Every finding on record at Kaiser Foundation Hospitals

Observed in Record Review. In 1 of 1 patient records reviewed, the organization did not ensure the patient's right to elect and revoke hospice care in accordance with Medicare hospice regulations. In HOS RRDC#2, it was noted that although the organization had a clear revocation process, the documentation of the patient's signed revocation could not be found. This was reviewed and verified with the Hospice Director of Patient Care Services

Observed in Record Review. In 1 of 14 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including interventions to manage pain/symptoms. In HOS RRNHV#2, it was documented by the RN that home oxygen was provided to the patient upon admission to hospice. There was no oxygen order included in the patient's plan of care until two (2) months later when it was documented the patient was on continuous oxygen 1 liter per nasal cannula. This was reveiwed and verified with the Director of Patient Care Services.

Observed in Record Review. In 3 of 9 patient records reviewed, the registered nurse responsible for the hospice aide supervision did not prepare written patient care instructions for the hospice aide. In HOS RRHV#3, the aide care plan indicated the hospice aide was to remove the oxygen during the shower/bath. The patient was not on home oxygen per the hospice plan of care. In HOS RRHV#4, the aide plan of care indicated the hospice aide was to document the patient's refusal to use assistive devices but did not specify what assistive devices the patient used or was in the home. In HOS RRNHV#2, the patient was on oxygen 1 liter per nasal cannula continuously, with an immediate drop in O2 saturation to 88% when the oxygen was removed as documented by the RN. There was no instructions on the aide plan of care related to the patient's home oxygen. This was reveiwed and verified with the Hospice Director of Patient Care Services.

Observed in Individual Tracer. The organization had not assessed potential medication related problems, including adverse effects, drug reactions, significant side effects and significant drug interactions, including ineffective drug therapy, duplicate drug therapy and noncompliance with drug therapy. For example, HOS HV 1 medication reconciliation the RN had identified that over the counter medications including preservision and guaifenesin had not been noted on the medication list. This was confirmed by the RN on site and the Hospice Supervisor.

Observed in Record Review. In 2 of 15 patient records reviewed, the organization had ensured, based on the COP the plan of care must specify the hospice care and services necessary to meet the patient and family-specific needs. For example during HOS RR 8 the Surveyor identified there was not an intervention in the plan of care to monitor for residual nutrition for a patient receiving tube feedings. This was supported by VNAA guidance Feeding Tube: Enteral Nutrition Administration (Home Health Care) CE section 20 sub section C which states Assess the contents of the aspirated fluid for signs of formula digestion. The second example is during the review of record from HOS HV2 the patient was prescribed three as needed bowel medications without clear hierarchy identified of which medication to use first, second or third or why to choose one over the other. This was confirmed with the Hospice Supervisor. Another example in the same visit, the patient had been taking a 40mg daily dose of Furosemide which was noted in the medical record to be an active order from 9/8/21 through 9/30/21. This was confirmed by the Hospice Supervisor.

Observed in Record Review. In 7 of 15 patient records reviewed, The organization had not revised the plan of care with information from updates to the patient's comprehensive assessment and addressed the patients progress toward goals and outcomes. For example in several HOS records reviewed the care plans were not removed or marked completed by Physical Therapy when ending treatment. Social work care plans were noted to have passed the goal dates and the documentation did not refer back to the goals and plan set from the assessments and the record failed to show progression toward listed goals. This was confirmed by the Hospice Supervisor.

Observed in Record Review. In 1 of 15 patient records reviewed, The organization provides the patient with care, treatment or services according to his or her individualized plan of care. For example, during HOS RR9 the CHHA (Aide) had orders to begin care from admission but failed to make a visit until week five. This was confirmed by the Hospice Supervisor.

Observed in Individual Tracer. In 1 of 3 home visits conducted, the organization had not followed accepted standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. For example, during HOS HV 3 the Skilled Nurse had not cleaned the interior/ lens area of the pulse oximeter. The manufactures recommended cleaning protocol states: Before measurement with the instrument, wipe the rubber finger pad using a piece of dry, soft cloth dipped with 75% medical alcohol. Clean the finger to measured using the medical alcohol for disinfection purposes before and after using. These actions were not done on this visit. The only cleaning of this instrument was done on the outside of the oximeter. This was confirmed by the Hospice Supervisor. Observed in Individual Tracer. In 1 of 3 home visits conducted, the organization had not followed accepted standards of practice to prevent the transmission of infections and communicable diseases, including the use of standard precautions. For example, during HOS HV 3 the nurse had not provided adequate rubbing of hands to allow hands to dry before moving from one activity to another. The organizations policy on handwashing indicates the need to rub hands together until dry following hand sanitizing. This was confirmed by the Hospice Supervisor.

Observed in Individual Tracer. In 1 of 3 home visits conducted, the organization had not ensured a list of medications, including dose, strength, frequency, route, date and time of administration for prescription and nonprescription medications, herbal products, and home remedies that relate to the patient's care was complete and correct. For example, during HOS HV3 review of medication record the Surveyor identified that clonidine remained on the active medication list despite it had been discontinued a week ago per the RN. This was confirmed by the Hospice Supervisor.