Every finding on record at The Hospice of San Diego

Observed in Record Review. In 1 of 6 active patient records reviewed, it was noted the organization failed to ensure that the care and services are provided in accordance with the plan of care. For example in RRHV#3, as per hospice plan of care, the volunteer was ordered to visit the patient once every 2 weeks (1x biweekly); however, no visits have been made since the order was initiated sometime during the 4th week of August and there was no evidence documented in the IDG meeting regarding those visits being missed. This finding was discussed and validated by the agency leadership team.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted the organization failed to ensure that the hospice must follow accepted standards of practice to prevent the transmission of infection and communicable disease, including the use of standard precaution. For example, during home visit conducted of RRHV#3, it was observed that the skilled hospice nurse cleaned the medical equipment used including the blood pressure cuff, thermometer, pulse oximeter and stethoscope with Chlorox disinfectant wipes. However, the nurse immediately placed the equipment back into the nursing bag without allowing the recommended air-drying time of at least 3 full minutes, as specified by the manufacturer. This finding was discussed and validated by the agency leadership team.

Observed in Record Review. In 1 of 3 active patient records with hospice aide services,, it was noted the organization failed to ensure that the written patient care instructions for a hospice aide must be prepared by a registered nurse who is responsible for the supervision of a hospice aide. For example in RRHV#1, based on the record review, the hospice aide care plan did not include any additional instructions related to the patient's oxygen therapy at home, such as whether the patient may use oxygen while taking s shower. This finding was discussed and validated by the agency leadership team.

Observed in Record Review. In 1 of 3 active patient records reviewed with hospice aide services, it was noted the organization failed to ensure that hospice aide supervision was conducted at the patient's home no less than every 14 days as required. For example, based the record review in RRNHV#3, the hospice aide supervisory visit was 28 days late. This finding was discussed and validated by the agency leadership team.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted the organization failed to ensure that the patient records contain clinical information related to list of medications, including dose, strength, frequency, route, date and time of administration for prescription and nonprescription medications, herbal products, and home remedies that relate to the patient's care, treatment, or services. For example in RRHV#1, during medication reconciliation, it was identified that Donepezil 1 tablet PO at bedtime, was missing from the medication list. The daughter-n-law confirmed that the patient has been taking this medication for the past seven years. Additionally, it was noted that the Nifedipine ER dosage did not match the medication list in the hospice plan of care. The daughter-in-law verified that the patient has been taking 90 mg, not 50 mg as listed, This finding was discussed and validated by the agency leadership team.

Observed in HR File Review. In 1 of 7 HR files reviewed, it was noted the organization had failed to obtain a criminal background check on the applicant as required by organization policy. For example in HR#2, the criminal background check through the Office of Inspector General (OIG) is required annually as per organization policy no. 10.21, however, there was no OIG check done for year 2023, and 2024. This finding was discussed and validated by the agency leadership team.

Observed in Individual Tracer. In 5 of 11 patient records reviewed, the organization did not consistently develop measurable goals with specific time frames. For example, HV 1 lacked time frames on education goals, there was no time frame related to bowel movement frequency and regular bowel movements was not defined. For HV 2 goals for edema and reducing incidence of falls was not measurable. There were no time frames for social work and spiritual goals. For RR4 goals related to regular bowels, reduced edema and reduced SOB were not measurable and had no specific time frame. In addition, there was no time frames for social work goals. For RR6 the goal related to agitation and shortness of breath was written as patient will have increased comfort from pain and symptoms as exhibited by verbal and nonverbal communication, for falls was reduce incident of falls. For RR8 the social work goals were not measurable and did not include time frames. The social work goals were stated as the patient and family will demonstrate their understanding of the process of changing the focus of the patient's care and patient/family/cg will verbalize or communicate an understanding of patient's terminal illness as evidenced by acceptance and demonstration of normal grief reactions.

Observed in Individual Tracer. In 3 of 11 patient records reviewed, the plan of care did not reflect a detailed statement of the scope and frequency of services. For example, HV 1 there was no update as of 9/29 to the spiritual care scope and frequency of services. The spiritual counselor documented plans to visit the following month. A second example, RR4 the aide frequency was not updated when aide visit frequency increased from one time a week to two times a week 9/12. The third example, RR5 was receiving volunteer services, however, the volunteer services was not on the care plan.

Observed in Individual Tracer. In 1 of 11 patient records reviewed, the organization did not ensure that care was provided in accordance with the plan of care. During record review for HV 3 the aide was transferring the patient 7/22 to 9/15, however, this was not assigned. Also passive ROM was assigned, however, was not performed 7/22 through 9/12.