Every finding on record at Ampl Management, Inc.

Observed in Tracer Visit. In 1 of 1 active patient records reviewed, the Interdisciplinary Group did not review, revise and documents the plan as frequently as every 15 calendar days. Identified during the record review for the only active patient, the IDG conducted two weeks prior to the survey date was conducted on day 16. This was reviewed and validated with the Director of Nursing.

Observed in Record Review. In 1 of 3 patient records reviewed, the surveyor noted that the plan of care had not included all the medications and treatments necessary to meet the patient’s needs. For example: RR #1, the patient had a scabbed area to the scalp. The order for wound care was missing the frequency care was to be provided. This was validated with the Director of Nursing.

Observed in Record Review. In 1 of 3 patient records reviewed, the Surveyor noted the patient Plan of Care (POC) had not been followed as ordered. For example, in RR #1, the POC had the Hospice Aide frequency of 3 times per week for the facility based patient. A missed visit note had been created by the scheduler the week of Memorial Day that one visit was not made due to the holiday. There was no indication the IDT was aware the plan of care was not followed. This was validated with the Director of Nursing.

Observed in Record Review. In 5 of 9 patient records reviewed, the Surveyor found that plan of care goals and interventions were not specific, measurable, nor with an appropriate time frame for achievement. Examples include: Facility will-maintained fall precautions, Patient caregiver will maintain and follow aspiration precautions, Pt edema shall be well managed within the limits of her disease, Pt shall remain free of injury, Pt SOB shall be well managed, Pt shall stop using insulin effectively, Pt insomnia shall be well managed. This was validated with the Director of Nursing and the Administrator.

Observed in Record Review. In 2 of 9 patient records reviewed, the surveyor noted that the plan of care had not included all the medications and treatments necessary to meet the patient’s needs. For example: HV/RR #1, the patient had a skin tear, however the POC had not included the wound care to the area. RR #2, the patient had a primary diagnosis of atherosclerotic heart disease; however this had not been included on the POC with interventions or goals. This was validated with the Director of Nursing.

Observed in Record Review. In 1 of 9 patient records reviewed, the Surveyor noted IDG meeting had not occurred every 14 days. In RR #6, there had not been an IDG meeting to review the patient's plan of care in 20 days. This was validated with the Director of Nursing.

Observed in Record Review. In 2 of 9 patient records reviewed, the Surveyor noted the patient Plan of Care (POC) had not been followed as ordered. For example, in RR #5, the POC had the Hospice Aide frequency of 3 times per week. No visit had been documented for 2 weeks for a total of 6 missed visits. There had been no documented communication between the HA and the IDG related to the missed visits. The beginning of week 3, there had been a documented missed visit. RR #6, the patient had skilled nursing visits ordered for 3 times per week; however only 1 visit per week had been recorded for 2 consecutive weeks. This was validated with the Director of Nursing.

Observed in Record Review. In 1 of 9 patient records reviewed, the Surveyor noted a lack of collaboration related to patient care. In RR #9, the patient had revoked the hospice benefit. There had been no communication noted between the IDG members related to the patients revocation and further provisions for care. This was validated with the Director of Nursing.

Observed in Tracer Activities. There was no evidence that the governing body and leadership had established requirements to support patient care treatment and services as evidenced by a a condition level finding at § 418.56, § 418.114(a), and § 418.116.

Observed in Record Review. In 2 of 7 patient records reviewed, where the patient had been discharged from services, the Surveyor noted that clinicians had not authenticated their documentation. In RR #4 and RR #8, the Death Discharge note had been created by the Case Manager Assistant, a non-clinical employee who had populated the document with clinical notes and then signed the document. This was validated with the Director of Nursing.

Observed in Record Review. In 1 of 7 patient records reviewed, where the patient had been discharged from HCO services, the Surveyor noted the absence of a discharge summary. This was validated with the Director of Nursing.

Observed in Record Review. In 2 of 3 patient records reviewed, where the patient has expired while on HCO service, the staff had not provided patient care within the scope of their license. In RR #4, the Surveyor noted the LVN documented that they pronounced the death of the patient. The LVN documented “Pronouncement visit, Arrived at Alf to find patient with no pulse time of death 2130.” There had been no notation that the MD had been called and had pronounced the patient. In RR #8 the LVN documentation again indicated they had pronounced the patient. The documentation read: 2415-Pt no longer breathing.” Again, no documentation the MD had been called and had pronounced the patient. This was validated with the Administrator and the Director of Nursing.

Observed in Tracer Activities. The Surveyor noted the HCO changed their Name and Address in 2021; however, they did not notify CMS of the changes until January 2023. The changes have not been approved as of April 2023. The Agency had also not notified California Department of Health Services of the changes to their address and name until March 2023. This was validated with the Administrator

Observed in Record Review. In 1 of 2 patient records reviewed, During HV#1 record review it was noted the MSW and chaplain did not document summaries of psychosocial/emotional and spiritual issues during IDG meetings every 14 days. The MSW and Chaplain documented inconsistently from May 2022-September 2022 IDG meetings. This was discussed with the organization leadership.

Observed in Record Review. In 1 of 1 patient records reviewed, During HV#1 record review it was noted the goals were not individualized and not measurable. For example: MSW:pt will exhibit appropriate coping and life changes adjustment. SN: pt's pain will be managed using pharmacological and non-pharmacological strategies. Pt will maintain clear, open airways as evidenced by normal breath sounds, normal rate and depth of respiration and ability to effectively cough up secretions after treatments and deep breathing. Pt maintains HR 60-100 beats per minutes. pt has clear lung sounds as manifested by absence of pulmonary crackles. Spiritual goals to be accomplished by death or discharge. This was reviewed with the organization leadership.

Observed in Record Review. In 1 of 2 patient records reviewed, During Bereavement RR#1, it was noted the first IDG meeting was documented 26 days after the SOC. This was reviewed with the organization leadership.

Observed in Individual Tracer. In 1 of 1 home visits conducted, During HV#1 it was noted the SN did not adhere to the manufacturer's guideline of a 1 minute wet to dry contact time. The SN wiped the BP cuff and stethoscope and immediately placed the equipment back in her bag. This was discussed with the organization leadership.

Observed in Record Review. In 1 of 1 patient records reviewed, for bereavement portion services. The hospice had not developed a bereavement plan of care that specifies the type of bereavement services to be offered and the frequency of service delivery. The bereavement IDG meeting did not include a discussion of the patient's death per organization policy. The verbal discussion with the Bereavement Coordinator on the survivor bereavement POC was not documented in the pt. medical record or bereavement section. This was discussed with the organization leadership.