Every finding on record at Greenwood Healthcare, Inc

Based on observation, interview and record review, the hospice staff failed to review all medications the patients are taking and update the medication profiles with the currently used medications for 2 of 4 sampled patients (Patients 1 and 2). This deficient practice has the potential to put the patient at risk for medication errors and adverse drug reactions. --- 2. A review of Patient 2's "Physician's Certification for Hospice Benefit" for the period of 11/9/22 to 1/7/23 indicated the patient was receiving routine hospice care for malignant neoplasm of the brain (otherwise known as brain cancer) with right sided body weakness and paralysis (inability to move one side of the body), seizures (a disorder in which nerve cell activity in the brain is disturbed), aphasia (a disorder that results from damage to portions of the brain that are responsible for language). Patient 2 has poor appetite and mainly in bed. Patint 2 has nutritional impairment with progressive weight loss. Requires pain and symptom management. Recertify for routing hospice care focusing on pain and symptom management and to provide optimal comfort. On 12/16/22, at 10:30 a.m., during a joint home visit with the Director of Patient Care Services (DPCS) at Patient 2's residence. Patient 2 was observed sitting up on bed awake and alert, not in any respiratory distress. Patient 2's husband was at bedside. DPCS initiated with her visit. During observation of Patient 2's visit, Patient 2 stated a pain level of 8 to the DPCS. Patient 2's husband stated she took her medications at 9:00 a.m., after breakfast. During an interview with the Patient 2's husband , stated that the nurse takes care of the patients medication on the weekly medication planner every Tuesday. Patient 2 also stated that he only gives her what the nurse had placed on the weekly medication planner. During a review of Patient 2's medications. The following discrepancies were noted in contrast with the medication profile: Acetaminophen (Tylenol) 500 mg 1 tablet by mouth every 4 hours as needed for pain. Patient 2's husband stated, "She doesn't take Tylenol, I bought that for my son when he complains of pain so I have it on stock." Multivitamin One-A-Day 1 tablet every day for supplement. Husband stated " I bought that over the counter and gave it to her." During an interview with the DPCS, DPCS stated importance of reviewing the medications and teaching the husband on how to manage pain every visit. A review of the HA's policy no. 4-050.1 titled " Medication Profile" dated November 2020, indicated that the medication profiles should be updated for each change to reflect the current medications, and new and/or discontinued medications. During subsequent home visits, the medication profile will be used as a care planning and teaching guide to ensure that the patient and family/caregiver, as well as other clinicians, understand the medication regimen. Findings: A review of Patient 1s Personal Information sheet, indicated a start of care date (SOC) of 6/13/22 with a diagnosis of Alzheimers disease (a progressive brain disease that destroys memory and other important mental functions). A review of Patient 1s Physician Certification for Hospice Benefit (CIT), dated 12/5/22, indicated a certification period of 12/10/22 to 2/7/23. Patient 1 had a diagnosis of Alzheimers disease. Co-morbidities include chronic kidney disease stage 3, atrial fibrillation (irregular, rapid heart rate that causes poor blood flow), and hypertension (high blood pressure). Patient 1 was alert, but non-verbal, bedbound and needs total assistance with activities of daily living. Patient has nutritional impairment, and has significantly declined in mobility. On 12/15/22, at 11:30 am, a home visit at an assisted living facility was conducted for Patient 1, with the Director of Patient Care Services (DPCS). Patient 1s medications were reviewed, and revealed Patient 1 was receiving a medication at the assisted living facility that was not on the HAs medication profile. A review of Patient 1s medication list from the assisted living facility titled ";Order Review Report", dated 12/15/22-12/31/22, indicated an order for Lovastatin tablet 20mg. Give 1 tablet by mouth one time a day for cholesterol control. The medication had an order date 6/13/22 and a start ate of 6/14/22. A review of Patient 1s HAs medication list titled ";Current Treatment/ Medication/DME List", did not have the Lovastatin medication listed. A review of Patient 1s Physicians Orders, dated 6/13/22, indicated an order to discontinue the medication Lovastatin. During an interview on 12/16/22, at 2:10 pm, DPCS stated the order for Lovastatin had been discontinued, but it was missed by the assisted living facility. DPCS stated the visiting nurse should be doing medication reconciliation at each visit to make sure that the patients are taking the correct medications and there are not any errors. A review of the HAs policy titled ";Medication Profile", dated 11/2020, indicated that patients receiving medications administered by the organization will have a current, accurate medication profile in the clinical record. Medication profiles will be updated for each change to reflect current medications, and /or discontinued medications.

Based on interview, and record review, the hospice agency failed to ensure other core services that included volunteers, spiritual counselor, and social worker were offered to 1 of 4 sample patients (Patient 2). The deficient practice has the potential to delay the patient care needs and services as identified in the plan of care. --- Findings: A review of the HA's document titled "Physician's Certification for Hospice Benefit" for the period of 11/9/22 to 1/7/23 indicated that Patient 2 was receiving routine hospice care for malignant neoplasm of the brain (otherwise known as brain cancer) with right sided body weakness and paralysis (inability to move one side of the body), seizures (a disorder in which nerve cell activity in the brain is disturbed), aphasia (a disorder that results from damage to portions of the brain that are responsible for language). Patient 2 had poor appetite, nutritional impairment with progressive weight loss. Patient 2 was recertified for routine hospice care focusing on pain and symptom management and to provide optimal comfort. A review of the HA's document titled "Plan of Care" dated 12/15/22 indicated hospice aide visits twice per week, Registered Nurse (RN) once every two weeks plus 1-2 visits per week as needed, Skilled Nurse (SN) once per week plus 1-2 visits per week as needed. On 12/16/22, at 10:30 a.m., during a joint home visit with the Director of Patient Care Services (DPCS) at Patient 2's residence. Patient 2 was observed sitting up on bed awake, alert, pleasant and not in any respiratory distress. Patient 2's husband was present at bedside. DPCS initiated with her visit. During an interview with Patient 2's husband/caregiver, stated "I would love to have someone come in and help bathe her. We are God loving people and we also would love to have a spiritual counselor come in and visit." Patient 2 also stated, "we both turned 65 years old, and It's getting hard for me to take care of her and would like to know what other services we can both have." Patient 2's husband also stated he was looking for another doctor. Patient 2's husband also stated he only talked to the nurse during the visit and had not spoken to the hospice doctor. During an interview with the DPCS after the home visit, DPCS stated the husband "declined" volunteer, spiritual counselor and medical social worker visits every time it was offered. DPCS agreed that the patient may benefit from spiritual counselor because they are religious people. DPCS stated Patient 2 used to have church services but because of the pandemic and patient's condition, they have to be at home all the time." During a phone interview with the hospice Medical director (MD), on 12/16/22 at 1:40 p.m., MD stated that he only conducts telehealth with the nurse during assessment for recertification and discuss the patient's condition during interdisciplinary team meetings. MD firmly stated he does not go to patient's home for recertification and assessment of hospice patients and was unable to recall when the last time he saw Patient 2. A review of the HA's policy no. 4-037.1 titled " Coordination of Care with contracts/Agreements" dated November 2020, indicated that core services including physician, nursing, social work, counselors, are provided directly by the hospice. The Case manager (CM) will coordinate services provided under contractual agreement. Hospice will maintain professional responsibility for all services provided. All care provided will be in accordance with the hospice hospice plan of care and documented in the clinical record.

Based on interview and record review the hospice agency (HA) failed to ensure a process of tracking, documenting, implementing their policies and procedures regarding Coronavirus disease 19 (COVID 19, a severe respiratory illness caused by virus and spread from person to person) infection control for all HA staff. This deficient practice has the potential risk in placing employees , patients, and their families at risk for spreading and/or contracting COVID-19 infection, that could lead to severe respiratory illness, hospitalization and/or death. Findings: An unannounced recertification survey was conducted on 12/14/22 to 12/16/22 at this location. It was observed there was no Covid-19 screening for visitors and staff upon entrance to the agency. On 12/15/22 at 2:27 p.m., during a concurrent interview with the Director of Patient Care Services (DPCS) and the Administrator (Admin) stated all hospice office and field staffs were 100% vaccinated and boosted for Covid-19. DPCS stated since their 100 % they did not have to do tracking, monitoring and documentation for screening for Covid-19. During a review of the HAs policy titled ";Covid-19 Vaccination" effective date 8/3/22, indicated TC Palliative and Hospice Care will ensure the following processes are in place. Track 100 % of staff specified in the Covid-19 Vaccination Policy, section A.1. Additional precautions intended to mitigate the transmission or spread of Covid-19 are taken for all staff who are not fully vaccinated for Covid-19. TC Palliative and Hospice will reference and follow CDC (Center for Disease control and prevention resources as guidance for mitigation strategies. A review of "Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2" dated 9/23/22 indicated guidance addressing recommended infection prevention and control practices including use of source control by HCP(health care personnel is available in Infection Control: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Employers should be aware that other local, territorial, tribal, state and federal requirements may apply, including those promulgated by the occupational Safety and Health Administration (OSHA). According to the State Public Health Officer Order dated 9/13/22 indicated facilities must continue to track workers' vaccination or exemption status to ensure they are complying with these requirements. CDPH(California Department of Public health) recommends that all workers stay up to date on Covid-19 and other vaccinations. CDPH continues to assess confitions on an ongoing basis. California must be vigilant to maintain situational awareness through surveillance and be ready to pause or reinstate a higher level of protective mitigation recommendations or requirements.