Every finding on record at American Carequest East Bay

Observed in Record Review. The hospice did not provide education and training to the primary caregiver specific to the patients bowel regimen. Example: In RRHV#1 there was lack of documentation of caregiver education about the bowel regimen specific to the indications for each one of the four prescribed medications as well as the specific instructions for when to administer the two included prn medications senna and lactulose. This was noted during record review and home visit. Reviewed with leadership.

Observed in Record Review. The organization did not provide clear instruction for when to take PRN medications. For example, in RRHV#1 the patient was prescribed senna and lactulose prn without clear instructions when to give which medication. Reviewed with leadership.

Observed in Record Review. In 1 of 1 live discharge records reviewed, the patient's rights to information on hospice revocation was not provided. Identified in RR#8, the patient had a change in condition acute confusion and hypotension and the PCG (patient care giver) decided to transfer patient to . . . for aggressive treatment. The patient was discharged from the hospice program on that day due to hospitalization, without the appropriate Revocation information provided or documents signed. This was reviewed and validated with the CEO.

Observed in Record Review. In 3 of 7 active records reviewed, it was identified that the PRN (As Needed) visit frequencies for visits in the Plan of Care did not include a detailed statement of the scope and frequency of services. For example, in HV#1, the Skilled Nurse frequency of visits was documented as 1 per week, and 3 PRN without indication of what constitutes a need for a PRN visit or within what timeframe it should be used. In HV#2, the Medical Social Worker (MSW) frequency of visits was documented as 3 per month and 1 PRN without indication of what constitutes a need for a PRN visit or within what timeframe it should be used. In RR#3, the MSW frequency of visits was documented as 1 per week and 1 PRN without indication of what constitutes a need for a PRN visit or within what timeframe it should occur. This was discussed and validated with the Quality Nurse and CEO.

Observed in Record Review. In 1 of 4 inactive patient records reviewed, the hospice care provided was not consistent with the patient's and family's needs and goals. Noted in the record of RR#5, the Registered Nurse (RN) identified that the patient had a change in condition, and was imminently dying on a Thursday, and documented the following, RN updated Medical Director, and RN scheduled a follow-up visit. In review of the Plan of Care, it was identified that Licensed Vocational Nurse (LVN) visits were added that day by the RN, LVN visits 2 per week and 1 prn (as needed). LVN visits occurred on Friday and Saturday, the two days following the RN's visit and change to the Plan of Care. The LVN included in the documentation that the patient was imminently dying, and that the wife of the patient was in need of assistance with the patient's care. The patient expired on the following Thursday, one week after the recognition of imminently dying without a nursing visit, RN or LVN, during the last 4 1/2 days of life . This was reviewed and validated with the Quality Nurse and CEO.