Every finding on record at First Solution Hospice Care Inc.

Observed in Emergency Management Session. On review of the organizations emergency management plan and processes, it was noted that the organization participated in 2022 Great California Great Shake Out. There was a certificate of participations and a sign in sheet for those who participated but no documentation of an evaluation of the exercise. This observation was reviewed with the DPCS and Office Manager. Observed in Emergency Management Session. On review of the Emergency Management Plan and processes, it was noted that the organization participated in the 2022, and 2021 Great California Shake Out yet there was no documentation of evaluation of the emergency response to include identification of deficiencies and opportunities for improvement. This observation was reviewed with the DPCS, and Office Manager.

Observed in Record Review. In 8 of 9 patient records reviewed, for active patients, the organization failed to ensure the hospice interdisciplinary group consider changes that have taken place since the initial assessment and include patient's progress toward desired outcomes and response to care. For example: on review of the active patient records the comprehensive assessment and plan of care lacked the patient's progress toward goals and outcomes as the goals and interventions remained the same IDG to IDG. Most goals were established on admission and remained without update based on the comprehensive assessment throughout care. For example: on HV#3 the goals stated patient/caregiver will verbalize/express understanding of medication/treatment orders and side effects daily for 30 days and had been in effect since admission in February. In HV#2 the goals were established such as altered skin will heal to maximum potential and altered skin will be free of infection. Will reassess in next 60 days were established on admission in 2020 and remain unchanged without noted progress to the goals. In RR#5 goal stated patient will verbalize and/or express decreased episodes of SOB at rest daily x 3 days, yet the goal had been established on admit in April 2023 and remained unchanged without documentation of progress toward the goal. Further examples of lack of documentation of progress toward goals can be see throughout all established active records. These observations were reviewed with the DPCS and Office Manager.

Observed in Record Review. In 9 of 9 patient records reviewed, for active patients, the organization failed to ensure the plan of care was based on the patient's goals and the time frames, settings, and services required to meet those goals. Throughout all active records reviewed the goals lacked being specific, measurable, and time bound. The goals were noted to lack specificity and short term goals to address needs with non-specific or unrealistic achieve-by dates. For example: in HV#1 a goal noted patient will remain free of injury daily if possible x 90 days, and will be able to prevent altered skin integrity daily if possible x 90 days. In HV#2 examples include Patient will have decreased anxiety related to respiratory distress and Patient will have optimum level of O2, along with Reassess next recert in 60 days. Example in HV#3 is Patient/caregiver will verbalize/express understanding of medication/treatment orders and side effects daily for 30 days. In RR#4 goal stated Aspiration will be prevented until next review. Similar examples can be see throughout the records reviewed. These observations were reviewed with the DPCS, and Office Manager.

Observed in Record Review. In 5 of 9 patient records reviewed, from active patients, the organization failed to ensure the plan of care included all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of HV#2 documentation noted the patient was suffering from lower extremity edema, yet edema was not reflected in the care plans. In HV#3 the patient had multiple wounds and wound care orders noted wound care to wounds 1 through 6, however on review of documentation from contracted wound care specialists wound #3, and #5 had healed. The changes in wound care were not reflected in the orders or plan of care. In review of RR#5 the documentation noted an issue with hypotension that required holding the patient's BP meds, yet this was not reflected in the care plan. In RR#6 the documentation noted poor intake, but no care plan for nutrition, Also, changes were made in the patient's pain meds, yet the changes were not reflected in the care plan. In RR#7 the documentation noted issues with decreased appetite and a new medication started for agitation, yet the care plan did not reflect the issues documented. These observations were reviewed with the DPCS and Office Manager.

Observed in Record Review. In 1 of 9 patient records reviewed, for active patients, the organization failed to ensure the care and services were provided in accordance with the plan of care. On review of HV#1 the documentation noted redness to the coccyx and plan of care orders clean redness to coccyx area with normal saline, pat dry, and apply silicon bordered dressing daily and PRN soiled or dislodged. On the home observation and interview with the LVN it was noted the area was being treated with moisture barrier and topped with powder and left open to air. In review of LVN documentation of the most recent visit it was documented that the area was covered with Duoderm for protection, which was not as ordered in the plan of care. This observation was reviewed with the DPCS.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization failed to ensure the staff implemented the infection prevention and control it had planned per policy. For example: on observation of the hospice aide on HV#3 the aide was observed to provide patient care to the patient's perineal area and change diaper, but failed to perform hand hygiene and change gloves prior to performing other duties in clean areas, such as dressed and positioned patient, and applied lotion after peri care. Further it was noted that the Aide after washing hands used a towel provided by the caregiver and not disposable towels as noted in policy. This observation was reviewed with the DPCS and Office Manager.

Observed in HR File Review. In the hospice aide hr file that was reviewed, there was no documentation of an annual on-site visit to the location where a patient is receiving care in order to observe and assess the aide while care was being performed. There was an annual performance evaluation documented, yet this form did not indicate that the performance eval was completed on-site to observe the Aide while providing care. This observation was reviewed with the DPCS.

Observed in Record Review. In 2 of 9 patient records reviewed, For active patients, the organization failed to ensure the medical director reviews the clinical information for each hospice patient and provide written certification that the patient's life expectancy is six months or less if the disease runs its normal course. For example: on review of RR#7 the physicians narrative on the CTI appeared similar each benefit period and lacked all required elements, specifically current subjective and objective findings. In Review of RR#9, the physician's narrative appeared very similar over the last several recertifications and also lacked all required elements, such as current subjective and objective findings. These observations were reviewed with the DPCS and Office Manager.

Observed in Record Review. In 1 of 9 patient records reviewed, for active patients, the organization failed to ensure the record contain all information that reflects the patient care, treatment, and services. For example: on review of HV#3 the patient had wounds that required dressing changes, however the SN's documentation failed to include necessary components and details of providing the ordered wound care. Documentation form the SN noted dressing changes were completed but lacked the type of dressing and how the dressing change was done as is required by organization policy. This observation was reviewed with the DPCS and Office Manager.