Every finding on record at Continuum Care Northbay, LLC

Based on interview and record review, the facility failed to implement Patient 1s facility physician orders for the medication Gabapentin (anticonvulsant medication). This failure had the potential to affect Patient 1's overall health condition. --- Findings: During a review of Patient 1s clinical record, Patient 1s ";Recertification Statement for second 90-day period" indicated, Patient 1 was readmitted to hospice (end of life care) with a start of care date of 8/19/2023. Resident 1s terminal diagnosis was Alzheimers dementia (a progressive disease that destroys memory and other important mental functions). During a review of Patient 1s hospice ";Physicians Orders/Plan of Care", dated 8/19/2023 to 11/16/2023, the physicians orders indicated, Patient 1 had been ordered Gabapentin 100 MG (milligrams) one capsule three times a day by mouth. During a review of Patient 1s facility physicians orders titled, ";Order Summary Report Active Orders As Of 08/29/2023," the Physicians orders dated 11/23/2022, indicated, Patient 1 had been ordered Gabapentin 100 MG one capsule three times a day by mouth for pain. In addition, the physicians order indicated, ";INCREASE BY 1 CAP (capsule) Per DAY EVERY 3 DAYS IF TOLERATED. CONTACT MD (medical doctor) IF DOSE IS OVER 900 MG/DAY. (Indications for Use: Anticonvulsant)." During Patient 1's home visit on 8/29/2023 at 11:06 a.m., a concurrent interview and record review was conducted with the Resident Care Coordinator (RCC) at the medication cart. Patient 1s Medication Administration Record (MAR), dated 8/1/2023 to 8/29/2023, was reviewed. The MAR indicated, Gabapentin 100 MG was to be administered three times a day for pain. In addition, Gabapentin was to be increased by one capsule every three days if tolerated, up to 900 MG/DAY. The MAR indicated Patient 1 had received Gabapentin 100 MG capsule three times a day. In addition, the label order on Patient 1s Gabapentin medication bottle indicated increase the medication every three days if tolerated. Review of the MAR indicated, there was no attempt made by licensed staff to increase the medication. RCC stated, ";[Patient 1] only takes it three times a day. No, its not being increased. I should clarify with the Physician on this." During an interview on 8/29/2023 at 3:29 p.m., with hospice Registered Nurse (RN 1), RN 1 stated the hospice physicians orders for Gabapentin were for 100 mg three times a day. RN 1 stated the physicians order did not include increasing the dosage every three days. RN 1 stated, the physician order did not include increasing the dosage every three days and had not reviewed Patient 1's medication profile for accuracy. During an interview on 8/31/2023 at 11:46 a.m., with the Regional Compliance Nurse (RCN), RCN stated during the clinical visit, the visiting nurse should do a medication reconciliation checking the facilitys medication list against the hospice list for any discrepancies. RCN stated, if any discrepancy, the visiting nurse should talk to the facility nurse and get orders coordinated and change whatever order needed to be changed. RCN further stated, when nurses do the visit, that's when reconciliation is done, and compare the orders with the bottle. During a review of the facilitys policy and procedure (P&P) titled, ";PC.M55 Medication – Profile", dated 4/15/2023, the P&P indicated, ";When a patient is admitted to Care Hospice, a medication profile is initiated to document all of the patients prescription and over-the-counter drugs, herbal remedies and other alternative treatments that could affect drug therapy. The patients medication profile review includes, but is not limited to: a. Determining accuracy and completeness of the profile... c. Ensuring appropriateness of the medication, the dose, route of administration, and dosage schedule." During a review of the facilitys P&P titled, ";PC.M45 Medication – Management", dated 8/29/2023, the P&P indicated, ";A Medication Profile is maintained for every patient and includes a listing of the current medication orders for each patient and specifies whether the medication is or is not related to the patients terminal illness... The Hospice monitors the medications dispensed to and used by the patient."

Based on interview and record review, the hospice failed to ensure Patient 1s physicians order for Morphine Sulfate (MS, narcotic pain medication) was carried out (available). This failure resulted in MS not being readily available for Patient 1 when needed for breakthrough pain. --- Findings: During a review of Patient 1s clinical record, Patient 1s ";Recertification Statement for second 90-day period" indicated, Patient 1 was readmitted to hospice (end of life care) with a start of care date of 8/19/2023. Patient 1's terminal diagnosis was Alzheimers dementia (a progressive disease that destroys memory and other important mental functions). During a review of Patient 1s hospice ";Physicians Orders/Plan of Care", dated 8/19/2023 to 11/16/2023, the physicians orders indicated on 8/20/2023, Patient 1 had been ordered MS solution 20 MG/ML (milligrams per milliliter) 0.25 ML as needed every hour by mouth for pain and shortness of breath. During a concurrent interview and record review of Patient 1s medications on 8/29/2023 at 11:06 a.m., with Resident Care Coordinator (RCC), the medication cart was reviewed. MS was not contained in the medication cart for Patient 1. RCC stated, ";[Patient 1] was admitted almost 10 days ago. Usually get it within three days." RCC further stated, ";[Patient 1] has an order for it, but still havent received it from the hospice. If we needed to give her Morphine we wouldnt have it available." During an interview on 8/31/2023 at 11:46 a.m., with the Regional Compliance Nurse (RCN), RCN stated, ";Anything ordered by the Physician should be filled. Make sure any meds the patient needs are in the home. Make sure they are delivered the same day for the patient and that they have enough supply on admission." During a review of the facilitys policy and procedure (P&P) titled, ";PC.M45 Medication – Management", dated 8/29/2023, the P&P indicated, ";Medications are provided on a timely basis and are available 24 hours a day and seven days a week as needed... Medications are dispensed in sufficient quantities to meet the needs of the patient..."

Based on interview and record review, the facility failed to ensure a bereavement care plan (plan of care that identified the kind of services available to the surviving family members for a period of at least one year after the death of the patient) was developed for Patient 3. This failure had the potential for the bereaved to not receive bereavement services based on assessed needs. --- Findings: During a review of Patient 3s ";Patient Information (PI)," the PI indicated, Patient 3 was admitted to hospice with a start of care date of 6/8/2023. The admitting diagnosis included cerebrovascular disease (an area of the brain is temporarily or permanently affected by lack of oxygen or bleeding). The PI indicated, Patient 3 expired on 6/11/2023. During a review of Patient 3's admission assessment titled, "Charts/Clinical Notes," dated 6/9/2023, the document identified the bereaved (person in mourning due to the death of a loved one) as Patient 3's sister. During a concurrent interview and record review on 8/30/2023 at 10:45 a.m. with Chaplain, Patient 3's, "Charts/Clinical Notes," dated 6/20/2023, was reviewed. The "Charts/Clinical Notes," indicated, an interdisciplinary group (IDG, team of clinicians from different disciplines working together collaboratively) meeting for Patient 3 had been held post death. Chaplain stated, an initial assessment and care plan should be developed within five days of admission. Chaplain stated, after a patients death an IDG meeting would be held to discuss the patient and the needs of the family members and based on that information develop a bereavement care plan. The Chaplain was unable to find that a bereavement care plan had been developed for Patient 3. During a review of the facilitys policy and procedure (P&P) titled, ";PC.B10 Bereavement – Care Planning," dated 4/14/2023, the P&P indicated, ";The Hospice bereavement plan of care is developed based on an assessment of the patient/family needs at the time of admission and during the provision of Hospice care and when the patient dies and includes: a. Patient/family grief and/or loss issues; b. Survivor needs; c. Social, spiritual, and cultural issues; d. Services to be provided and the frequency of service delivery; e. Referrals to other community resources; f. Grief risk factors; g. Potential for pathological grief reactions; and h. Individual counseling, support groups, letters and cards... The bereavement plan of care reflects the assessed needs of the bereaved and notes the kind of bereavement services to be offered and the frequency of delivery... The Bereavement Coordinator ensures that the bereavement plan of care is followed for at least 12 months following the patients death, appropriate to the level of need assessed."

Based on observation, interview, and record review, the facility failed to ensure the expiration date on Patient 1s Caltrate 600 +D Plus Minerals (vitamin supplement) bottle was legible. This failure had the potential for Patient 1 to be administered an outdated and ineffective supplement. --- Findings: During a review of Patient 1s clinical record, Patient 1s ";Recertification Statement for second 90-day period" indicated, Patient 1 was readmitted to hospice (end of life care) with a start of care date of 8/19/2023. Patient 1s terminal diagnosis was Alzheimers dementia (a progressive disease that destroys memory and other important mental functions). During a review of Patient 1s ";Physicians Orders/Plan of Care", dated 8/19/2023 to 11/16/2023, the Physicians Orders indicated Patient 1 had been ordered ";Caltrate 600+D Plus Minerals" by mouth one tablet daily. During a review of Patient 1s Medication Administration Record (MAR), dated 8/1/2023 to 8/29/2023, the MAR indicated Patient 1 had received Caltrate 600+D Plus Minerals by mouth daily at 8 a.m. During Patient 1s home visit on 8/29/2023 at 11:06 a.m., a concurrent observation and interview was conducted with the Resident Care Coordinator (RCC) at the medication cart. Patient 1s Caltrate 600+D Plus Minerals bottle was observed without a legible expiration date. RCC stated he was unable to read the expiration date because, ";The label was worn off." During a review of the facilitys policy and procedure (P&P) titled, ";PC.M25 Medication Administration", dated 4/15/2023, the P&P indicated, ";All drugs are administered in accordance with physician orders. All drugs, biological and nutritional therapies are administered in accordance with physician orders, labeled instructions accepted standards of practice... Drugs, biologicals and nutrition therapies are stored and distributed in accordance with acceptable standards, established by the manufacturer including temperature, light and length of time."