Every finding on record at Hope Hospice, Inc.

Observed in Record Review. In 2 of 14 active patient records reviewed, the plan of care did not contain orders necessary to provide care. On RRHV #2, it was noted on the plan of care that the oxygen orders were for 3L of oxygen but on the home visit the oxygen concentrator was at 5L. On RRNHV #6, it was noted that there was a gap of 6 days that wound care was being provided without a order. This finding was reviewed with and validated with Hospice leadership.

Observed in Record Review. In 2 of 14 active patient records reviewed, the plan of care did not include medical supplies and appliances necessary to meet the patient's needs. On RRHV #1 it was noted that the plan of care did not include all equipment needed to care for the patient including air mattress and wheelchair. On RRHV #4, it was noted on the by the nurse surveyor during the home visit that patient has a hospital bed, bedside table and shower chair that is not reflected on the plan of care. This finding was reviewed and validated with Hospice leadership.

Observed in Record Review. In 1 out of 14 active patient charts reviewed with aide services, that had ordered aide services, the Aide Care Plan did not have specific instructions for the aide. During the home visit for RRHV #4, the assigned tasks did not include specific instructions for care of the patient for example patient is incontinent and using adult diapers. Patient is also using a shower chair for showers and this detail is not reflected in the aide care plan.. This finding was reviewed and validated with Hospice leadership.

Observed in Patient Home. In 1 of 4 home visits conducted, the organization did not provide copy of its written policy and procedures on management and disposal of controlled substances to the patient or caregiver. On RRHV #1, it was noted that patient was not given a the policy and procedure for controlled substance when controlled substances were ordered. The organization has just recently updated their admission packet but this patient was admitted prior to the updated and did not receive the information. This finding was reviewed and validated with agency leaders.

Observed in Record Review. In 3 of 5 bereavement records reviewed, the organization did not follow California regulations regarding pronouncement of death. Per California regulation, death may only be pronounced by RNs under special circumstances, as such, this task may not be delegated to an LVN. On RRBR #2, it was noted in the documentation that the LVN documented this action was performed under the auspice of the RN”. On RRBR #4, it was noted in the documentation that the LVN documented “Under auspices of RN confirmed the time of death of patient was 1002”. On RRBR #5, it was noted in the death visit documentation that the LVN documented “This action was performed under the auspice of the RN”. This finding was reviewed, discussed and validated with the hospice leadership team.

Observed in Individual Tracer. In 1 of 3 home visits conducted, the organization did not promote the exercise of the patient's rights. In HV #1, the surveyor noted the patient's admission folder in the facility included a blank addendum that was signed by the patient representative. This was discussed with the Chief Patient Officer. Observed in Record Review. In 13 of 13 patient records reviewed, the patient was not informed of their financial liability prior to the initiation of services. In all records reviewed, the HCO failed to notify the patient of their financial responsibility in writing prior to care being provided. This was confirmed with the Chief of Quality and Compliance.

Observed in Record Review. In 7 of 13 patient records reviewed, the plan of care was not based on the patient's goals and the time frames, settings and services required to meet those goals. In HV #1, the surveyor noted the following non-measurable goals: Patient achieves feelings of spiritual comfort. Patient/caregiver will consult with MSW as needed for support. This was confirmed with the Chief of Quality and Compliance.In HV #2, the surveyor noted the following non-measurable goal: Patient/family will review life for meaning/acceptance. In addition, goal timeframes for nursing were to be completed at the end of the certification period including verbalizing when to call hospice. Also, the chaplain goals were to be achieved in one year from the start of care date. This was confirmed with the Chief of Quality and Compliance.In HV #2, the surveyor noted the following non-measurable goal: Patient/Caregiver will utilize appropriate bereavement resources as needed for support. This was confirmed with the Chief of Quality and Compliance.In RR #2, the surveyor noted the nursing goal time frames were all for the end of the certification period including the following goals: Patient will express satisfactory control of symptoms. Patient will verbalize understanding of pain management regimen. In addition, the chaplain goal time frames were all one year from the start of the certification period. This was confirmed with the Chief of Quality and Compliance.In RR #4, the surveyor noted the plan of care included the following non-measurable goals: patient/family will acknowledge support and understanding of plan. In addition, the timeframe for all nursing goals were the end of the certification period including: patient/caregiver can describe management of a seizure episode. This was confirmed with the Data Analyst.In RR #5, the surveyor noted the plan of care included the following non-measurable goals: Patient/family will demonstrate health, functional approach to dealing with patient situation and anticipated loss. All nursing goals were to be achieved at the end of the certification period including patient/caregiver will demonstrate understanding of measures to prevent/alleviate constipation. All chaplain goals were to be achieved 12 months after the start of care. This was confirmed with the Data Analyst.In RR #7, the surveyor noted the plan of care included the following non- measurable goal: patient's nutritional needs will be met as patient's condition/comfort allows. All nursing goals had a target date at the end of the certification period including caregiver will demonstrate ability to care for dependent patient. This was confirmed with the Chief of Quality and Compliance.

Observed in Record Review. In 7 of 13 patient records reviewed, the plan of care did not include interventions to manage pain and symptoms.In HV #1, the surveyor noted the patient was at risk for skin breakdown and was coughing with congestion; however, the plan of care did not include interventions to address these identified needs. In addition, the plan of care did not include interventions to reach patient goals for the medical social worker, only assessments. This was confirmed with the Chief of Quality and Compliance.In RR #1, the surveyor noted the patient was identified as having pain, fatigue, shortness of breath, skin break down risk, dysphagia, fall risk and edema; however, the plan of care did not include interventions to address these identified needs. This was confirmed with the Chief Quality Officer.In RR #3, the surveyor noted the patient was identified as having 4+ pitting edema, at risk for falls; however, the plan of care did not include interventions to address these identified needs. This was confirmed with the Data Analyst.In RR #4, the surveyor noted the patient was identified at risk for aspiration and skin breakdown; however, there were no interventions on the plan of care to address this identified need. The plan of care was updated 20 days after the start of care to address skin breakdown. This was confirmed with the Data Analyst.In RR #6, the surveyor noted the patient was identified as having severe diarrhea and at risk for falls however, the plan of care did not include interventions to address these identified needs. This was confirmed with the Data Analyst. In RR #7, the surveyor noted the patient was identified at skin breakdown risk and fall risk; however, the plan of care did not include interventions to address these identified needs. This was confirmed with the Chief of Quality and Compliance.In RR #9, the surveyor noted the patient was identified as having pain, ascites and edema on admission; however, the plan of care did not include interventions to address these identified needs. This was confirmed with the Chief of Quality and Compliance.

Observed in Record Review. In 8 of 13 patient records reviewed, the plan of care did not include a detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs.In HV #1, the surveyor noted the plan of care did not include a visit frequency for the medical social worker except 5 prn visits. This was confirmed with the Chief of Quality and Compliance.In HV #2, the surveyor noted the plan of care included a skilled nursing visit frequency of 1 - 5 visits per week with 15 prn visits. This was confirmed with the Chief of Quality and Compliance.In RR #3 and RR #9, the surveyor noted the patient declined chaplain services; however, the plan of care included a chaplain visit frequency of 5 prn visits. This was confirmed with the Chief of Quality and Compliance.In HV #3, the surveyor noted the plan of care included conflicting skilled nursing visit frequency. Under the discipline section, the plan of care indicated a visit frequency for skilled nursing 1 - 2 visits per week; however, under the narrative section, the skilled nursing visit frequency indicated 2 - 3 visits per week. This was confirmed with the Chief of Quality and Compliance.In RR #5, the surveyor noted the plan of care included 15 prn skilled nursing visits. This was confirmed with the Data Analyst.In RR #6, the surveyor noted the plan of care visit frequency was 1 - 2 x's per week. The second week of service, the patient's condition changed and prn visit were utilized; however, the plan of care visit frequency for nursing was not updated although the patient was being seen 5 x's per week. The skilled nurse added additional prn visits to the plan of care rather than increasing the visit frequency. This was confirmed with the Data Analyst.In RR #7, the surveyor noted the patient declined chaplain services and medical social services; however, the plan of care included a chaplain visit frequency of 5 prn visits. This was confirmed with the Chief of Quality and Compliance.

Observed in Record Review. In 6 of 13 patient records reviewed, the plan of care did not include all drugs and treatment necessary to meet the needs of the patient.In HV #3, the surveyor noted the plan of care wound care intervention did not include the frequency of the wound care. This was confirmed with the Chief of Quality and Compliance.In RR #1, the surveyor noted the patient had a suction machine; however, there was no intervention for suctioning on the plan of care. In addition, the patient had a foley catheter; however, the plan of care did not include interventions related to the foley catheter to include size, balloon and frequency of change. This was confirmed with the Chief of Quality and Compliance.In RR #2, the surveyor noted the plan of care order for lidocaine topical did not specify the location of application. This was confirmed with the Chief of Quality and Compliance.In RR #3, the surveyor noted the patient had a foley catheter; however, the plan of care did not include interventions for the foley catheter such as the size of the foley catheter, balloon size, and when to change. This was confirmed with the Data Analyst.In RR #7, the surveyor noted the plan of care included a medication order for ketocanzole topical ; however, the plan of care did not include the location of application. This was confirmed with the Chief of Quality and Compliance.In RR #9, the surveyor noted the plan of care included a medication order for olopatadine ophthalmic drops which indicated each affected eye; however, the order did not specify which eyes or what indication for apply in the affected eye. This was confirmed with the Chief of Quality and Compliance.

Observed in Record Review. In 2 of 13 patient records reviewed, the organization did not provide care, treatment or services for each patient.In RR #1, the surveyor noted the plan of care skilled nursing visit frequency was 1 -2 x's per week; however, the patient was seen 4 x's the second week of service and daily visits started the third week of care. The plan of care was not updated to reflect the change in visit frequency. This was confirmed with the Chief of Quality and Compliance.In RR #6, the surveyor noted the aide documented two missed visits as the care was already provided by the facility; however, the RN was not notified of the missed visits. This was confirmed with the Data Analyst.

Observed in Individual Tracer. In 1 of 3 home visits conducted, the hospice did not use standard precautions to reduce the risk of infection. In HV #1, the surveyor noted the aide doffed gloves after performing peri-care and donned new gloves without performing hand hygiene. This was discussed with the Chief Patient Officer.

Observed in Record Review. In 4 of 13 patient records reviewed where the patient received aide services, the aide did not provide services as ordered in the plan of care.In HV #3, the surveyor noted the aide plan of care included washing feet and applying lotion, skin care to include applying lotion with every visit, change linen every visit and oral care every visit; however, these tasks were not performed at the first aide visit. The documentation did not specify if the patient refused or the nurse was notified. This was confirmed with the Chief of Quality and Compliance.In RR #1, the surveyor noted the aide obtained the patient's temperature; however, this was not on the aide plan of care. This was confirmed with the Chief of Quality and Compliance.In RR #4, the surveyor noted aide plan of care included oral care and foot care; however, this was not performed on two aide visits. There was no documentation of patient refusal or RN notification. This was confirmed with the Data Analyst.In RR #6, the surveyor noted aide plan of care included oral care; however, this was not performed on the first aide visit. This was confirmed with the Data Analyst.

Observed in Competency Session. In 2 of 10 HR files reviewed, the hospice did not assess the skills and competence of all individuals furnishing care. In HR #8, the surveyor noted the bereavement coordinator did not have competence assessed in the past 3 years. This was confirmed with the Chief of HR. In HR #9, the surveyor noted the physician designee did not have competence assessed in the past 3 years. This was confirmed with the Chief of HR.

Observed in Record Review. In 2 of 3 patient records reviewed where the patient was recertified, the medical director, physician member of the interdisciplinary team, or physician designee did not review the patient's clinical information before the recertification period. In HV #3, the surveyor noted the certificate of terminal illness was not signed until 8 days after the second certification period began. This was confirmed with the Chief of Quality and Compliance.

Observed in Individual Tracer. In 1 of 3 home visits conducted, the clinical record did not contain an accurate medication list.In HV #2, the surveyor noted the medication profile indicated the patient was taking hydrocortisone topical to the left hand; however, the patient's caregiver reported that had been discontinued at the time of admission to hospice. This was confirmed with the Chief Patient Officer. Observed in Record Review. In 6 of 13 patient records reviewed, the patient record did not contain all clinical information.In RR #4, the surveyor noted there was no documentation of seizure activity on a routine visit note. In discussion with the RN, the assessment was performed; however, the nurse failed to document the assessment. This was confirmed with the Data Analyst. In RR #3, RR #8, RR #9 and RR #10, the surveyor noted the recently hired skilled nurse documented the patient requested the notice of non-covered Medicare drugs and treatments; however, in discussion with the skilled nurse, she stated this was inaccurate documentation as she did not understand the document. The patient did not request the document. This was confirmed with the Data Analyst.In RR #10, the surveyor noted the nurse documented the patient had a urinary catheter under supplies; however, the patient did not have a foley catheter. This was confirmed with the Chief of Quality and Compliance.In HV #2, the surveyor noted the assessment indicated tracheostomy supplies; however, the patient did not have a tracheostomy. This was confirmed with the Chief of Quality and Compliance.

Observed in Infection Control System Tracer. In 3 of 3 home visits conducted, the organization did not provide individualized procedures to follow if services were disrupted during a natural disaster or emergent event.In HV #1, HV #2, HV #3, the surveyor noted the organization did not provide education on an individualized emergency management plan for the patient to address clinical, functional, caregiver support and equipment needs during a disaster or emergency. This was confirmed with the Chief of Quality and Compliance.