Every finding on record at Tri Valley Hospice Care, Inc.

Observed in Record Review. In 3 out of 4 record reviews, the hospice’s interdisciplinary group, in consultation with the patient’s attending physician did not complete the comprehensive assessment no later than five calendar days after the election of hospice care. Example: In 3 out of 4 records the social worker failed to complete their initial assessments within five days after the election of hospice as evidenced by RRHV#1 SW initial assessment done 8 days after hospice election, RRNHV#1 SW initial and bereavement assessment done 19 days after the hospice election, and RRNHV#2 SW initial assessment done 13 days after the hospice election date. This was confirmed by the Nursing Administrator.

Observed in Individual Tracer. In 1 out of 2 home visits with nursing, the nurse did not compare the medication information the patient is currently taking with the medications ordered for the patient in order to identify and resolve discrepancies per organization policy. Example: During HV#1, the RN did not perform medication reconciliation per the agency's Medication Management policy, which states that on every visit the nurse must perform by comparing each bottle to the current medication list and evaluating for changes. This was confirmed by the Nursing Administrator.

Observed in Tracer Visit. In 2 out of 5 record reviews, the organization did not provide the patient with care, treatment, or services according to the patient's individualized plan of care. Example: In RRNHV#1, there was 1 missed RN visit during week 7 and 8 of benefit period #2. In RRNHV#1 there were 1 missed Aide visit during week 7 and 2 missed Aide visits during week 8 of benefit period 2. In RRNHV#2, there was 1 missed Aide visit during week 9 and 2 missed Aide visits during week 10 of benefit period #2. This was confirmed by the Nursing Administrator.

Observed in Record Review. The hospice did not provide the patient’s attending physician with a copy of the hospice discharge summary and, if requested, a copy of the patient’s clinical record. Example: RRDC#1, the agency did not provide the physician with the discharge summary after the patient revoked hospice services.

Observed in Record Review. In 2 of 13 patient records reviewed, in RR #5 and RR #6, the Hospice Surveyor noted the bereavement risk assessment was not completed as part of the comprehensive assessment. This was confirmed with the DPCS/Administrator.

Observed in Patient Home. In 2 of 3 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. During HV#2/RR#2, the skilled nurse donned gloves, picked up the bubble packets and lock med box, and began filling the patient's pill minders. The nurse used the same gloves to turn on a light switch and pick up fallen pills off the table, without changing her gloves or performing hand hygiene. During HV #3/RR #3, the chaplain changed gloves several times without conducting hand hygiene. Findings were discussed and verified by the Assistant Director, who was present during the visit.