Every finding on record at Kaweah Delta Healthcare District

Observed in Tracer Visit. In 2 of the 14 records reviewed, the initial comprehensive assessment was not completed within the required timeframe of no later than 5 days following the election of hospice care. Examples: In HSRRHV#2, the initial spiritual care assessment was conducted 12 days after the election of hospice. In HSRRNHV#5, the psychosocial assessment was completed 6 days after the election of hospice. These findings were confirmed by the Hospice Director and the Clinical Manager

Observed in Record Review. In 2 of the 14 records reviewed, reassessments were not completed according to policy. Specifically, in RRNHV#9 and RRNHV#10, weekly wound measurements required by the Wound Care Policy were not documented. For RRNHV#9, no wound measurements were recorded on or after admission. For RRNHV #10, wound measurements were missing for weeks 3 through 11. Also in RRNHV#9, the Falls Risk Assessment was not completed at recert as required by the Falls Policy. These findings were confirmed by the Hospice Director and the Clinical Manager.

Observed in Tracer Visit. In 3 of the 14 records reviewed, the plan of care did not include interventions to manage symptoms and risks identified in the comprehensive assessments. Specifically in HSRRHV#1, HSRRHV#4, and HSRRNHV#8, the fall risk assessment scores indicated that the patients were at high risk for falls. However, the corresponding plans of care did not include interventions to manage the fall risk. These findings were confirmed by the Hospice Director and the Clinical Supervisor.

Observed in Tracer Visit. In 3 out of 14 records, orders specifying the frequency of services required to meet patient needs were incomplete or missing. Examples: In HSRRHV#1, nursing visit frequencies were not ordered for two visits completed during week 2 of benefit period 5. In HSRRNHV#6, the Foley catheter order was incomplete, lacking both the catheter size and the frequency for catheter changes. In HSRRHV#3, the oxygen order with a range from 2-5 LPM was missing parameters and indications for adjusting. These findings were confirmed by the Hospice Director and Clinical Manager.

Observed in Record Review. In 6 out of 14 records, there were multiple PRN medications that addressed the same symptom without indication of when each medication was to be administered. Examples: In HSRRHV#3 and HSRRHV13, Ativan and Oxycodone were ordered for SOB. In HSRRNHV#9, Ativan and Dilaudid were ordered for SOB. In HSRRHV#4, HSRRNHV#11 and HSRRNHV#12, Ativan and Morphine Sulfate were ordered for SOB. This was confirmed by the Hospice Director and Clinical Manager.

Observed in Record Review. In 3 out of 14 records, services were not provided per the plan of care. Specifically in HSRRHV#1, there was a missed aide visit during the first week of benefit period 5. In HSRRNHV#6, there were 2 missed aide visits during the second week of benefit period 1. In HSRRHV#2, there was a missed MSW visit during month 2 of benefit period 1. These missed visits were not known prior to the survey. The findings were confirmed by the Hospice Director and Clinical Manager.

Observed in Tracer Visit. In 3 of the 4 applicable records that included hospice aide services, the written patient care instructions for the aide did not reflect the identified safety precautions. Examples: In HSRRHV#1 and HSRRHV#3, fall and aspiration precautions were identified in the plan of care. However, these precautions were not included in the hospice aide care plan. In HSRRHV#4, fall precautions were documented in the plan of care but were not included in the aide care plan. This was confirmed by the Hospice Director and Clinical Manager.

Observed in Record Review. In 1 of the 10 records reviewed, competencies were not assessed or documented as part of staff orientation. Example: In HSHR#10, no competencies had been documented in the volunteer file since the date of hire. This finding was confirmed by the Hospice Director. Observed in Competency Session. In 1 of the 10 HR records reviewed, the organization had not established defined competencies for staff providing volunteer services. This was demonstrated in HSHR#10, where no competencies were documented for the volunteer role. In interviewing the Volunteer Coordinator and Hospice Director, it was confirmed that volunteer competencies had not been established.

Observed in Tracer Visit. In 1 of 4 home visit records, the medication list within the medical record was inaccurate. Example: In HSRRHV#2, the patient reported taking the following medications which were not noted on the medical record profile: Hydrochlorothiazide and Atorvastatin. Patient reported taking these medications since admission 8 weeks ago. Patient also reported taking Amlodipine Besylate 10 mg tablets daily since admission instead of the 5 mg tablets noted on the profile within the medical record. This was confirmed by the Hospice Director.

Observed in Record Review. In 2 out of 2 live discharge records, the hospice did not provide the patients' attending physicians a copy of the hospice discharge summary. Examples: In HSRRDC#1 and HSRRDC#2, there is no documentation indicating that the discharge summary was sent to the attending physician. These findings were confirmed by the Hospice Director and Clinical Manager.

Observed in Regulatory Review. In 13 of 13 patient records reviewed, the Hospice Surveyor noted the plan of care was not based on the patient's goals and the time frames and services required to meet those goals. In all the records reviewed the goals were either not measurable, specific or did not address care needs of the patient. Examples include: On HSHV/RR #1, goal of prevent complications of decreased mobility and Adjust to pt's altered mental function, on HSHV/RR #2, patient is a pediatric patient with long term technology dependence and not goals related to ongoing support needs for caregiver fatigue. Other examples seen in the records include goals: alter the level of loneliness Maintain desired level of safety, Adjust to changing nutrition needs Connect with spiritual strengths and practices, adjust to emotional level of physical deterioration, Improvement in skin condition. This was reviewed and confirmed with the Clinical Director and Hospice Clinical Manager.

Observed in Record Review. In 1 of 3 bereavement records, the surveyor noted that care was not provided in accordance with the organization's policy no HO2-010 Bereavement Services which states that a phone call will be made at 60 days for a level 2 bereavement level. On review of HSBR #2, the 60 day call had not been completed by the bereavement coordinator. This finding was reviewed and validated with the Nurse Director and Hospice Nurse Manager.

Observed in Patient Home. In 1 of 3 Hospice Home visits the agency did not follow manufacturer protocol to reduce the risk of infections associated with supplies/equipment. During HSHV/RR#1, the clinician was observed cleaning her vital signs equipment with SaniWipes. and equipment was placed back in the bag without following the 2-minute wet time as indicated per manufacturer’s instructions. This was discussed and validated with the Nurse Manager who was present during the visit.

Observed in Record Review. In 2 out of 4 patient records reviewed, that had ordered aide services, the Aide Care Plan did not have specific instructions for the aide. During record review of HSHV/RR #3 patient had a wound dressing on her back and there was no detail regarding the wound/dressing to the aide who showers the patient. On review of HSRR #5 patient has oxygen but nothing was noted about the oxygen on the aide delegation. This finding was reviewed and validated with the Clinical Director and Clinical Manager.

Observed in Record Review. In 2 of 2 patient records reviewed, where patient discharged from service, a discharge summary for care and treatment was not sent to the provider or a notification given that it was available. In HSRR #12, the discharge summary indicated the patient revoked, a summary was written but it was not sent to physician and notification of it's availability was not completed. On HSRR #13, the patient discharged from service and a summary was completed but it was not sent or notification of its availability sent to physician. This was reviewed and validated with the Hospice Manager and Nurse Administrator.