Every finding on record at Hospice of Humboldt, Inc.

Based on observation, interview, and record review, the facility failed to ensure Patient 6s back pain was effectively managed. This failure resulted in ineffective pain management for Patient 6. --- Findings: During a review of the facilitys policy and procedure (P&P) titled, ";Pain Assessment Protocol," dated 6/1/17, the P&P indicated, ";Patients are never left in pain above their self-identified acceptable level of pain." The Pain Severity Assessment Scale form, indicated 0=none; 1-2, annoying; 3-5, uncomfortable; 6-7, distressing; 7-9, horrible and 10, unbearable. During a review of Patient 6s Face Sheet, the Face Sheet indicated Patient 6 was admitted for hospice services on 10/16/22, with diagnoses including right buttock pressure ulcer and chronic back pain syndrome. During a home visit on 9/12/23 at 2:55 p.m. in [name of assisted living facility], Patient 6 was in bed, awake, and alert. During Patient 6s right buttock wound care procedure with Registered Nurse 4 (RN 4), on 9/12/23 at 3:10 p.m., Patient 6 was observed moaning and complaining of pain. RN 4 completed Patient 6s right buttock wound care procedure but did not address Patient 6s complaint of pain during the procedure. During an interview with Patient 6 on 9/12/23 at 3:15 p.m., Patient 6 stated she had back pain, and it was an 8 (horrible) on the 0-10 pain level scale. Patient 6 also stated that she had not receive pain medication prior to the procedure. During an interview with RN 4 on 9/12/23 at 3:17 p.m., RN 4 stated she did not administer pain medication to Patient 6 prior to the right buttock wound care procedure. During a review of Patient 6s Medication Administration Record (MAR), dated 9/11/23, the MAR indicated Oxycodone IR (Intermediate Release- pain medication to treat moderate to severe pain) 10 milligrams (mg) every 2 hours by mouth/sublingual (under the tongue) as needed for pain. During an interview on 9/14/23 at 9:10 a.m., with Director of Patient Care Services (DPCS), DPCS stated RNs should assessed and evaluated Patient 6s level of pain and administered pain medications as needed prior to wound care.

Based on interview and record review, the facility failed to ensure home visits were followed according to plan of care for 5 of nineteen sampled patients (Patient 6, 7, 8, 10, 13) when: 1. Patient 6 did not receive 27 home visits (HV). 2. Patient 7 did not receive 1 HV. 3. Patient 8 did not receive 32 HV. 4. Patient 10 did not receive 4 HV. 5. Patient 13 did not receive 1 HV. These failures had the potential for the facilitys patient care needs and services to be unmet. --- 1a. During a concurrent interview and record review with Director of Patient Care Services (DPCS), the Face Sheet indicated, Patient 6 was admitted for hospice services on 10/16/22, with diagnoses including pressure ulcer on right buttock. During a review of the Patient Care Volunteer (PCV) assigned frequency of HV starting 10/20/22, indicated 2 times a week for 12 weeks. During the Visit Calendar and Frequency of Visit Review (VCFVR) for certification period from 10/16/22 to 1/13/23, the VCFVR indicated there were a total of 15 missed PCV visits as follows: 4 missed HV from 10/30/22 to11/26/22. 6 missed HV from 11/27/22 to 12/17/22. 1 missed HV from 12/18/22 to 12/24/22. 4 missed HV from 12/25/22 to 1/3/23. 1b. During a review of the Medical Social Worker (MSW) assigned frequency of visits starting 1/14/23 indicated 3 times a month for 3 months. During the VCFVR for certification period from 1/14/23 to 4/13/23, the VCFVR indicated there were a total of 6 missed MSW visits as follows: 2 missed HV in January. 2 missed HV in February. 2 missed HV in March. 1c. During a review of Skilled Nursing (SN) and Home Health Aide (HHA) assigned frequency of HV starting 4/14/23, indicated SN 1 to 2 visits per week for 10 weeks and HHA once a week for 10 weeks. During the VCFVR review for certification period from 4/14/23 to 6/12/23, the VCFVR indicated, there were a total of 2 missed visits as follows: 1 missed SN visit during the week of 6/11/23. 1 missed HHA visit during the week of 4/14/23. 1d. During a review of Home Health Aide (HHA) assigned frequency of HV starting 6/13/23, indicated HHA once a week for 9 weeks. During the VCFVR review for certification period from 6/13/23 to 8/11/23, the VCFVR indicated, there was 1 missed HHA visit during the week of 6/13/23. 1e. During a review of SN, HHA and PCV assigned frequency of HV starting 8/12/23, indicated SN once a week for 1 week then 1 to 3 weeks for 9 weeks, and 5 visits as needed (PRN), HHA once a week for 10 weeks, and PCV once a week for 3 weeks. During the VCFVR review for certification period from 8/12/23 to 10/10/23, the VCFVR indicated, there were a total of 6 missed visits as follows: 1 missed SN visit during the week of 8/12/23. 1 missed HHA visit during the week of 8/12/23. 2 missed HHA visits during the week of 9/3/23. 3 missed PCV visits from 8/12/23 to 8/26/23. During an interview with the DPCS on 9/14/23 at 11:08 a.m., the DPCS was unable to provide documented evidence to show the 27 HV were coordinated and conducted as ordered for Patient 6. The DPCS stated Patient 6 should have received the 27 HV as ordered. 2. During a concurrent interview and record review with the DPCS, the Face Sheet indicated, Patient 7 was admitted on 8/31/23 with diagnoses including cancer of the brain. During a review of HHA assigned frequency of HV starting 8/31/23, indicated once a week for 13 weeks. During the VCFVR review for certification period from 8/12/23 to 11/25/23, the VCFVR indicated there was 1 missed HHA visit during the week of 9/3/23. During an interview with the DPCS on 9/14/23 at 10:27 a.m., the DPCS was unable to provide documented evidence to show the HV was coordinated and conducted as ordered for Patient 7. DPCS stated Patient 7 should have received the HV as ordered. 3a. During a concurrent interview and record review with the Clinical Manager II (CM II), the Face Sheet indicated, Patient 8 was admitted on 2/17/22 with diagnoses including heart disease. During a review of Pets for Peace of Mind (PPM) assigned frequency of HV starting 2/17/22, indicated 1 to 2 visits a week for 11 weeks. During the VCFVR review for certification period from 2/17/22 to 5/17/22, the VCFVR indicated, there were a total of 22 missed PPM visits. There were no PPM visits conducted during the entire certification period. 3b. During a review of PPM and PCV assigned frequency of HV starting 9/15/22, indicated PPM once a week for 6 weeks, PCV 3 times a week for 6 weeks. During the VCFVR review for certification period from 9/15/22 to 11/13/22, the VCFVR indicated, there were a total of 10 missed visits as follows: 6 PPM missed visits, No visit for the whole certification period. 2 PCV missed visits during the week of 9/15/22. 1 PCV missed visit during the week of 9/18/22. 1 PCV missed visit during the week of 10/9/22. During an interview with CM II on 9/13/23 at 2:34 p.m., with the CM II, the CM II was unable to provide documented evidence to show the 32 HV were coordinated and conducted as ordered for Patient 8. CM II stated Patient 8 should have received the 32 HV as ordered. 4. During a concurrent interview and record review with CM II, the Face Sheet indicated, Patient 10 was admitted on 6/29/22 with diagnoses including liver cancer. During a review of SN and HHA assigned frequency of HV starting 8/23/23, indicated SN 1 to 3 visits per week for 9 weeks and HHA visit once a week for 9 weeks. During the VCFVR review for certification period from 8/23/23 to 10/21/23, the VCFVR indicated, there were a total of 4 missed HV as follows: 3 missed SN visits during the week of 9/3/23. 1 missed HHA visit during the week of 9/3/23. During an interview with CM II on 9/13/23 at 3:25 p.m., CM II was unable to provide documented evidence to show the 4 HV were coordinated and conducted as ordered for Patient 10. CM II stated that Patient 10 should have received the 4 HV as ordered. 5. During a concurrent interview and record review with the DPCS, the Face Sheet indicated Patient 13 was admitted on 2/11/23 with diagnoses including lung disease. During a review of SN assigned frequency of HV starting 8/10/23, indicated SN 1 to 3 visits per week for 9 weeks. During the VCFVR review for certification period from 8/10/23 to 10/8/23, the VCFVR indicated, there were a total of 1 missed SN visit during the week of 8/10/23. During an interview with the DPCS on 9/13/23 at 3:05 p.m., the DPCS was unable to provide documented evidence to show the HV was coordinated and conducted as ordered for Patient 13. The DPCS stated that Patient 13 should have received the HV as ordered.

Based on observation, interview, and record review, the facility failed to ensure Patient 7s oxygen equipment was available for use. This failure had the potential for Patient 7s care needs to be unmet. --- Findings: During a review of Patient 7s face sheet (demographic), the face sheet indicated Patient 7 was admitted for hospice services on 1/12/23, with diagnoses including cancer of the right lung/bronchus and emphysema (damage to the lung tissue). During a home visit on 9/12/23 at 9:50 a.m., Patient 7s family member reported to Registered Nurse (RN 1) that they were waiting for the oxygen equipment to be delivered to the home since 9/7/23. The family member stated Patient 7 had an episode of ";wet sounding cough" on 9/6/23, and they informed RN 2 on 9/7/23. During an interview on 9/12/23 at 11:25 a.m., with RN 1, RN 1 confirmed the oxygen equipment was not present in Patient 7s home (five days later). During a review of Patient 7s Clinical Note (CN), completed by RN 2, dated 9/7/23, the CN indicated as reported by the daughter, Patient 7 had a self-limiting episode of a wet sounding cough. The CN, completed by RN 2, dated 9/8/23, indicated oxygen will be delivered for next week. During a review of Patient 7s Physician Order (PO), dated 9/8/23, the PO indicated oxygen 2 liters per minute by nasal cannula (tubing) as needed for dyspnea (difficulty of breathing). During a review of Patient 7s CN, completed by RN 1, dated 9/13/23, the CN indicated RN 1 called [name of the Durable Medical Equipment contractor] and there was no record that oxygen was requested for Patient 7. During an interview on 9/13/23 at 3:30 p.m., with Clinical Manager (CM 1), CM 1 stated Patient 7s oxygen equipment should have been in the home within 24 hours. During a review of facilitys policy and procedure (P&P) titled, ";Medical Supplies and Durable Medical Equipment," dated 7/11/23, indicated, ";...provide patients with all medical supplies and durable medical equipment necessary for the ... and management of symptoms related to the patients terminal illness."

Based on interview and record review, the facility failed to ensure Patient 4s pain medication orders included pain level parameters (when to administer medication based on the patients pain level). This failure had the potential to result in ineffective pain management for Patient 4. --- Findings: During a review of Patient 4s Face Sheet, the Face Sheet indicated Patient 4 was admitted for hospice services on 5/19/23, with diagnoses including cerebrovascular disease and right sided hemiplegia. During a concurrent interview and record review with RN 4 and Medication Aide 2 (MA 2) on 9/12/23 at 4:10 p.m., Patient 4s MAR, dated 9/11/23, included two pain medications but did not include pain level parameters (when to administer for patient stated pain level) as follows: The Oxycodone IR (Intermediate Release- treats moderate to severe pain) 2.5 mg. as needed for pain. The Acetaminophen (treats mild pain) 650 mg. as needed for pain. During the above interview, MA 2 stated that if Patient 4 complained of mild pain (below 5) she would administer the Acetaminophen. MA 2 also stated if Patient 4 complained of moderate to severe pain (above 6) she would administer the Oxycodone. RN 4 stated Patient 6s pain medication orders should have included level of pain parameters prior to administration. During an interview with Director of Patient Care Services (DPCS) on 9/14/23 at 9:10 a.m., the DPCS stated Patient 4s pain medication orders should have included pain level parameters.

Based on observation, interview, and record review, the facility failed to ensure Patient 6 was provided with privacy during care. This failure had the potential to not preserve Patient 6s privacy and dignity. --- During Patient 6s home visit observation on 9/12/23 at 2:54 p.m., at [name of the assisted living facility], Registered Nurse 4 (RN 4) entered Patient 6s room to conduct wound care. RN 4 removed Patient 6s bed sheet and exposed her diaper while the room door was open. During an interview on 9/12/23 at 3:24 p.m., with RN 4, RN 4 stated the door should have been closed prior to exposing Patient 6s body for wound care. During an interview on 9/14/23 at 2:34 p.m., with the Director of Patient Care Services (DPCS). The DPCS stated RN 4 should have ensured Patient 6s privacy prior to the start of care. During a review of the facilitys policy and procedure titled, Rights and Responsibilities of Patient and Families dated 7/11/23, indicated, ";Patients and families have the right to receive treatment with consideration, respect, and full recognition of dignity and individuality, including privacy in treatment and care of personal needs."

Based on observation, interview, and record review, the facility failed to ensure appropriate infection control practices were followed by nursing staff. This failure had the potential for cross-contamination and illness for the facilitys patients. --- a. During an observation on 9/12/23 at 10:38 a.m., in Patient 7s room, Registered Nurse 1 (RN 1) was observed preparing the clean area (for clean and disinfected items). During Patient 7s care, RN 1 placed her personal phone on the clean area. b. During a follow-up observation on 9/12/23 at 11:12 a.m., RN 1 was observed touching Patient 7s medication with bare hands. During an interview with RN 1 on 9/12/23 at 11:28 a.m., RN 1 stated that she should have not placed her phone on the clean area, and she should have not counted the medication with bare hands. c. During an observation on 9/12/23 at 12:21 p.m., with RN 3 in Patient 8s room, RN 3 was observed to place her personal phone and notepad on the clean area. During an interview on 9/12/23 at 12:55 p.m., with RN 3, RN 3 stated that she should have not placed her personal phone and the note pad on the clean area. During an interview on 9/14/23 at 2:34 p.m., with Director of Patient Care Services (DPCS), the DPCS stated the patients clean area should have been maintained by nursing staff and patient medications should not be handled with bare hands.