Every finding on record at Bristol Hospice - Inland Empire, LLC

It is required that each patient’s individualized written plan of care: reflects patient and family goals; [and] identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed, the agency did not ensure that the patient's plan of care identified planned interventions based on problems identified in the comprehensive assessment. Clinical Record 8: The patient elected hospice care on 09/26/2024. The initial nursing assessment dated 09/26/2024 documented, "Patient has a stage 1 pressure ulcer to the right buttock." The plan of care dated 09/26/2024 through 12/24/2024 did not include interventions related to skin integrity. During a joint record review and interview on 11/20/2024, the Regional Director of Clinical Operations stated, "There are no interventions for skin integrity on this plan of care."

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 8 of 17 (47%) clinical records reviewed of patients who received Hospice Aide (HHA) services, the agency did not ensure that all written patient care instructions were included in the aide care plan. Clinical Record 2: The patient elected hospice care on 06/11/2024. On 06/11/2024, the physician ordered, "Oxygen 4 liters continuously via nasal cannula." The plan of care dated 06/11/2024 through 08/09/2024 ordered "Aide 2x per week." The HHA care plan dated 06/11/2024 assigned the HHA the relevant task of a "Shower at every visit." The HHA care plan did not provide the HHA with instructions addressing the use of oxygen during the shower. Clinical Record 4: The patient elected hospice care on 10/18/2024. On 10/18/2024, the physician ordered wound care with dressing to a wound on the patient's left hip and "Oxygen 2 liters continuously via nasal cannula." The plan of care dated 10/18/2024 through 01/15/2025 ordered "Aide 2x per week." The HHA care plan dated 10/18/2024 assigned the HHA the relevant task of a "Bed bath at every visit." The HHA care plan did not provide the HHA with instructions addressing using oxygen during the bed bath or instructions for the left hip dressing should the dressing become wet or dislodged during the bed bath. Clinical Record 5: The patient elected hospice care on 10/11/2024. On 10/24/2024, the physician ordered, "Oxygen 7 liters continuously via nasal cannula." The plan of care dated 10/11/2024 through 01/08/2025 ordered "Aide 2x per week." The HHA care plan dated 10/24/2024 assigned the HHA the relevant task of a "Bed bath at every visit." The HHA care plan did not provide the HHA with instructions addressing the use of oxygen during the bed bath. Clinical Record 7: The patient elected hospice care on 03/04/2024. On 03/04/2024, the physician ordered wound care with dressing to a wound on the patient's left buttock and left arm. The plan of care dated 03/04/2024 through 06/02/2024 ordered "Aide 2x per week." The HHA care plan dated 03/04/2024 assigned the HHA the relevant task of a "Bed bath at every visit." The HHA care plan did not provide the HHA with instructions should the left buttock or left arm dressings become wet or dislodged during the bed bath. Clinical Record 10: The patient elected hospice care on 10/09/2024. On 10/10/2024, the physician ordered wound care with dressing to a wound on the patient's right arm. The plan of care dated 10/09/2024 through 01/06/2025 ordered "Aide 3x per week." The HHA care plan dated 10/15/2024 assigned the HHA the relevant task of a "Shower at every visit." The HHA care plan did not provide the HHA with instructions should the right arm dressing become wet or dislodged during the shower. Clinical Record 13: The patient elected hospice care on 10/02/2024. On 10/02/2024, the physician ordered a Foley catheter. The plan of care dated 10/02/2024 through 12/30/2024 ordered "Aide 3x per week." The HHA care plan dated 10/02/2024 did not include catheter care instructions. Clinical Record 14: The patient elected hospice care on 06/21/2024. On 06/21/2024, the physician ordered, "Oxygen 3 liters continuously via nasal cannula.". The plan of care dated 06/21/2024 through 09/18/2024 ordered "Aide 2x per week." The HHA care plan dated 06/21/2024 assigned the HHA the relevant task of a "Shower at every visit." The HHA care plan did not provide the HHA with instructions addressing the use of the oxygen during the shower. Clinical Record 18: The patient elected hospice care on 05/29/2024. On 05/29/2024, the physician ordered wound care with dressing to a wound on the patient's left abdomen. The plan of care dated 05/29/2024 through 07/01/2024 ordered "Aide 3x per week." The HHA care plan dated 05/29/2024 assigned the HHA the relevant task of a "Shower at every visit." The HHA care plan did not provide the HHA with instructions should the left abdomen dressing become wet or dislodged during the shower. During a joint record review on 11/20/2024, the Regional Director of Clinical Operations confirmed that the HHA care plans did not include catheter care, oxygen, or wound dressing instructions for the HHA.

It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to: assess the quality of care and services provided by the hospice aide; [and] ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 8 of 17 (47%) clinical records reviewed of patients who received Hospice Aide (HHA) services, the agency did not ensure that HHA supervisory visits were completed no less frequently than every 14 days. Clinical Record 1: The patient elected the hospice benefit on 03/18/2021. The plans of care dated 04/28/2024-06/26/2024, 06/27/2024-08/25/2024, and 08/26/2024-10/24/2024 ordered: "Aide 2x/week." HHA supervisory visits were documented as completed on 06/18/2024 and 07/03/2024, with 15 days outstanding; 07/24/2024 and 08/14/2024, 21 days outstanding; and 09/12/2024 and 09/27/2024, with 15 days outstanding. Clinical Record 3: The patient elected the hospice benefit on 10/07/2022. The plan of care dated 07/28/2024-09/25/2024 ordered: "Aide 3x/week." HHA supervisory visits were documented as completed on 07/02/2024 and 07/22/2024, with 20 days outstanding; 07/22/2024 and 08/12/2024, with 21 days outstanding; and 08/26/2024 and 09/18/2024, with 23 days outstanding. Clinical Record 6: The patient elected the hospice benefit on 05/24/2024. The plan of care dated 05/24/2024-08/21/2024 ordered: "Aide 1x/week." HHA supervisory visits were documented as completed on 07/01/2024 and 07/16/2024, with 15 days outstanding, and 07/31/2024 and 08/15/2024, with 15 days outstanding. Clinical Record 7: The patient elected the hospice benefit on 03/04/2024. The plans of care dated 06/02/2024-07/31/2024, 08/01/2024-09/29/2024, and 09/30/2024-11/27/2024 ordered: "Aide 2x/week." HHA supervisory visits were documented as completed on 06/05/2024 and 07/03/2024, with 28 days outstanding; 07/31/2024 and 08/15/2024, with 15 days outstanding; and 09/25/2024 and 10/23/2024, with fourteen (14) days outstanding. Clinical Record 8: The patient elected the hospice benefit on 09/26/2024. The plan of care dated 09/26/2024-12/24/2024 ordered: "Aide 2x/week." HHA supervisory visits were documented as completed on 10/22/2024 and 11/07/2024, with 16 days outstanding. Clinical Record 12: The patient elected the hospice benefit on 05/31/2024. The plans of care dated 05/31/2024-08/28/2024 and 08/29/2024-11/26/2024 ordered: "Aide 2x/week." HHA supervisory visits were documented as completed on 08/20/2024 and 09/17/2024, with 28 days outstanding. Clinical Record 14: The patient elected the hospice benefit on 06/21/2024. The plan of care dated 06/21/2024-09/18/2024 ordered: "Aide 2x/week." HHA supervisory visits were documented as completed on 07/03/2024 and 07/26/2024, with 23 days outstanding. Clinical Record 16: The patient elected the hospice benefit on 03/11/2024. The plan of care dated 03/11/2024-05/18/2024 ordered: "Aide 2x/week." HHA supervisory visits were documented as completed on 04/05/2024 and 04/23/2024, with 18 days outstanding, and 04/23/2024 and 05/17/2024, with 24 days outstanding. During a joint record review and interview on 11/20/2024, the Regional Director of Clinical Operations confirmed that the aide supervisory visits were less frequent than every 14 days.