Every finding on record at Snowline Hospice of El Dorado County

Observed in Record Review. In 1 of 18 patient records reviewed, it was noted that the patient record was incomplete. For example, in record RRHV#4 the documentation of the foley catheter RN changed catheter and placed 16fr foley with 10ml balloon did not include technique used, what the balloon was inflated with or how much was placed in the balloon. This was confirmed and discussed with the DPCS and CCO present.

Observed in Record Review. In 2 of 18 patient records reviewed, it was noted that the plan of care did not include all treatments necessary to meet the patient's needs. For example in record RRHV#4 the POC related to the patient's foley catheter was incomplete. It stated: Foley catheter changed 16 French secured with 10ml balloon with no frequency, technique or what balloon was to be secured with. In record RRNHV#2 the POC included an incomplete foley catheter order, PRN clogged or dislodged-16fr COUDE which was missing the balloon size, what to fill balloon with and technique. This was confirmed and discussed with the DPCS CCO present.

Observed in Record Review. In 3 of 18 patient records reviewed, it was noted that the organization had not provided patient care according to the patient's individualized plan of care. For example, in record RRHV#2 the volunteer did not follow the visit frequency of 3-4 visits per month of 1 hour each. The volunteer had stopped seeing the patient, however the POC continued to have the volunteer frequency order on it for 3 IDGs. In record RRHV#6 the volunteer plan frequency stated '2-4 visits/mnth for 2-4 hours each' was not included on the IDG or a supplemental order. There were goals and intervention on IDG but no frequency and the volunteer had completed visits. In record RRNHV#6 the volunteer plan frequency stated 1 visit a week was not included on the IDG or a supplemental order. There were visits documented and goals and intervention on IDG but no frequency and the volunteer had completed visits. This was discussed and confirmed with the DPCS present.

Observed in Data Session. During the Data system tracer it was noted that the organization did not have documentation to show improved compliance based on hand hygiene goal. This was confirmed and discussed with the CCO, Education manager and DPCS.

Observed in Record Review. In 3 of 3 bereavement records reviewed, , the Hospice pharmacy surveyor noted that the organization had not individualized the bereavement care plans as to when a particular goal identified by the bereavement coordinator post death would actually be achieved or planned to be achieved For example, the goals identified for each bereaved individual were left blank containing no plan to reach aby of the goals The lack of individualization was validated with organization leadership at the time of the survey,

Observed in HR File Review. In 2 of 2 HR files reviewed, the Hospice pharmacist noted that neither of the appropriate volunteer files reviewed included documentation of orientation and training consistent with Hospice industry standards. This omission was validated with the Director of Volunteer Services and pharmacy leadership at the time of the survey.

Observed in HR File Review. During a review of the file for the contracted medical director, the Hospice pharmacy surveyor noted that the physician's contract was signed on 6/1/24 and on that day he had access to patient records. His background check was scheduled by the organization approximately one year after his contract began. In addition to the Hospice requirement, the organization required a background check for all employees prior to starting employment, This omission was validated with the HR manager and organization leadership at the time of the survey.

Observed in Emergency Management Session. It was noted by the nurse surveyor that the organization’s emergency communication plan did not contain the names and contact information of relevant tribal leaders. The finding was verified by the Chief Clinical Officer.

Observed in Record Review. In 1 of 12 patient records reviewed, for active patients, it was noted by the nurse surveyor that for HOSRR#7, the Chaplain did not complete the comprehensive assessment within five calendar days of the election of hospice care. There was no documentation in the electronic medical record to indicate why it was not completed timely. Findings were verified by the Director of Hospice Patient Services.

Observed in Record Review. In 1 of 12 patient records reviewed, for active patients, the hospice surveyor noted that for HOSRR#8, the bereavement risk assessment was not completed as part of the comprehensive assessment. Findings were verified by the Director of Hospice Patient Services.

Observed in Record Review. In 12 of 12 patient records reviewed, of active patients. It was noted by the nurse surveyor that for all active records reviewed for hospice, the goals were not measurable. For example, “Skin integrity will be maintained within limits of terminal disease through end of life,” and “Pt. will verbalize/demonstrate respiratory comfort within disease limitations at each visit while on hospice.” Additionally, there were no short-term goals at start of care to address issues of immediate needs such as understanding medication management, symptom management, pain management, mobility, or safety, most were to be achieved by the end of the hospice stay or did not have a time frame at all. Findings were verified by the Director of Hospice Patient Services

Observed in Record Review. In 1 of 12 patient records reviewed, For active patients, the nurse surveyor noted that care was not provided according to the hospice plan of care. HOSHV#1/RR#1, the Spiritual Counselor did not see the patient every month as specified by the plan of care. No documentation was noted to explain the missed visit. Findings were verified by the Director of Hospice Patient Services.

Observed in Patient Home. In 2 of 4 home visits conducted, it was observed by the Nurse Surveyor that the organization did not implement the infection prevention and control activities it had planned per their “Hand Hygiene Policy”. For example, during HOSHV#2/RR#2 the skilled nurse used hand sanitizer, donned gloves, then removed the patient’s dirty dressing from her buttocks, then cleaned the wound bed with the same gloves on. During HV#3/RR#3 with a skilled nurse, proper hand technique was broken per policy. The skilled nurse used hand sanitizer and donned gloves, then proceeded to do a medication reconciliation, touching all the patient’s medications. She then without changing gloves or hand sanitizing, she put her fingers into the medication planner box to remove the old medications. Findings were verified by the Nurse Educator who was present during the home visit.

Observed in Record Review. In 5 of 8 patient records reviewed, for active patients with HHA, it was noted by the nurse surveyor that for HOSHV#1/RR#1 and HOSHV#3/RR#3, the hospice aide care plan did not include instructions on what to do with the patient’s oxygen during the bath. For RR#7 and RR#10, the patients had both oxygen and wounds with no instructions given to the hospice aide of their responsibilities while giving care. For RR#12, the patient had a supra pubic catheter with no instructions of the hospice aide’s responsibility for its care. Findings were verified by the Director of Hospice Patient Services.

Observed in Record Review. In 1 of 8 patient records reviewed, of active patients with the hospice aide, the surveyor noted that for HOSRR#10, one Hospice Aide Supervisory visit was completed 21 days apart, not the required 14 days. This was verified with the Director of Hospice Services.