Every finding on record at Hospice Care Providers, Inc.

Observed in Record Review. In 3 of 3 patient records reviewed, with discharge for extended prognosis, the organization failed to respect the patient's rights in decisions about their care, treatment, or services as the Notice of Medicare Non-Coverage was signed in RRDC#1, RRDC#2 and RRDC#3 on the same day of discharge and not at least two days prior to discharge as required. Further, the form failed to provide the correct number to the QIO for California. These observations were reviewed with the Administrator and DPCS.

Observed in Record Review. In 3 of 8 patient records reviewed, the organization failed to conduct and document a patient-specific comprehensive assessment and reassessment that identified the patient's need for hospice care and services. For example: on review of RRHV#3 the patient had orders for IV fluids for hydration with daily RN visits yet the RN documentation failed to document assessment of the IV site to include location, any leaking, redness, tenderness, swelling, and condition of dressing. There was no documentation of the procedure to discontinue the IV to include the condition of the catheter, character or the site, and any patient symptoms related to the procedure. In RRNHV#4 the patient record had a wound documented as an open area called perineal excoriation yet the SN failed to document a comprehensive assessment of the wound as there was no description of the size or character of the skin involved. There were also wounds documented to the foot that also lacked description of a size as required by policy that noted documentation should include appearance, odor, and size of the wound, dressing procedure and time of dressing change. In RRNHV#7 there were wounds noted to the patient's forehead, one described as a skin tear, and another as an open wound yet there was no documentation of the size of the wounds as required. There observations were reviewed with the Administrator and DPCS.

Observed in Record Review. In 1 of 8 patient records reviewed, for active records, the organization failed to ensure the patient record was complete, promptly and accurately documented. For example: on review of RRHV#3 the patient record noted the patient had IV fluids for hydration that was discontinued in June yet the next day, after the stop order, documentation by the RN noted IV D5 1/2 NS @ 30cc hr. This observation was reviewed with the Administrator, and DPCS.

Observed in Record Review. In 2 of 8 patient records reviewed, the organization failed to ensure the care and services were provided in accordance with the plan of care. For example: on review of RRHV#2 the documentation noted the patient with an open wound in mid June with new dressing change orders and update to the plan of care, however in the next two LVN visits after the change in plan of care the LVN documented performing the previously discontinued order. In review of RRHV#1 the plan of care noted a new stage 1 to the sacrum with orders to provided treatment daily on SN days and for caregiver to provide on non-nursing days yet on home observation the LVN was not observed to provide the treatment ordered in the plan of care. These observations were reviewed with the Administrator and DPCS.

Observed in Record Review. In 2 of 8 patient records reviewed, the organization failed to ensure the Registered Nurse provide complete written patient care instructions for the hospice aide. For example: on review of RRHV#2 the patient had a wound with a dressing to the sacrum yet there were no instructions how to handle the dressing while showering the patient. In RRNHV#7 there were wounds documented to the patient's forehead yet the aide assignment was not updated to provided instruction to the aide on how to handle the area while providing care. These observations were reviewed with the Administrator and DPCS.

Observed in Record Review. In 2 of 3 patient records reviewed, for patient death, the organization failed to ensure the staff are available to attend the to the patient at death, and assist the family with after-death care in accordance with the family's request and law and regulation. On review of RRHV#1, and RRHV#2 there was no documentation that a visit was made at the time of death. There was a discharge summary that the RN indicated a date and time of death yet no indication that a visit was made. These observations were reviewed with the Administrator and DPCS.

Observed in Leadership Session. Upon review of all tracer activities, it was noted that there was a pattern of staff failing to follow established organization policy and the governing body/leadership did not ensure that the Conditions of Participation for 418.100, and 418.104 were met per policy as determined through observations, documentation, and staff interviews.

Observed in Competency Session. In 2 of 2 contracts reviewed, for the Medical Director, and Alternate Medical Director the contract failed to ensure the physician services were made routinely available on a 24 - hour basis 7 days a week. The contract noted that the Medical Director/ Alt Medical Director will be available 8:00-4:30 Monday-Friday for on-call consultation, assistance and decisions regarding patient care. There was no provision noting the physician would be available 24/7. This observation was reviewed with the Administrator.

Observed in Record Review. In 4 of 8 patient records reviewed, the organization failed to ensure the patient record contained information to reflect the patient's care, treatment, or services. For example: on review of RRHV#3 the RN failed to provided documentation of the procedure used to insert the IV for fluid administration. The documentation noted that IV was started to Rt hand and tolerated well but failed to note the size of needle and canula, number of attempts needed or how the IV was secured and dressed. Further, during daily visits there was no documentation of amount of fluid infused, or when bag was changed. There was no documentation of when the IV canula was discontinued and the procedure to remove and how the patient tolerated the procedure. In RRNHV#4 the patient had documentation of wound treatments yet in the last 3 LVN visits the documentation noted SN performed treatment as ordered and patient tolerated well yet there was no description of the procedure done as required. In RRNHV#6 there was an example in June of the LVN providing care to the wound but documentation noted SN performed wound care as ordered. In RRNHV#7 there were multiple SN visits in May that did no document the treatment provided as it stated patient was able to tolerate treatment for right side of forehead skin tear, and right side forehead open wound yet no description of the treatment provided as required. These observations were reviewed with the Administrator and DPCS. Observed in Record Review. In 1 of 3 patient records reviewed, the organization failed to ensure the record reflect the patient's care, treatment and services. For example: on review of RRBR#1 the only visit after admission prior to death documentation was noted to be incomplete in the record as it had a time in yet many aspects of the note were blank and did not reflect the patient status. The note was from 2023 and well beyond policy for submission. This observation was reviewed with the Administrator.

Observed in Regulatory Review. In 2 of 8 patient records reviewed, the organization failed to ensure all entries in the patient record were legible, clear, complete and appropriately authenticated and dated in accordance with organization policy and currently accepted standards of practice. For example on review of RRNHV#4 most nursing visits dating back many months were not signed in the record as they had been documented and submitted but were left in a review status, where there was no signature and date stamp noted on the record. In RRNHV#8 most of the nursing comprehensive assessment visits were also left in review status therefore not having a clinicians signature and date stamp visible on the record. These observations were reviewed with the Administrator and DPCS.

Observed in Record Review. In 3 of 3 patient records reviewed, who were discharged for extended prognosis, the organization failed to ensure that prior to discharge the organization assists in arranging the services required by the patient after discharge in order to meet the ongoing needs for care services. For example: on review of RRDC#1, RRDC#2, and RRDC#3 there was no documentation of discharge planning to ensure a smooth transition from hospice services. There was no documentation of arranging for the ongoing needs after discharge as all three discharged patient had oxygen and DME equipment such as hospital bed, wheelchair, nebulizer that were noted on the plan of care as hospice covered yet no arrangements for how the patient would attain the needed equipment after discharge from hospice. Further, there was no documentation that the patient/family was assisted in getting an appointment with a providor to continue care after discharge. These observations were reviewed with the Administrator and DPCS.

Observed in Record Review. In 3 of 6 patient records reviewed, it was noted that the visits were not provided in accordance with the plan of care. For example, in RR#1 the aide was ordered at SOC to visit 2 times per week but 3 visits were made during week one. In RR#2 an extra SN visit was made during week one and in RR#3 the SN was ordered twice weekly but only one visit was made week one as it was the last day of the week. This was discussed with the Administrator and DPCS.