Every finding on record at Cp Napa N-Ca Hospice, LLC

Based on observation, interview, and record review, the facility failed to ensure medications were accurate and current for two of thirteen sampled patients (Patient 1 and Patient 2) when: 1. For Patient 1, Lidocaine (prevents pain by blocking the signals at the nerve endings in the skin), 5 percent patch (an adhesive material of lidoderm containing 5 percent lidocaine) was not active on the current medication list and plan of care (POC). 2. For Patient 2, Trazodone (for depression and inability to sleep) 50 milligrams (mg) tablet, give 0.5 tablet (25 mg) by mouth at bedtime, was not active on the current medication list. These failures had the potential to cause ineffective drug therapy and noncompliance. --- Findings: 1. During a review of Patient 1s clinical record, the clinical record indicated, start of care 1/23/2019 with current certification period of 7/1/2023 through 8/29/2023. The clinical record indicated, Patient 1s diagnosis included, coronary artery disease (arteries that carry blood to the heart become narrowed and blocked), involving native coronary artery of native heart with angina pectoris (arteries that carry blood to the heart become narrowed and blocked and the heart muscle does not get enough blood and oxygen). During a home visit on 8/1/2023 at 9:35 AM in the presence of Patient 1s niece, an observation of Patient 1s available medication in the home included lidocaine patch 5 percent right shoulder at night every 12 hours and was not included with Patient 1s most current medication list dated 8/1/2023. During an interview on 8/1/2023 at 9:37 AM with Patient 1s niece, Patient 1s niece stated, the case manager told her, the lidocaine 5 percent patch was discontinued and to keep the patches in case Patient 1 needs them for pain. During an interview on 8/1/2023 at 3:11 PM with Clinical Services Manager (CSM), CSM stated, they were missing a step on updating the medications on the POC and active medication list. CSM further stated, they should not rely on the POCs. During an interview on 8/1/2023 at 3:16 PM with Case Manager (CM 1), CM 1 stated, he did not add the lidocaine 5 percent patch to the POC because Patient 1 had refused the lidocaine patch for 3 months. CM 1 further stated, the lidocaine patch has not been discontinued by the physician and he should have notified the physician about Patient 1s refusal of the lidocaine patch. CM 1 stated, ";All medications should be included in the POC." During a review of Patient 1s "Not on plan of care document" dated 7/30/2023, the "Not on plan of care document" indicated, lidocaine (Lidoderm) 5 percent patch place 1 patch onto the skin daily. Place on painful area. On for 12 hours and off 12 hours. Indication for pain. The lidocaine patch was not documented in the POC. During a review of Patient 1s "Medication Orders," dated 2/14/2023, the "Medication Orders" indicated, lidocaine (Lidoderm) 5 percent patch, place one patch onto the skin daily. Place on painful area. On for 12 hours and off 12 hours. The start date was 12/19/2022. During a review of the facilitys policy and procedure (P&P) titled, ";Medication List, Drug Profile, and Reconciliation," dated 3/2023, the P&P indicated, ";The patients medication list will be documented on admission and updated as needed to remain current and accurate in the clinical record..." During a review of the facilitys policy and procedure (P&P) titled, ";Plan of Care," dated 7/2023, the P&P indicated, ";The POC will be initiated upon admission and developed through ongoing assessments of the patients needs. Will identify the provided services necessary to meet those needs including medications, treatments, supplies, and equipment..." 2. During a review of Patient 2s clinical record, the clinical record indicated, start of care 5/05/2020 with current certification period of 6/19/2023 through 8/17/2023. The clinical record indicated, Patient 1s diagnosis included, severe Alzheimer's Dementia (memory loss, confusion, and emotional distress) with anxiety and unspecified timing of Dementia (memory loss) onset. During a concurrent interview and record review on 8/1/2023 at 11:20 AM with the Skilled Nursing Facility (SNF) Licensed Vocational Nurse (LVN 1), Patient 2s Medication Record dated 8/1/2023 was reviewed. The Medication Record indicated, Trazodone (for depression and inability to sleep) 50 milligrams (mg) tablet, give 0.5 tablet (25 mg) by mouth at bedtime. LVN 1 confirmed, Trazodone 50 mg tablet, give 0.5 tablet (25 mg) by mouth at bedtime, was not included with Patient 2s most current hospice active medication list dated 8/1/2023. During an interview on 8/1/2023 at 2:59 PM with Case Manager (CM 2), CM 2 confirmed, the physician should have been notified regarding the Trazodone 50 mg medication discrepancy. During a review of Patient 2s "Active Hospice Medication List," dated 8/1/2023, the "Active Hospice Medication List" indicated, trazodone 50 mg by mouth nightly for trouble sleeping. During a review of Patient 2s "SNFs Medication Review Report-Physician Orders," dated 8/1/2023, the "SNF Medication Review Report-Physician Orders," indicated, Trazodone tablet 50 mg, give 0.5 tablet (25 mg) by mouth at bedtime. The order start date was 7/25/2022. During a review of the facilitys policy and procedure (P&P) titled, ";Medication List, Drug Profile, and Reconciliation," dated 3/2023, the P&P indicated, ";The patients medication list will be documented on admission and updated as needed to remain current and accurate in the clinical record..."

Based on observation, interview and record review, Registered Nurse 1 (RN 1) failed to remove contaminated gloves after performing wound care for one of three sampled patients (Patient 3) observed. This failure had the potential to transmit infectious disease. --- Findings: During a review of Patient 3s clinical record, the clinical record indicated, start of care began on 5/22/2023. The clinical record indicated, Patient 3s diagnosis included: Degenerative disease of the central nervous system (a disease that affects the brain), with severe dementia (loss of intellectual functioning) and insomnia (the inability to sleep). During a review of Patient 3's "Interventions form," dated 8/1/2023, the "Interventions form" indicated, ";...Wound Care: LLE [Left Lower Extremity]; Using clean technique; cleanse area using wound care spray..., pat dry and cover with optifoam dressing..." During an observation on 8/1/2023, at 1:20 PM, in Patient 3s room, RN 1 put on two sets of gloves and began performing wound care. RN 1 removed a soiled, gauze bandage from Patient 3s lower left shin and cleaned the area. RN 1 then removed the first set of gloves and began placing a clean bandage over Patient 3s left shin with the contaminated second set of gloves. During an interview on 8/1/2023, at 1:23 PM, with RN 1, RN 1 stated she kept the contaminated second set of gloves on, while placing the clean bandage because that is the way she was taught in nursing school. During an interview on 8/1/2023, at 3:30 PM, with the Clinical Services Manager (CSM), the CSM stated she would wear clean gloves to remove the dirty bandage, then hand wash or sanitize and put on clean gloves to place the clean bandage. During an interview on 8/2/2023, at 8:40 AM, with the Quality Manager (QM), the QM stated she does not know why RN 1 said she learned to double glove in nursing school and that is not common practice at this facility. The QM further stated, this is not something we train our staff to do and not something I've ever heard of. During a review of the facilitys policy and procedure (P&P) titled, "Standard Precautions," revised 4/2022, the P&P indicated, ";...Gloves will be worn when there is potential contact with body fluids, secretions, excretions, mucous membranes, blood or non-intact skin...Remove after use, before touching non-contaminated items and surfaces..."