Every finding on record at Vitas Healthcare Corporation of California

It is required that the hospice inpatient facility has documented and dated written reports of Life Safety Code fire drills at varied times on all shifts. This standard was not met as evidenced by document review and interview. A review of the inpatient facility fire drill logs revealed the agency did not ensure compliance with the National Fire Protection Act (NFPA) section 18/19.7.1.6, which stated, "Fire drills conducted at unexpected times under varying conditions, at least quarterly, on each shift." The inpatient facility's fire drill logs documented for the first quarter of 2024 included 01/12/2024 from 1530-1600, 02/20/2024 from 1800-1820, and 03/07/2024 from 0815-0845. The inpatient unit had three (3) shifts (0730-1600, 1530-2400, and 2330-0800). There was no evidence of a fire drill conducted for the third shift (2330-0800) in the first quarter of 2024. Following the joint review of the fire drill logs on 06/19/2024, the team manager confirmed that no fire drill was conducted for the third shift (2330-0800). A review of the fire drill logs revealed the agency did not ensure compliance with the National Fire Protection Act (NFPA) section 18/19.7.1.6 which stated, "Fire drills conducted at unexpected times under varying conditions, at least quarterly, on each shift."

It is required that the Interdisciplinary Group, in collaboration with the individual's attending physician (if any), reviews, revises, and documents the individualized care plan. A revised plan of care includes: information from the patient’s updated comprehensive assessment; [and] record of the patient’s progress toward the outcomes and goals specified in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 3 of 30 (10%) clinical records reviewed, the agency did not ensure that the patient's plan of care included information from the patient’s updated comprehensive assessment and the patient’s progress toward the outcomes and goals specified in the plan of care. Clinical Record 6: The patient elected the hospice benefit on 11/15/2023 with a diagnosis of cerebral atherosclerosis. A clinical record review revealed the "Plan of Care Review" paper forms, which were utilized to document updates to the comprehensive assessment, responses to care, and plan of care review. The "Plan of Care Review" forms dated 11/28/2023, 12/12/2023, and 01/09/2024 were photocopied with only the date they were signed changed. The "Plan of Care Review" forms dated 03/26/2024, 04/09/2024, and 04/23/2024 were photocopied with only the date they were signed changed. During a joint record review, the National Patient Care Administrator confirmed that the forms had been copied and there was no other documentation to support that the plans of care were reviewed, revised, or showed patient progress towards goals. Clinical Record 7: The patient elected the hospice benefit on 01/19/2024 with a diagnosis of chronic obstructive pulmonary disease (COPD). The Chaplain signed the documented initial psychosocial/spiritual assessment dated 01/21/2024. Per that assessment, the patient answered "yes" to the question, "Do you want help to change or complete your final arrangements?" The forms completed for the plan of care updates, titled "Plan of Care Review," included a section for response to care and updates to comprehensive assessments for "End of Life Choices" in which the clinicians documented, "DNR (do not resuscitate) - needs final arrangements" on 01/24/2024, 02/07/2024, 02/21/2024, 03/06/2024, 03/20/2024, 04/03/2024, 04/10/2024, 04/17/2024, 05/01/2024, 05/15/2024, 05/29/2024, and 06/12/2024. A clinical record review revealed no documented evidence that hospice staff were assisting the patient with progressing toward this goal. On 06/19/2024, the Patient Care Administrator (PCA) reported that they contacted the Social Worker for this patient, who said, "(The patient) had final arrangements but hadn't provided the hospice agency a copy yet." On 06/21/2024, the PCA confirmed the record did not contain additional documentation to support revisions to this care plan or the patient's progress toward the goal of completing the final arrangements. Clinical Record 12: The patient elected the hospice benefit on 05/20/2023 with a diagnosis of COPD. A clinical record review revealed the paper forms titled "Plan of Care Review," which were utilized to document updates to the comprehensive assessment, responses to care, and plan of care review. The "Plan of Care Review" forms dated 05/30/2023 and 06/14/2023 were photocopied with only the date they were signed changed. During a joint record review, the National Patient Care Administrator confirmed that the forms had been copied and there was no other documentation to support that the plans of care were reviewed, revised, or showed patient progress towards goals.

It is required that all entries in the patient record are legible, complete, and appropriately authenticated and dated by the person performing the care/service in accordance with hospice policy and with currently acceptable standards of practice. This standard was not met as evidenced by clinical record review, document review, and interview. In 5 of 30 (17%) clinical records reviewed, the agency did not ensure that the patient records contained legible and authenticated documents. Document 1: "Correcting an Error in the Clinical Record" (no date), stated in relevant parts, "The patient's medical record is considered a legal document...You may NOT use whiteout or any other substance to cover what is written in a legal document...You may NOT attempt to fix an error by writing over something already written." Clinical Record 5: The patient elected hospice care on 09/06/2023. A clinical record review revealed the paper form titled "Plan of Care Review." The "Plan of Care Review" forms signed by the Registered Nurse (RN) on 05/07/2024 and 06/04/2024 documented words covered with white corrective fluid and written over. During a joint review of the record on 06/18/2024, the Patient Care Administrator (PCA) [Personnel Record 2] confirmed the presence of the corrective fluid in two areas within the record. Clinical Record 6: The patient elected hospice care on 11/15/2023. A clinical record review revealed the paper form titled "Plan of Care Review." The "Plan of Care Review" form was utilized to document updates to the comprehensive assessment, responses to care, and the plan of care review. The "Plan of Care Review" forms dated 11/28/2023, 12/12/2023, and 01/09/2024 were photocopied with only the date they were signed changed. The "Plan of Care Review" forms dated 03/26/2024, 04/09/2024, and 04/23/2024 were photocopied with only the date they were signed changed. The nurse's signature on the forms had been photocopied. During a joint review of the record on 06/19/2024, the National Patient Care Administrator confirmed the forms, including the signatures, had been photocopied. Clinical Record 10: The patient elected hospice care on 04/17/2024. A review of the clinical record revealed the paper form titled "Nursing-Updated Comprehensive Assessment," signed by the RN and dated 05/31/2024. The form contained a section documenting the patient's and caregivers' reported level (0-10) of concern. Both sections documented a number that had been scribbled over the top of another number, making it illegible. Clinical Record 12: The patient elected hospice care on 05/20/2023. A clinical record review revealed the paper form titled "Plan of Care Review." The "Plan of Care Review" form was utilized to document updates to the comprehensive assessment, responses to care, and the plan of care review. The "Plan of Care Review" forms dated 05/30/2023 and 06/14/2023 were photocopied, and only the date they were signed was changed. The nurse's signature on the forms had been photocopied. During a joint review of the record on 06/19/2024, the National Patient Care Administrator confirmed the forms, including the signatures, had been photocopied. Clinical Record 29: The patient elected hospice care on 06/16/2024. A review of the clinical record revealed the paper form titled "VIPU RN-Initial Comprehensive Assessment," signed by the RN and dated 06/16/2024. The document contained areas where words had been scribbled over, making them illegible. During a joint clinical record review, the Inpatient Unit (IPU) Team Manager confirmed multiple areas where words were scribbled over.

Based on interview and record review, the agency failed to provide care consistent with patient and family needs for 1 of 2 sampled patients (1). As a result, the agency did not provide care and service to Patient 1 and the family. --- Findings:Patient 1 was admitted to the agency on 6/8/21 with diagnoses which included Cerebral atherosclerosis (build-up of plaque in the brain's blood vessels) per the agency's Case Sheet. A record review was conducted. Per the TeleCare Call Note, the following entry happened: On 2/25/22 at 8:12 P.M., the caregiver reported to Hospice that Patient 1 was declining and did not want to eat or drink. On 2/25/22 at 8:16 P.M., the family member asked the Hospice for a nurse visit. On 2/25/22 at 8:18 P.M., the TeleCare staff categorized Patient 1's need as P2 (Priority 2- Hospice to visit within 24 hours). Patient 1 had difficulty swallowing and needs comfort medicines. On 2/26/22 at 12:01 A.M., the caregiver stated they would like a hospice nurse to come and visit Patient 1. On 2/26/22 at 7 A.M., the family member stated there were no nurse visits last night. Patient 1 was agitated and appeared to be in pain. On 2/27/22 at 10:13 A.M., the family member reported the hospice nurse made no nurse visit and would like to speak to the supervisor. On 2/27/22 at 10:25 A.M., the TeleCare staff categorized Patient 1's need as P1 (Priority 1- Hospice to visit within one hour). On 2/28/22 at 12 P.M., the Registered Nurse (RN) made the in-person visit, per the Focus Visit Note. The RN and the team manager were not available for an interview. On 9/13/23 at 3:15 P.M., a joint interview and record review was conducted with the National Patient Care Administrator (NPCA). The NPCA stated the nurse should have visited Patient 1 and assessed the needs. Per the agency's Standard, titled Telecare, "...Telecare staff are interdisciplinary team members who collaborate with program clinical staff to ensure that patient and family needs are met 24/7...c. Priority Levels i. One (P1) 1. Dispatch to the visit within one hour of completing the phone assessment ii. Two (P2) 1. Dispatch a visit today (or within 24 hours)..."

Based on interview and record review, the agency failed to provide nursing services per the plan of care for one sampled patient (1). As a result, Patient 1 was placed at an increased risk of infection. Findings: Per the facilitys Plan of Care dated 2/22/23 through 3/8/23, Patient 1 was admitted to the agency on 2/22/23 with diagnoses to include heart failure and diabetes (abnormal blood sugar). The Plan of Care listed edema (swollen with fluid) to feet as one of Patient 1s symptoms, but did not direct staff to use needles to drain fluid from Patient 1s feet. Per the facilitys Nursing-Updated Comprehensive Assessment, dated 2/23/23, Skilled Nurse (SN) 2 documented, Patient 1 had edema in both feet, and SN 2 used a needle to remove a large amount of extra fluid in both feet. On 3/15/23 at 2:30 P.M., a telephone interview was conducted with the Branch General Manager (BGM). The BGM stated, SN 2 used a needle to drain fluid from Patient 1s edematous legs. The BGM further stated, SN 2 was acting outside of her scope of practice, and it was not a procedure the agency would have permitted her to perform. On 6/13/23 at 2 P.M., a telephone interview was conducted with the Medical Doctor (MD). The MD stated, SN 2 used a needle to puncture Patient 1s legs about five times each, then applied gauze for the fluid to drain into. The MD further stated, he did not order the procedure, SN 2 did not discuss it with him, and it placed Patient 1 at an increased risk of infection. Per the facilitys policy, titled Job Descriptions Vitas Nurse, RN, revised 8/9/19, ";...The Vitas RN...practices within the scope of the RN license...Delivers care in accordance with the patients plan of care..."

Based on interview and record review, the agency failed to notify the Department of an allegation of mistreatment for 1 of 2 sampled patients (1). As a result, the Department could not verify the patient's safety. Findings: Patient 1 was admitted to the agency on 1/26/22 with diagnoses which included malignant neoplasm of the biliary tract (cancer in the slender tubes that carry the digestive fluid bile through the liver) per the agency's Case Sheet. A review of Patient 1's clinical record was conducted. Per the Home Health Aide/Homemaker Note, dated 3/29/22, Certified Home Health Aide (CHHA) 1 documented that she tried to take Patient 1's shirt off and complained of pain when CHHA 1 touched Patient 1, so CHHA 1 requested to see the bottle of medication to see if Patient 1 could take pain medication at this time, the family member got mad and asked CHHA 1 to leave [Patient 1] alone. On 5/11/22 at 9:55 A.M., an interview was conducted with the Patient Care Administrator (PCA) 1. PCA 1 stated on 3/29/22, when CHHA 1 was supposed to provide a bed bath, there was no allegation of abuse or mistreatment. PCA 1 said the family member requested CHHA 1 to leave their house. PCA 1 stated mid-April when Adult Protective Service called and filed a complaint against CHHA 1. PCA 1 said the investigation and in-progress. On 5/12/22 at 1:50 P.M., an interview was conducted with the CHHA 1. CHHA 1 stated she was unfamiliar with Patient 1, and on 3/29/22, she was supposed to provide a bed bath to Patient 1. CHHA 1 said she did not ask Patient 1 about pain before removing the clothes, and when she lifted Patient 1's arm to remove the clothing, Patient 1's complained of pain, so she inquired about giving Patient 1 pain medicine and the family member got mad. The family member asked CHHA 1 to leave the house. CHHA 1 explained herself to the family member and called PCA 1. On 5/12/22 at 4:43 P.M., an interview was conducted with Skilled Nurse (SN) 1. SN 1 stated she was the nurse that visited Patient 1 the next day after CHHA 1. SN 1 said the family member told her that CHHA 1 was too rough with Patient 1. SN 1 stated she listened to the family member but did not ask further questions as she did not want to be involved. SN 1 further said the family member told her the agency was aware of the incident. On 6/6/22 at 3 P.M., an interview was conducted with PCA 1. PCA 1 stated she did not report the allegation of abuse to the Department and should have been reported. On 6/14/22 at 1 P.M., an interview was conducted with the Social Worker (SW). The SW stated on 4/26/22 at 3:30 P.M., she received a report from the Adult Protective Services about CHHA 1 mishandling Patient 1 and relayed the information to PCA 1 the same day. There was no documented evidence that the allegation of mistreatment was reported to the Department by the agency. Per the agency's Management Standard, dated 2021, titled Reportable Events, "... the program senior management is responsible for ensuring suspicion is reported no later than 24 hours after notification of the suspicion. The report must be made directly to local law enforcement and the state survey agency within 24 hours..."