Every finding on record at Kaiser Foundation Hospital Hospice-Oakland

Based on interview and record review, the Hospice Agency's licensed nursing staff did not manage the pain for one (Patient 11) of 14 sampled patients. During repeated visits Patient 11 reported to staff his level of pain was above the established tolerable level. This resulted in unnecessary pain for Patient 11. --- Record review of the document ";Pain Management," dated 5/31/2023, showed ";The patients right to pain management is respected and supported. Hospice clinicians plan, support, and coordinate activities and resources to ensure that the pain of all patients is recognized and addressed appropriately." Record review of the document ";Home Care Agency Information" showed Patient 11s Start of Care was 8/6/2024. Diagnoses included End Stage Renal (kidney) Disease. Review of the document ";Hospice Plan of Care" showed the current certification period was 8/28/2024 to 9/10/2024. On-going problems included a long history of chronic pain. Skilled nursing visits were ordered by the doctor for ";Symptom management and family support." Record review of the document ";SN Hospice Admission ASMT," dated 8/6/2024, showed Patient 11s pain was at a level 8 (0 is no pain and 10 is the highest amount of pain). ";Patients acceptable pain level: 3." Patient 11 reported to the skilled nurse he uses the pain medication ";sparingly" and reported ";It does work when he takes it." There was no documentation which showed how the level 8 pain was addressed or why he was taking the medication sparingly. Record review of the document ";SN Hospice Home Visit" (SHHV), dated 8/15/2024, showed Patient 11s pain level was at a 4 and he was out of pain medication. Record review of the ";SHHV," dated 8/22/2024, showed Patient 11s pain was rated at a 5. There was no documentation which showed how the pain was addressed. Record review of the ";SHHV," dated 8/31/2024, showed Patient 11s pain was at a level 4. There was no documentation which show how the pain was addressed. During an interview on 9/11/2024 at 11:35 a.m. with Registered Nurse Quality Coordinator (RNQC), RNQC confirmed there was no documentation in the visit notes which addressed the pain nor was the issue raised at the Interdisciplinary Group meetings on 8/14/2024 and 8/27/2024. The RNQC stated that staff are expected to treat the pain while in the home and assess the effectiveness. The RNQC stated if the pain continued to remain at an unacceptable level the staff should call the doctor and obtain new pain medication orders.

Based on interview and record review, the Hospice Agencys licensed nursing staff did not notify the doctor for a change in condition for one (Patient 8) of 14 sampled patients. Patient 8 fell in his home and the nursing staff did not notify the doctor. This resulted in the potential for further injury from the fall without a known source. --- Review of the document ";Monitoring Patients Response/Reporting to Physician," dated 5/31/2023, showed ";Clinicians will establish and maintain ongoing communication with the patients physician and the hospice Medical Director to ensure safe and appropriate care for the patient. Record review of the document ";SN Hospice Home Visit" (SNHV) showed Patient 8s start of care was 5/19/2024 with a diagnosis of lung cancer. Review of the ";SNHV," dated 8/27/2024, showed Patient 8 had fallen the night before on a wet floor. There was no documentation in the record which showed the fall had been reported to the doctor. In a concurrent interview and record review on 9/11/2024 at 1:40 p.m. with Registered Nurse Quality Coordinator (RNQC), RNQC confirmed there was no documentation which showed the doctor had been called. The RNQC stated, ";You want to know if there was a fall on a particular date and if injuries subsequently show up as a result of the fall."