Every finding on record at Seasons Hospice & Palliative Care of California-Oakland, LLC

Observed in Record Review. In 2 of 14 patient records reviewed, the organization failed to assess and reassess. During record review for RRNHV#1 and RRNHV#7, the Hospice Nurse Surveyor observed required initial comprehensive assessments were not completed timely. Organizational policy s;tated a comprehensive spiritual care and psychosocial assessment would be done within 5 days. The RN did a brief assessment of psychosocial and spiritual care needs at start of care but did not assess all needs. For example, RRNHV#1, the bereavement assessment was completed one month after start of care. In RRNHV#7, the start of care nurse documented open to all disciplines and there was no further communication. The comprehensive spiritual care assessment was completed a month after start of care. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 14 of 14 patient records reviewed, the organization failed to assess and reassess its patients. During record review for all records, the Hospice Nurse Surveyor observed the records did not include the need for volunteer services to offer support or respite to the patient, family, or other caregivers. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 7 of 7 patient records reviewed, of patient records with recertification, the organization failed to document patient's progress toward desired outcomes. During record review for RRHV#1, RRHV#2, RRNHV#2, RRNHV#3, RRNHV#5, RRNHV#6, and RRNHV#7, the Hospice Nurse Surveyor observed the patients had been recertified, at least once, and there was no documentation of measurable progress towards goals and desired outcomes. Upon conversation with the Director, she stated that the EMR kept track of percentage of goals closed and the one's that remain open but that there was no documentation of measurable progress by discipline or by individual goal. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 14 of 14 patient records reviewed, the organization failed to plan the patient's care. During record review for all records, the Hospice Nurse Surveyor observed the goals listed did not include timeframes to meet those goals. For example in RRHV#1, a goal was listed as need skilled teaching regarding alternate pain measures with no timeframe to meet that goal. And in RRHV#3, the patient had a goal stated patient/ CG will demonstrate appropriate knowledge of insulin administration with no timeframe. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 2 of 14 patient records reviewed, the organization failed to plan the patient's care. During record review for RRHV#1, and RRHV#2, the Hospice Nurse Surveyor observed the plan of care did not include documentation of all services needed for the palliation and management of terminal illness and related conditions. For example in RRHV#1, the plan of care did not include orders related to goals and interventions for dizziness and nausea ,which upon conversation with the daughter, the patient had been experiencing for awhile. For RRHV#2, the patient had recent orders for wound care of a Stage 1 pressure ulcer but it was not addressed on the plan of care. And the patient had goals and interventions for Music Therapy but the organization no longer had a music therapist on staff. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 8 of 14 patient records reviewed, the organization failed to plan the patient's care. During record review forRRHV#1, RRDC#2 and RRNHV#5, the Hospice Nurse Surveyor observed the patients had documented information for DNR status but the status was not included on the Plan of Care. During record review for RRHV#1, RRHV#3, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#5, the Hospice Nurse Surveyor observed the orders for PRN medications did not include indications for use. For example in RRHV#1, RRHV#3, and RRNHV#3, the patient had orders for PRN Morphine and Tylenol but no indication when to use which medication. In RRNHV#1, the patient had Morphine and Ibuprofen for pain with indication for the Morphine but not the Ibuprofen. In RRNHV#2, the patient had Morphine and Tylenol for pain with indication for the Morphine but not the Tylenol. During record review for RRHV#2, the Hospice Nurse Surveyor observed the organization failed to maintain an accurate patient medication list. During record review for RRHV#2, the Hospice Nurse Surveyor observed the patient medication contained many errors. The Tylenol Supp, Hycosamine, Compazine, Biscodyl, Morphine, Acetaminophen extra strength, and Hydrocodone all contained scheduled orders but were intended to be PRN. This surveyor reviewed the record with the Hospice Director who confirmed. If orders had been correct the patient would be getting round the clock Tylenol, Acetaminophen extra strength and Hydrocodone which would be above the acceptable amount. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 1 of 14 patient records reviewed, the organization failed to provide care, treatment, or services according to the plan of care. During record review for RRNHV#4, the Hospice Nurse Surveyor observed the orders for nursing frequency was 1week 9 but no visits were made for the week of 3/31. And the Home Health Aide frequency orders were for 2 week 12 to begin week of 3/24. No HHA visits were made the week of 3/24 and only one visit was made the following week. This was discussed and reviewed with the Hospice Team. Observed in Record Review. In 5 of 14 patient records reviewed, the organization failed to provide care, treatment, or services in accordance with orders. During record review for RRHV#3, RRNHV#1, RRHV#1, RRHV#2, and RRNHV#6, the Hospice nurse surveyor observed the frequency orders were not followed. For example in RRHV#3, the nursing orders were for 4wk1 and the nurse only made one visit that week. In RRHV#2, there were no aide visits the weeks of 11/13 and 11/20. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 2 of 13 patient records reviewed, patients receiving aide services, the organization failed to plan the patient's care. During record review for RRNHV#3, the Hospice Nurse Surveyor observed the aide care plan had not been updated to reflect a new order 2 months prior to survey stating thickened liquids and cannot use a straw. The patient was also on Eliquis and bleeding precautions were not addressed on the aide POC. For RRNHV#4, the aide patient was on aspirin but bleeding precautions were not on the aide POC. This was discussed and reviewed with the Hospice Team.

Observed in Tracer Activities. The organization failed to provide services that meet the patient needs. During tracer activities for volunteer services, the Hospice Nurse Surveyor observed the rolling volunteer percentage was 1% and the organization currently had no volunteers. This was discussed and reviewed with the Hospice Team.

Observed in Tracer Activities. The organization failed to implement policies and procedures. During tracer activities for Leadership, the Hospice Nurse Surveyor observed the organizational leaders did not implement policies related to the Plan's of Care which results in non-compliance with 418.54, 418.56, and 418.100. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Record Review. In 1 of 14 patient records reviewed, the organization failed to maintain an accurate patient medication list. During record review for RRNHV#1, the Hospice Nurse Surveyor observed the patient had orders for Metronidazole to be given for 7 days but it had never been updated. The order was a month old. This was discussed and reviewed with the Hospice Team.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization failed to provide patient education and training based on each patient's needs and abilities. During home visit for RRHV#1, the Hospice Nurse Surveyor observed the patient did not have an individualized emergency preparedness plan in the home. She had been on service for 4 months. This was discussed and reviewed with the Hospice Team.