Every finding on record at Elara Hospice, Inc.

Observed in Patient Home. In 3 of 3 home visits conducted, the hospice did not provide the patient with written information about its policies on advance directives. The home folders at all three patient visits included the state of California information, but not the organization's policy on advance directives. This was discussed with a Governing Body member, Administrator/DPCS and Office Manager.

Observed in Patient Home. In 1 of 5 patient records reviewed, the hospice did not ensure that the patient record contained accurate information. In the record of RRHV#2 the medication list included Rosuvastatin 10 mg 12 tablets by mouth once daily. In that same record a registered nurse documented that the patient had left hemiplegia. During the home visit the surveyor observed that the patient was able to stand, walk, and move her left arm. There was no sign of hemiplegia. This was reviewed with a Governing Body member, Administrator/DPCS and Office Manager.

Observed in Record Review. In 5 of 5 patient records reviewed, the organization did not develop plans of care that were based on patient’s goals and the time frames, settings, and services required to meet those goals. Most goals did not include specific measures to indicate progress and did not identify completion dates. For example: Patient, caregiver, family “will understand signs and symptoms of dying process prior to patient's death; will achieve optimal grief reaction prior to patient's death; will maintain optimal mobility during care within two weeks; pain will remain at a comfortable level during care within a two-week period of time; will demonstrate ability to manage bowel routine within two weeks; fall prevention will be maintained during care. This was reviewed with a Governing Body member, Administrator/DPCS and Office Manager.

Observed in Record Review. In 5 of 5 patient records reviewed, the hospice did not adequately assess its patients. In every record reviewed the RN completing the initial comprehensive assessment also completed the spiritual assessment despite not having the education and training to do so. This was reviewed with a Governing Body member, Administrator/DPCS and Office Manager. Observed in Competency Session. In 1 of 9 HR files reviewed, the hospice did not assess competence initially as part of orientation. In HR#9 there was no competence assessment documented for the medical director. This was reviewed with a Governing Body member, Administrator/DPCS and Office Manager.

Observed in Record Review. In 1 of 5 patient records reviewed, the patient record did not include all medications the patient was using. For example, at RRHV#1 there was a prescription bottle labeled Amlodipine 10 mg one tablet by mouth daily that was filled three weeks prior to this visit. It was not included on the medication list in the patient's home or their medical record. This was reviewed with a Governing Body member, Administrator/DPCS and Office Manager.