Every finding on record at University of California, Davis Medical Center

Observed in Record Review. In 1 of 13 patient records reviewed, the hospice agency failed to document a spiritual care assessment as part of the initial comprehensive assessment. In HOHV#1 there was no documented visit by a spiritual counselor with an associated spiritual assessment and there was no documentation in the record to explain why this assessment did not occur. This was validated by the Hospice Supervisor.

Observed in Record Review. In 9 of 13 patient records reviewed, the plan of care did not include goals with time frames required to meet those goals. In HOHV#3 the only goal that was timed and prioritized on admission was related to verbalizing methods to manage GI symptom in one week. Three weeks later that same goal was the only timed goal, it still was timed for a week and there was no documentation that addressed the patient/caregiver's ability to verbalize managing GI symptoms and therefore no reasoning for why this goal was not resolved or retimed. In HORR#1 goals that were targeted for one week after the start of care were not updated after one week of care. In HORR#2 understanding medication regimen within 2 weeks was the only timed goal. A paracentesis device was added two days after admission and the plan of care was updated to reflect this care. However the goal was Paracentesis via an implanted device there were no goals or time frames associated with this problem. In HORR#2, HORR#4, HORR#5, HORR#6, HORR#8, HORR#9, and HORR#10 at start of care there were a few goals that were prioritized with short term dates but they were almost identical across charts and were never updated throughout the course of care. This was validated with the Hospice Supervisor.

Observed in Record Review. In 10 of 13 patient records reviewed, the hospice plan of care did not address all patient needs. In HOHV#1 the social worker identified that there were no funeral arrangements in place. The only intervention planned and/or documented was to provide the patient family with a list of mortuaries. Ten months after admission to hospice the patient record did not document any funeral arrangements and there were no further interventions planned or documented after the initial list was provided. In HOHV#2 the comprehensive assessment indicated that the patient's life expectancy was one to two weeks. The MSW documented that funeral plans were identified as not done. The plan for follow up was for funeral plans to be in place approximately 6 weeks after hospice admission and the social worker visit frequency was set for 3 times per month. There was no indication that the MSW planned to follow up within the patient's life expectancy. In addition the plan of care did not address the Foley catheter observed during the home visit. In HOHV#3, HORR#5, HORR#6, and HORR#8 the absence of funeral plans was identified and not addressed. In HORR#3 impaired swallowing and aspiration risk were not addressed. In HORR#4 the comprehensive assessment indicated a risk for skin breakdown and the plan of care did not include strategies for preventing skin breakdown. In HORR#6 the patient had six wounds. The plan of care addressed wound care for five of the wounds but treatment for the sixth wound was not addressed. IN HORR#8 the plan did not address a coccyx wound or maintaining skin integrity. In HORR#9 the plan of care did not address fall risk or skin risk. In HORR#10 for a wound that was assessed on admission there were no wound care interventions on the plan of care until day 16 of care. This was validated with the Hospice Supervisor.

Observed in Record Review. In 5 of 13 patient records reviewed, the hospice record included unclear or incomplete medication orders. In HOHV#1 Colace suppository, Senna, and Milk of Magnesia were all ordered for constipation and Tylenol liquid, and oxycodone 5mg were both ordered for mild pain. The patient medication list did not include any directions for the caregiver to differentiate when to use which medication for the indicated symptom. In HOHV#2 Tylenol suppository and Tylenol tablets were ordered for elevated temperature without differentiation. In HOHV#3 Tylenol suppository and tablets were ordered prn for fever and oxycodone solution and tablets were ordered prn for pain or dyspnea. In HORR#2 Zofran was ordered prn without an indication. In HORR#4 Tylenol tablets were ordered without specifying a frequency or indication, Tylenol liquid was ordered every 8 hours prn pain, and Tylenol suppository for fever. There was no maximum dosage indicated. Agency policy Reconciliation and Documentation of Medications- 650.2 states an indication or reason for all medications will be included on the medication record and confirmed with PMD as necessary. This was validated with the hospice supervisor.

Observed in Record Review. In 2 of 13 patient records reviewed, the hospice agency failed to document care provided according to orders. In HORR#3 the plan of care called for wound care every 5 days. The actual care delivered ranged from every 4 days to 7 days. In HORR#8 drainage via a Pleurex catheter was ordered three times per week. There was one instance in which the procedure was only done twice in the week with no documentation as to the reason for the missed treatment. This was validated with the Hospice Manager.

Observed in Tracer Activities. The governing body/leadership did not ensure that the following Conditions of Participation were met as determined through observations, documentation, and staff interviews: 418.56.

Observed in Record Review. In 2 of 4 patient records reviewed, for patients with wounds, the agency failed to regularly document wound assessments. In HORR#3 the wound assessment did not include location, type of wound, measurements, appearance, or drainage. In HORR#6 the patient had six wounds that the wife was providing wound care for. There was no documented assessment of wounds for the first two months of care.

Observed in Record Review. In 1 of 6 patient records reviewed, for patients who had oxygen, the medical record did not document an assessment of safe storage of oxygen equipment. In HORR#7 the home oxygen safety assessment was conducted before oxygen equipment was delivered to the home and not repeated after the oxygen was present. Since there was no documented safety assessment with oxygen in the home there was no documented assessment that oxygen equipment was stored correctly and any related appropriate teaching. This was validated with the Hospice Supervisor.