Every finding on record at Bristol Hospice - San Diego LLC

Based on interview and record review, the agency failed to complete home visits per the plan of care for 3 of 11 sampled patients (1, 2, 9). As a result, the patients did not receive the number of visits ordered by the physicians which addressed patient care needs. Findings: 1. Per the agency's Plan of Care for the certification period 6/5/22 through 8/3/22, Patient 1 was admitted to the agency on 6/10/21 with diagnoses which included Alzheimer's disease (a brain disorder that slowly destroys memory and thinking skills). Patient 1 had an order for five CHHA visits per week for nine weeks. A review of Patient 1's clinical record was conducted. The CHHA visited Patient 1 the week of 6/5/22 through 6/11/22 four times instead five. 2. Per the agency's Plan of Care for the certification period 7/2/22 through 9/19/22, Patient 2 was admitted to the agency on 11/29/20 with diagnoses which included Alzheimer's disease (a brain disorder that slowly destroys memory and thinking skills). Patient 2 had an order for three CHHA visits per week for nine weeks. A review of Patient 2's clinical record was conducted. The CHHA visited Patient 2 the week of 7/24/22 through 7/30/22 two times instead three times per week. On 8/12/22 at 9:33 A.M., a concurrent interview and record review was conducted with the RCM. The RCM stated the CHHA should have completed the plan of care, and the CHHA should have rescheduled a visit that same week. If the CHHA missed a visit, a note should have been completed and placed in the patient's clinical records. The RCM stated Patients 1 and 2 had missed visits, and there was no documentation of the reasons for the missed visits. 3. Per the agency's Plan of Care for the certification period 6/12/22 through 9/9/22, Patient 9 was admitted to the agency on 6/12/22 with diagnoses which included heart disease. Patient 9 had an order on 7/13/22 for two CHHA sweet dreams visits per week for three weeks. On 8/12/22 at 9:55 A.M., a telephone interview and joint record review of Patient 9's record was conducted with the RDQ. The RDQ stated, there was only one CHHA sweet dreams visit documented on the week of 7/10/22 through 7/16/22. The RDQ further stated, the CHHA should have completed the second ordered visit, or documented a missed visit. Per the agency's policy and procedure, dated 5/20, titled Missed Visits, "...Missed visits will be communicated to the Interdisciplinary Group at the IDG Meeting. A missed visit will be rescheduled the same week, if possible. Missed visits will be documented in the clinical record..."

Based on interview and record review, the agency failed to ensure certification for terminal illness (CTI) was available to review for 1 of 11 sampled patients (4). As a result, there was a potential for Patient 4 ' s medical record to be inaccurate. Finding: Per the agency's Plan of Care for the certification period 6/24/22 through 8/22/22, Patient 4 was admitted to the agency on 11/7/19 with diagnoses which included Hemiplegia (paralysis of one side of the body). A review of Patient 4's clinical record. There was no evidence that Patient 4 had received certification for terminal illness for the period od 1/6/20 through 3/5/20 (certification period ). On 8/12/22 at 9:33 A.M., a concurrent interview and record review was conducted with the RCM. The RCM stated she could not provide Patient 4's certificate of terminal illness. On 8/12/22 at 11:30 A.M., an interview was conducted with the RVP. The RVP stated Patient 4 ' s clinical record should be complete, and the certification of terminal illness should have been scanned and accessible to review. The RVP said Patient 4 did not have a CTI in the clinical record. Per the agency's policy and procedure, dated 11/21, titled Record Retention, "...All active (open) paper records will be filed alphabetically and stored in a secure area with access by the approved personnel only. Electronic medical records will be stored in a secure manner that is easily retrievable if records are requested..."

Based on interview and record review, the agency failed to update the Plan of Care to reflect the visit frequency for 1 of 11 sampled patients (11). As a result, there was the risk of Patient 11 not receiving the visits to address patient care needs. Findings: Per the agency's Plan of Care for the certification period 3/27/22 through 5/25/22, Patient 11 was admitted to the agency on 4/24/20 with diagnoses which included Alzheimer's disease (a brain disorder that slowly destroys memory and thinking skills). Patient 11 had an order on 3/27/22 for CHHA visits five times per week for nine weeks. A review of Patient 11's clinical record was conducted. Per the agency's IDT note, dated 4/14/22, the CHHA visit frequency had been three times per week and not fives times per week as ordered by the physician. On 8/11/22 at 10:23 A.M., a telephone interview was conducted with CM 5. CM 5 stated, she was responsible for updating visit frequencies in the POC. CM 5 further stated, CHHA visit frequency was changed from five times per week to three times per week, but she forgot to update the POC. On 8/12/22 at 9:55 A.M. a telephone interview and concurrent review of Patient 11's record was conducted with the RDQ. The RDQ stated, Patient 11's CHHA order should have been updated when the visit frequency was changed.

Based on interview and record review, the agency failed to ensure the skilled nurse (SN) followed the physician's order for wound care for 1 of 2 sampled patients (1). As a result, there was a potential for prolonged wound healing. Findings: Per the Plan of Care (POC), dated 2/15/21 through 4/15/21, Patient 1 was admitted to the agency on 6/20/20 with diagnoses which included Alzheimer's disease (impaired memory). In addition, the POC stated Patient 1 had an arterial ulcer (a wound that happens when blood is unable to flow to the lower extremities) and for the SNs to cover the wounds with versatel (a dressing designed to allow wound fluid to transfer into a secondary dressing quickly) and abdominal pads, wrap the area with bandage twice a week. A review of Patient 1's clinical record was conducted. Per the Wound Care Note, dated 3/5/21, the physician changed the order for the wound care to include SN to apply tetracyte (an ointment that kills bacteria) daily and keep the wound clean and dry. However, there was no documented evidence provided by the SNs to reflect the physician's order's had been followed to apply tetracyte to the Patient 1's wound. On at 8:25 A.M., a joint record review and interview was conducted with SN 1. SN 1 stated she was the assigned nurse for Patient 1, and the only nurse who could change Patient 1's wound dressing. SN 1 further stated, she used the versatel dressing and abdominal pads and wrapped Patient 1's left foot with kerlix (bandage) twice a week. SN 1 stated she missed the physician's order, and Patient 1 did not receive the daily wound treatment. SN 1 further said it was important to follow the physician's order to ensure the patient's wound does not worsen. On 6/14/22 at 9 A.M., a joint record review and interview was conducted with the Director of Patient Care Services (DPCS). The DPCS stated the skilled nurses should have followed the physician's order. Patient 1 did not receive daily wound treatment as ordered by the physician. Per the agency's policy and procedure, dated 9/21, titled Wound Care, "...1. The hospice nurse will provide wound care per physician order..."