). A review of Patient 8's Supervisory Visit notes on 8/1/2022, indicated that Admin/DPCS conducted a supervisory visit with the LVN on 7/26/2022 and 7/27/2022. The narrative notes indicated the visit was conducted in the patient's room, bathroom and home. Patient and caregiver were present. A review of Patient 9's face sheet indicated patient is an 87-year-old male with a start of care (SOC) of 10/14/2021 with a certification period on 6/22/2022 to 8/9/2022 with medical diagnoses including atherosclerotic heart disease (is a condition of which there is hardening and narrowing of your arteries caused by cholesterol plaques lining the artery over time) and dementia (is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life). A review of Patient 9's Supervisory Visit notes on 8/1/2022, indicated that Admin/DPCS conducted a supervisory visit with the HHA on 7/25/2022. The narrative notes indicated the visit was conducted in the patient's room, bathroom and home. Patient and caregiver were also present. A review of http://ph.lacounty.gov/acd/docs/CCFGuidance.pdf, indicated Entry Screening o Every individual entering the facility (including residents, staff, visitors, outside healthcare workers, vendors, etc.), regardless of reason, should be asked about COVID-19 symptoms and have their temperature checked if possible. They should be asked about their vaccination status, if they have been in close contact with a COVID-19 positive person, and if they have traveled outside of California. An exception to this is Emergency Medical Service (EMS) workers responding to an urgent medical need. They do not need to be screened by the facility as they are screened at the beginning of their shift by their agencies. o Facilities should limit access points and ensure that all accessible entrances have a screening station. o Anyone with a fever (100.4° F or 37.8° C) or symptoms of COVID-19 may not enter. o Staff who interact directly with residents should be allowed to work per guidelines for healthcare personnel. o General visitors who have been a close contact of a person positive for COVID-19, regardless of their vaccination status, or who have traveled outside of California and are not fully vaccinated, should not enter the facility until 14 days have passed. This visitor restriction is purposefully longer than the shorter quarantine option for the general public given the high-risk nature of these facilities. o Essential and general visitors with COVID-19 should only enter facilities after completing their isolation AND after 10 full days have passed from onset of symptoms (or from date of test collection if they remained asymptomatic). This visitor restriction is purposefully longer than the shorter isolation option for the general public given the high-risk nature of these facilities A review of http://publichealth.lacounty.gov/media/Coronavirus/docs/HOO/HOO_CommunityCareFacilities.pdf, indicated masks are required for all staff at all times while working in the facility when around residents, visitors, and other staff. It also indicated the facility shall report all confirmed or suspected COVID-19 cases and deaths within 24 hours to LAC DPH, A review of http://publichealth.lacounty.gov/acd/ncorona2019/isolationquarantine/, indicated, When COVID-19 is confirmed or presumed, the diagnosing provider is asked to: " Evaluate whether care at home is suitable for the patient. Most patients do not require hospitalization and can self-isolate at home. Considerations for the suitability of at-home care include: o If the person is stable enough to be at home o If needed, appropriate and competent caregivers are available at home o If the person and other household members have access to recommended PPE (mask and gloves) and can adhere to recommended precautions as part of home care or self-isolation (e.g., respiratory hygiene, cough etiquette, hand hygiene). " Unless the patient requires alternate provisions, instruct them to immediately self-isolate and provide the patient with LAC DPH Health Officer Isolation Orders and instructions. Isolation and Quarantine Housing is available for persons who are able to perform activities of daily living (ADLs) independently. " Inform them that LA County Public Health may contact them to answer any questions they may have regarding COVID-19 and steps to take to prevent exposing others and to interview them for contact tracing. " Review the home isolation instructions, including: o How long to isolate-Everyone with COVID-19 must isolate for at least 5 days. How long they must isolate depends on whether they have symptoms and if they get a negative viral test on Day 5 or later. o Taking care of their health-discuss home care, what to do if symptoms worsen, when to seek medical care, and when to call 9-1-1. o Protecting others-they must stay isolated, except to get medical care, until the home isolation period ends. o Tell close contacts-Patients must inform all of their close contacts from 2 days before their symptoms began (or 2 days before the date of positive test if asymptomatic) that they were exposed. They must give them the Instructions for Close Contacts. The instructions are available in multiple languages at ph.lacounty.gov/closecontacts. " Make a plan to closely monitor patients at increased risk for severe disease and prescribe outpatient therapy for COVID-19, if clinically appropriate. A review of the Health Officer Order revised 2/25/2022 at http://publichealth.lacounty.gov/media/coronavirus/docs/HOO/HOO_HealthCareWorkerVaccination.pdf, requires COVID-19 testing for workers to improve the protection against COVID-19 for both the individuals served as well as the workers providing the services. According to the Center for Disease Control and Prevention (CDC) at https://www.cdc.gov/ The Occupational Safety and Health Administration (OSHA) (29 CFR 1910.134), it requires respirator users to be fit tested to confirm the fit of any respirator that forms a tight seal on your face before using it in the workplace. Fit testing is important to ensure the expected level of protection is provided by minimizing the total amount of contaminant leakage into the facepiece through the face seal ... Occupational Safety and Health Administration (OSHA) respirator fit testing requirement, both annually and when physical changes have occurred. According to the Health Officer Order For The Control Of COVID-19 Public health Emergency Isolation Order revised order issued may 18, 2022 indicated that all individuals regardless of vaccination status, previous infection or lack of symptoms, who reside or work in the Los Angeles County Health Jurisdiction, who have tested positive for or been diagnosed with COVID-19 are required to isolate themselves from others and follow all instructions in this Order until its safe for them to be around others. "A person considered to be diagnosed with COVID-19 based on one or both of the following criteria: a). they received a positive viral test for COVID-19 and/or b). a healthcare provider clinically suspects that they have COVID-19. To prevent the spread of COVID-19, the County of Los Angeles Health Officer requires everyone who tests positive for or is diagnosed with COVID-19, regardless of vaccination status, previous infection, or lack of symptoms to immediately: self-isolate for at least 5 days and wear a highly protective mask until your isolation ends".

Based on interview and record review, the hospice agency failed to provide volunteer training to the volunteer coordinator. This deficient practice resulted in the volunteer coordinators not having training. Finding: On 9/8/2022, a review of the Administrator Designee (ADMD) employee records indicated that the ADMD was also the Volunteer Coordinator. However, there was no certificate of training on file. During an interview with the Administrator Designee (ADMD) on 09/12/2022, at 2:31 p.m., she stated the only training she received regarding being a volunteer coordinator was what was taught to her by the Administrator. The Administrator Designee further stated that she does not have a certificates or proof of documentation regarding the training. A review of the agency undated policy and procedure titled "Volunteer Services," indicated the purpose of the policy and procedure is to ensure that qualified volunteers provide appropriate services in accordance with the plan of care and hospice program needs.

Based on interview and record review, the hospice agency failed to ensure that the employee records were updated and accurate for four out of 20 employees (Director of Patient Care Services Designee [DPCSD], Certified Home Health Aide [CHHA 2], Medical Director [MD], and Secretary [SEC]). This deficient practice resulted in an inaccurate Purified Protein Derivative (PPD) skin test (test that determines if you have tuberculosis [serious lung infection]) date in the employee records. Findings: During a concurrent record review and interview with the Clinical Manager (CM) on 08/01/22 at 12:50 p.m., she stated that PPD test should be read between 48 hours to 72 hours. CM stated and confirmed that the PPD tests for the DPCSD, CHHA 2, MD & SEC all had wrong dates. CM further stated that she is the one who checks the employee records, but she did not look over the history and physical and PPD. A review of the agency's policy and procedure titled, "Personnel Record Content," undated, indicated that the agency will maintain accurate and complete personal files on all staff.

Based on interview and record review, the hospice agency failed to update and implement their coronavirus (COVID-19 - highly contagious respiratory disease caused by a virus that can spread from person to person) employee vaccination policies and procedures to ensure a process of documenting an employee's approval for medical or religious exemption for two of 20 agency employees (Licensed Vocational Nurse [LVN 1] and Certified Home Health Aide [CHHA 1]). This deficient practice resulted in the agency not having an updated policy and procedure for COVID-19 employee vaccination and two employees not having proof that religious exemption was approved. Findings: On 09/08/2022 and 09/12/2022, a review of the agency's COVID-19 policy and procedure and COVID-19 employee vaccination list was conducted. The COVID-19 vaccination list indicated that there were two (LVN 1 and CHHA 1) out of 20 employees who did not receive the COVID-19 vaccine and that they each submitted a COVID-19 Vaccine Exemption/Declination Form. During an interview with the Administrator Designee (ADMD) on 09/12/2022, at 12:55 p.m. and 2:03 p.m., she stated all employees were fully vaccinated except for LVN 1 and CHHA 1. Administrator Designee (ADMD) further stated that both LVN 1 and CHHA 1 submitted declination forms but no other document regarding the approval of the religious exemption. A review of the agency's undated policy and procedure titled "COVID-19 Policy and Procedure," indicated that the organization will comply with all applicable CMS (Centers for Medicare and Medicaid Services) and CDC (Centers for Disease Control and Prevention) recommendations for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2).