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

Observed in Record Review. In 1 of 13 patient records reviewed, the surveyor noted that the reassessment of pain was inconsistent. For example, in RR#9 the comprehensive assessment included the use of the 0-10 tool to assist the patient in rating her pain. She stated that a level of 1 was acceptable for her. However in subsequent visits this tool was not used although the patient's pain remained a primary issue. Such as the visit the patient stated that she had used the Morphine 6 or 7 times in the past 24 hours and the visit she had chest pain and a new medication was ordered. This was confirmed with the Regional Director of Patient Operations present.

Observed in Record Review. In 16 of 16 patient records reviewed, the surveyor noted that the written plan of care was not based on the patient’s goals and the time frames, settings, and services required to meet those goals. For example in record HV#1 the POC was not individualized and the goals did not include time frames. Record HV#2 the nurses POC included over 50 goals which were not individualized to the patient/family and did not include time frames. Records HV#3 and RR#1 through #10 were similar with goals that did not include time frames and were not individualized for the patient and family. For example RR#10 one goal was appropriate referrals made to deal with mental illness. Bereavement records BR#1, BR#2 and BR#3 included interventions, but no documentation of goals in the POC. This was confirmed with the Regional Director of Clinical Operations and the Regional Director of Patient Experience.

Observed in Record Review. In 3 of 16 patient records reviewed, the surveyor noted that written plan of care was not based on the patient’s goals and services required. For example during home visit HV#1 the patient hit the staff. The hospice staff as well as the assisted living staff both laughed and said that everyone was aware that the patient was a hitter and were cautious when caring for him. The POC did not include safety precautions related to the patient's hitting out at caregivers or the patient's agitation. Record HV#3 the assessment stated that the patient is a high risk for falls and new to oxygen use. The POC did not include goals related to oxygen safety or fall safety. RR#7 the patient was taking Warfarin, a medication on the organization's high risk medication list, and there was no documentation of goals or interventions related to this high risk medication. Also, the comprehensive assessment rated the patient as a high risk for falls and there was no documentation of goals or interventions related to fall safety. This patient also had a test pending for scabies and was started on medication for scabies. The POC did not include safety measures for visitors or staff. This was confirmed with the Regional Director of Clinical Operations.

Observed in Record Review. In 1 of 16 patient records reviewed, the surveyor noted that the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including the following: A statement of the scope and frequency of the services necessary to meet the patient’s and family’s needs. For example in record HV#2 the POC did not include the frequency that the nurse, aide, spiritual counselor, social worker or music therapist were to see the patient. This was confirmed with the Regional Director of Clinical Operations.

Observed in Record Review. In 7 of 16 patient records reviewed, the surveyor noted that care was not provided according to hospice plan of care. For example, the hospice POC in record HV#1 included music therapy to visit the patient 1-2 times every 3 weeks. The record of visits included a 4 week time August into September during which no visits are documented. In RR#2 the POC included nursing visit twice a week and during the first week of care the patient was seen by a nurse one time. In RR#4 the POC included HHA visits 4 times a week and the aide saw the patient 3 times a week. In RR#7 both the music therapist and social worker visit frequency was not according to the hospice plan of care. In RR#8 the music therapist and the volunteer did not complete the frequency of visits as ordered on the POC. RR#9 the music therapist did not complete the frequency of visits as ordered on the POC. In RR#10 the Chaplain's visit frequency on the POC was for 1 visit, however multiple visits were made. This was confirmed with the Regional Director of Patient Operations present.

Observed in Patient Home. In 3 of 3 home visits conducted, the surveyor noted that the organization did not implement its infection prevention and control activities. For example, during HV#1 the RN was observed going in and out of her supply bag with the same gloves on without removing the gloves and washing her hands before each entry into the supply bag. The Bag Technique policy documented that if additional supplies are needed once patient care has begun, remove the gloves, perform hand hygiene and obtain the additional items. During HV#2 the aide was observed removing gloves and not performing hand hygiene. The Hand Hygiene policy stated that hand hygiene was to be performed 2. b. After removing gloves. During HV#3 the RN was observed wearing gloves and moving from patient care to charting on the tablet device to using equipment and back to patient care without performing hand hygiene. This was confirmed by the Director of Operations and Regional Observed in Patient Home. In 1 of 2 home visits conducted, that included staff taking the supply bag into the home, the surveyor noted that the staff did not follow accepted standards of practice to prevent the transmission of infections and communicable diseases. For example during HV#1 the RN used individually packaged purple top Sani wipes to disinfect the equipment prior to returning it to the supply bag by wiping the equipment and immediately placing it in the supply bag. The organization's Bag Technique policy stated Multi-patient use items such as blood pressure cuffs, stethoscopes,.... should be cleaned after each use with a germicidal disposable cloth per the manufacturer's instructions before returning them to the supply bag. The Sani wipe manufacturer's instructions on the package state a 2 minute contact/wet time when using the product. This contact time was not observed.

Observed in HR File Review. In 1 of 9 HR files reviewed, the surveyor noted that the staff competence was not assessed and documented once every three years. For example, in the HR file for the music therapist the most recent competency was documented over 3 years ago. This was confirmed with the Director of Patient Operations.

Observed in Record Review. In 1 of 4 patient records reviewed, that included aide services, the surveyor noted that the supervising nurse did not assess the hospice aide completing the tasks in the plan of care. For example in record RR#4 although the frequency of supervisory visits met the Standards, the RN did not identify that the aide was not following the visit frequency on the plan of care. As such this did not represent effective aide supervision. This was confirmed with the Regional Director of Patient Operations.

Observed in Record Review. In 1 of 16 patient records reviewed, the surveyor noted that entries into the patient record were not appropriately authenticated. For example, in RR#1 the staff social worker and medical director did not sign the IDG note. This was confirmed with the Regional Director of Patient Operations present.

Observed in Record Review. In 1 of 2 patient records reviewed, that included a living patient discharge from hospice the surveyor noted that the organization did not inform the attending physician of the availability of a discharge summary. For example RR#1 the patient revoked hospice and there was no documentation that the patient's physician had been notified that a discharge summary was available. This was confirmed with the Regional Director of Patient Operations.