Every finding on record at Prudential Hospice Care, Inc

Observed in Record Review. In 11 of 11 patient records reviewed, the plans of care did not consistently include individualized time frames within which to accomplish the stated goals. For example, goals which had safety measures or pain identified as a problem would include reasonable times frames such as 24 -48 hours (for pain) within one week (safety). Otherwise time frames would be missing for goals for satisfaction with expressing feelings, communicating an understanding of terminal illness, expressing feelings of grief for example. This was discussed with the VP and the DON.

Observed in Record Review. In review of clinical record HV#3 following the home visit, there was an order in the record stating that the oxygen was to flow at 2 liters/minute via nasal cannula continuously. However, during the home visit, the patient was not wearing the oxygen and the caregiver stated that she only wears it a night. This was also heard by the DON who was present at the visit.

Observed in Patient Home. In 4 of 4 home visits conducted, The staff were using a Sani wipe towelette to clean their equipment after using the equipment on their patients. However the staff were unable to keep their equipment wet for the 2 minutes required by the product's manufacturer to achieve disinfection . This was discussed with the VP and the DON.

Observed in HR File Review. In 1 of 1 home health aide's personnel file, there was no documentation that a registered nurse had made an annual on-site visit for evaluation of the aide's performance as required by regulation.. This was discussed with the VP.

Observed in HR File Review. There was no documentation in the bereavement coordinator's personnel's file that she had been competencied to her new position. This was discussed with the VP.

Observed in Patient Home. In 3 of 4 home visits conducted, medications found in the patients' homes did not match the medications listed on the agency's MARs (medication administration record) for the patients. For example during medication review with the LVN on home visit #1, it was observed that the morphine indications for which strength to administer were written backwards eg: mild = 1.0mls; moderate =.5ml; sever = 0.25ml. Also there was no documentation that the facility was documenting when they administered PRN medications. In review of the comfort kit for this patient, it was observed that there was only one packet of Zofran tablets left of the six delivered. No staff could say what had happened to the other 6 packets. During medication review at home visit #2 with the DON, and in review of the insulin administration log book, it was observed that the patient had not received his sliding scale insulin as directed for blood sugars above 131 on multiple occasions over the last 6 weeks. The patient also had his routine insulin ordered as 20 units as twice daily. Over the last 4 - 6 weeks,, there was no documentation on at least 6 separate occasions that the patient had received his second dose of routine insulin. At home visit #3, the physician had ordered atorvastatin (Lipitor) but found in the home was Lovastitin (Mevacor). There was no order in the medical record changing the medication. These observations were also observed by the DON who was present on the visits.

Observed in Record Review. In 11 of 11 patient records reviewed, there was no documentation in the records that the patients had been education on the management and disposal of narcotics as required by regulation. This was discussed with the VP and the DON.

Observed in Record Review. In 1 of 4 death records reviewed, documentation in clinical record RR#1, indicated that the LVN had documented that she pronounced the patient dead without contacting the physician or a registered nurse.. LVN's in the State of California are not permitted to pronounce patients. This was discussed with the VP and the DON.