Every finding on record at Nexus Hospice of Riverside LLC

Upon patient record review, 1 of 5 (Patient # 4) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: Patient 4: There is evidence on the medication profile of an order on 2/13/24 for Diclofenac 1 application gel to affected area. There is no evidence of specification for amount and location to apply.

Upon patient record review, 1 of 5 (Patient #1) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 1: There is no evidence the POC contained problems/goals/interventions on 01/14/26 addressing the risk for bleeding and contains an order for Eliquis.

Upon patient record review, 1 of 5 (Patient # 4) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 4: The POC on 2/13/24 contains an order for Diclofenac 1 application gel to affected area. There is no evidence of specifications for amount and location to apply.

Upon personnel record review, 1 of 13 (Personnel #6) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel 6: The nurse aide personnel file contains only an initial competency review with all observations marked "v" verbal review only and there is no evidence of annual observation visits for direct assessment of competency.

Upon personnel record review, 1 of 13 (Personnel #6) did not have evidence in the hospice aide personnel file that a registered nurse made an annual on-site visit to the location where a patient is receiving care in order to observe and assess each aide while he or she is performing care. The supervising nurse must assess an aide's ability to demonstrate initial and continued satisfactory performance in meeting outcome criteria that include all required content. Personnel 6: There is no evidence the supervising registered nurse made an annual on-site visit to observe and assess aide while she is performing care.

Upon patient client record review, 2 of 5 (Patient # 1 and 4) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 1:There is evidence of LVN visits on 1/19/26 and 1/23/26 with no LVN signature. Patient 4: There is evidence of RN visit on 6/22/23 with no RN signature.

Upon patient record review, 4 of 5 (Patient #1, 2, 4, 5) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #1:Plan of Care - under intervention for Respiratory Problem says Oxygen as ordered via ___ at ____ l /min. The blanks are not filled in. However, there is a physician order for 2-5L/min. Patient #2: Patient admitted 1-5-23. Initial Comprehensive Assessment RN documents "exhibits dyspnea after ambulation 30 ft. Patient has order for Oxygen and nebulizer. There is no related problem, interventions or goals included in IDG POC. Patient #4: Patient admitted 1-20-22 with Metastatic Lung CA. Peripheral infusion was initiated upon admission, per physician order. There was no related Problem, interventions or goals documented as part of the IDG POC. Patient #5: Patient admitted 1-27-22 with ESRD. The patient had been diagnosed with COVID x 2, testing positive 1/16/22 prior to admission. Patient had order for Oxygen. There was no related problem, interventions or goals as part of the IDG/POC.

Upon observation and clinical record review, 1 of 5 (Patient #4) there was no evidence the hospice maintains a system of communication and integrations, in accordance with the hospice's own policies and procedures, to ensure that the IDG maintains responsibility for directing, coordinating, and supervising the care and services provided. Patient #4: Patient admission visit was performed by LVN for explanation of benefit and signing of admission documents including consents and election. During that visit and prior to RN initial assessment and plan of care development which occurred the following day, the family requested intravenous hydration. The LVN contacted physician and obtained order. Inserted peripheral IV and initiated infusion. (CA. Certification verified in personnel file). There was no documentation of the LVN's contact/coordination with RN Case Manager or supervisor during the visit.

Upon personnel record review, 1 of 13 (Personnel #5 ) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·(C) Shampoo, sink, tub, and bed Personnel #5: The Competency form utilized by the agency does not specify sink, tub, bed type shampoo, but simply shampoo; therefore the specific competencies are not validated as written.

Upon patient record review 1 of 5 (Patient #4) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #4: HA Assignment for Shower Chair type bath. HA Visits 3/2/22, 3/4/22, 3/9/22, the Shower Chair bath is checked (Hospice MD software), but "Bed Bath provided" is specified in narrative. It is not clear if patient refused shower. There is no documentation of coordination/reporting to RN.

Upon patient client record review, 1 of 5 (Patient #3) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #3: RN comprehensive assessment identifies that patient has indwelling Foley Catheter. She further notes that patient has no s/sx of UTI. There is no evidence of antibiotic prescription, however, the physician CTI documents that patient was started on antibiotic. Upon review for clarification, Administrator reports that physician was mistaken in his notation.