Every finding on record at Kaiser Foundation Hospitals

Observed in Record Review. In 1 of 3 patient records reviewed, the Surveyor noted an ordered service had not documented an evaluation within the appropriate time frame. For example, in HRRHV#1, the patient had an order for physical therapy evaluation placed on initial evaluation; however, by the date of survey, there had been no evaluation or patient communication documented in the patient record (28 days). Of note, this was a hospice patient needing a service from Home Health. This was validated with HCO leadership present during the record review.

Observed in Record Review. In 1 of 20 patient records reviewed, During RRHV# 1's patient record review it was noted the organization had not ensured it completed the comprehensive assessment no later than five calendar days after the election of hospice care. For example: review of RRHV# 1's patient record revealed an initial bereavement risk assessment completed approximately 40 days after the election of benefit (EOB). This was reviewed, discussed, and validated with the Clinical Supervisor.

Observed in Patient Home. In 1 of 4 home visits conducted with medication reconciliation, During RRHV# 1's home observation it was noted the organization had not ensured the hospice nurse conducted a medication assessment that identified all medications per organization policy Medication Profile that included reviewing the in home medication list, prescription bottles, and the hospice medication list for a complete medication reconciliation. For example: during RRHV# 1's home observation the registered nurse (RN) was observed completing a medication reconciliation with the Skilled Nursing Facility (SNF) nurse. The SNF nurse inquired if the hospice RN would like a copy of the medication administration record (MAR) and the hospice RN shared it was not necessary as she/he would compare the medications in the medication drawer with the hospice profile. The hospice RN then proceeded to review the medications and on the Lorazepam bottle found a prescription that read to give the Lorazepam every 4 hours as needed. The hospice RN shared they had changed the lorazepam order to every 8 hours, as it was listed on the hospice medication list and the Lorazepam every 4 hours as needed was discontinued. In addition, the hospice RN shared the SNF MAR was reviewed last week and validated the medication change. However, review of the SNF MAR revealed Ativan every 4 hours as needed in addition to Lorazepam every 8 hours as needed. This was observed, reviewed, and validated with the Clinical Supervisor.

Observed in Record Review. In 2 of 20 patient records reviewed, During RR# 1 and RR# 4's patient records review it was noted the organization had not ensured the plan of call included all the services needed for the palliation and management of the terminal illness and related conditions to include interventions to management plan and symptoms. For example: review of RR# 1's patient record revealed RR# 1 had diagnosis of dysphagia, was on a pureed diet and had aspiration precautions. However, review of RR# 1's plan of care revealed no goals or interventions related to dysphagia, pureed diet, and aspiration precautions. Review of RR# 4's plan of care revealed wound care orders for the right inner thigh to apply Medi honey to the wound bed and change dressing at routine hospice visits and if the dressing is dislodge. However, there was no documentation of what type of dressing for the wound care. This was reviewed, discussed, and validated with the Clinical Supervisor.

Observed in Patient Home. In 1 of 6 home visits conducted, During RRHV# 1's home observation it was noted the organization had not ensured it respected, protected, and promoted patients' rights. For example: during RRHV# 1's home observation at a Skilled Nursing Facility (SNF) the registered nurse (RN) was observed completing a patient assessment with the room door open and the roommate sitting in between the beds with the privacy curtain open. This was observed, discussed, and validated with the Patient Care Services.

Observed in Record Review. During RR# 4's patient record review it was noted the organization had not ensured the patient record contained information that reflected the patient's care, treatment, or services. For example: review of RR# 4's patient record revealed documentation the RR# 4 had a stage II pressure ulcer to the right upper thigh and wound care was to be completed every routine skilled nurse visit. Review of RR# 4's SN visit notes revealed documentation that wound care was provided with no documentation of what kind of wound care was provided. This was reviewed, discussed, and validated with the Clinical Supervisor. Observed in Record Review. In 2 of 20 patient records reviewed, During RRHV# 2's patient record review it was noted the organization had not ensured the patient record contained information that reflected the patient's care, treatment, or services. For example: review of RRHV# 2's patient record revealed RRHV# 2 had a right chest wall port-a-cath. However, review of the registered nurse (RN) comprehensive assessment revealed no documentation of a right chest wall port-a-cath. Further review of the Skilled Nurse (SN) visit notes revealed no documentation of a right chest wall port-a-cath. Review of RRHV# 2's plan of car and subsequent updated plans of care revealed no documentation of a right chest wall port-a-cath. Further review of RRHV# 2's patient record revealed documentation dated approximately 42 days after the start of care of a right chest wall port-a-cath. This was reviewed, discussed, and validate with the Clinical Supervisor. Observed in Patient Home. In 1 of 4 home visits conducted with medication reconciliation, During RRHV# 5's home observation it was noted the organization had not ensured the patient record contained information that reflected the patient's care, treatment, or services. For example: review of RRHV# 5's medication profile revealed a Lidocaine patch for pain. However, during the medication reconciliation RRHV# 5's spouse shared that RRHV# 5 had not used it since the start of care as it did not work. Review of RRHV# 5's plan of care revealed a start of care date approximately 55 days prior to the surveyor home observation. This was observed, discussed, and validated with the Clinical Supervisor.

Observed in Record Review. In 1 of 4 patient records reviewed with LVN death attendance, In 1 of 4 patient records reviewed, where the patient passed while on service with the LVN attending the death, the staff did not provide patient care within the scope of their license. The surveyor noted the LVN pronounced the patient's death in RR #11 as evidenced by the documentation from the death visit stated the clinician noted no signs of life, and the time of death was recorded, and the mortuary notified prior to notifying the physician. This was confirmed with Clinical Supervisor, Director of Patient Care Services, and the Administrator. This was validated with the LVN who indicated they were the one who determined the time of death along with the family and did not call the physician and instead left a message for the IDG members in TEAMs regarding the death.

Observed in Individual Tracer. It was found on HV#3 that the patient care giver needed further education related to infection control and the procedure for changing a dressing on the patient's back. It was observed during the visit that the caregiver removed the dressing on the patient's back after a shower . He did not wash his hands or don gloves. He removed the soiled dressing and then cleaned the area and placed a clean dressing. He did not wash his hands or don gloves to perform the dressing change. This was verified with the Hospice Clinical Director.

Observed in Record Review. It was found in review of HV#3 record review that physician orders were not being followed. The Plan of Care/Physician orders stated the patient's port was to be flushed every month. Patient was admitted 12/8/21. There was not documentation in the nurses notes that the port was flushed in January or February. This was verified with the Clinical Manager.

Observed in Record Review. It was found on HV#3 record review that the medication profile was not complete according to organization process. Clinical Manager stated that Heparin used for flushing a catheter should be on the medication profile. On review of this record the patient had a port and it was to be flushed with saline and Heparin every month. The Heparin was not documented on the medication profile. This was verified with the Clinical Manager.