Every finding on record at Vitas Healthcare Corporation of California

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. In 2 of 23 (9%) clinical records reviewed, the agency did not ensure that the hospice interdisciplinary group (IDG) completed an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care. Clinical Record 22: The patient elected the hospice benefit on 01/20/2024. The initial psychosocial/spiritual comprehensive assessment was completed on 02/02/2024, which was thirteen (13) days after the election of hospice care. A review of the clinical record revealed no evidence that the patient and family/caregiver refused Chaplain (SC) and Social Work (SW) services during the five (5) calendar days after the election of hospice care. Clinical Record 23: The patient elected the hospice benefit on 04/26/2024. A clinical record review revealed evidence of a Chaplain (SC) visit note dated 05/07/2024, and a Social Work (SW) visit note dated 04/29/2024. There was no documented evidence that the SC or SW completed the initial psychosocial or spiritual comprehensive assessments. There was no evidence that the patient and family/caregiver refused the services during the five (5) day period after the election of hospice care. During an interview on 06/26/2024, the General Manager, National Patient Care Administrator, and the Patient Care Administrator confirmed that the agency did not ensure the members of the IDG completed an initial comprehensive assessment no later than five calendar days after the election of hospice care.

Based on interview and record review, the agency failed to ensure communication was effective and accurate for one of 2 sampled patients (Patient 1) when the family was mistakenly notified by the agency staff that she had died, condolences calls made to the family and, a condolences card mailed to the family due to miscommunication. This failure resulted in emotional pain to the family, and they requested Patient 1 be discharged to another hospice agency. --- Findings: According to the 'Intake Information' received by the Department on 12/28/22, Patient 1's family had been mistakenly notified by the agency staff that she had died at the care home where she resided. Additionally, the family had received condolences audio messages and a bereavement card from the agency. A review of Patient 1's Admission Orders ... indicated the Start of Care (SOC) date was 3/29/22 and she was admitted with a terminal diagnosis of dementia. The Planned visits were by the nurse, the social worker, the chaplain and the hospice aide. Patient 1s Transfer/Discharge Summary ... was reviewed and indicated she was transferred to another hospice on 12/13/22. During an interview on 1/6/23, at 1:40 p.m., with the Team Manager (TM), she stated she had emailed the night shift on-call Registered Nurse (RN) in the morning of 12/13/22 to get the report for a home visit to Patient 1 that was scheduled through the agencys 24-hour call center. The TM stated Patient 1 lived in a senior care home and was to be seen by the RN the night of 12/12/22 for a nosebleed. The TM stated she had emailed the RN because there was no documentation from the nurse or the call center the visit was done. The TM stated her email included Patient 1s full names and the RN replied that the patient had died. The TM stated the RN mistakenly replied that the patient had died but was referring to another patient. The TM stated she had no way of knowing the RN was referring to another patient and at that point, the agencys team signed a condolences card to be mailed to the family and the Case Manager (CM) called the family to offer the teams condolences. The TM stated this was a mistake that could have been avoided had the RN read the email she sent to her properly before replying and had there been a documentation by the RN or the 24/7 call center staff that Patient 1s visit was not done as planned. The TM stated Patient 1s family requested transfer to another hospice agency which she facilitated. The TM stated the family was extremely affected and their feelings hurt by the mistake, and they felt they couldnt overcome the pain if they were to remain under the agencys care. An interview conducted with the CM on 1/6/23, at 1:48 p.m., she stated that after she received the information Patient 1 had died, she called her son, and he was frantic on the phone and hang up. The CM stated the senior care home manager called the agency and he was upset that the agency had told the son his mother had died when she had not. The CM stated she called the Patients 1s son to apologize for the mistake. The CM stated the TM emailed the entire team to let them know Patient 1 had not died and it was a mistake. The CM stated she spoke to the Chaplain about it, and she was not sure why he did not pull back the condolences card before it was mailed out to the family. During a telephone interview with the RN on 1/6/23, at 2:23 p.m., she stated she was initially requested to go check on Patient 1 who had a nosebleed on the night of 12/12/22 but before she made the visit, she was re-routed to another patient who had died. RN stated she did not call Patient 1s senior care home to cancel the visit and she did not document the visit was not completed. RN stated by the time she received the email from the TM on 12/13/22 in the morning requesting to know how Patient 1s visit went, she did not read the email properly and she replied to the team manager that she was still completing the death visit. A review of the agencys policy titled, ... Communication Program dated 7/25/19 directed staff to use the agencys provided communication devices, for telephone calls, text messages and emails and to document calls to patients and families. The program indicated that after hours activities should go through telecare (the call center). The policy did not indicate who was responsible to document visits that were scheduled and not completed and who was responsible to call the patient, family or facility if the visit was changed or cancelled for whatever reason/s. During an interview with the Patient Care Administrator (PCA), on 1/6/23, at 3 p.m., she indicated the mistake should have been avoided had the RN read the team managers email properly.

Based on observation, interview and record review, the agency's Hospice Aide (HA) failed to follow the care plan instructions for one of 18 sampled patients (Patient 13) when she did not clean her dentures during visits. This failure had the risk potential for Patient 13's oral health to be compromised. Findings: According to Patient 13's 'Initial Assessment' dated 4/21/21, the Registered Nurse (RN)documented she had both upper and lower dentures. Patient 13's hospice aide services care plan dated 7/12/21 was reviewed and directed the hospice aide to clean the dentures during home visits. During a home visit on 9/14/22, starting from 9:15 a.m., the hospice aide was observed providing a shower to Patient 13. The hospice aide did not clean Patient 13's dentures as directed by the care plan. An interview conducted with the hospice aide on 9/14/22, shortly after 9:15 a.m., she stated Patient 13 had her own teeth and she used toothettes to clean her teeth during visits. The hospice aide stated she stored the toothettes in her car and did not bring them to the house during this visit. When the hospice aide was asked if Patient 13 had teeth or dentures, she stated she had her own teeth. A care-giver at the home confirmed Patient 13 had dentures and opened a cupboard located in the shower room where the dentures cleaning supplies were stored. The hospice aide validated that she did not clean Patient 13's dentures and she was not aware the patient had dentures. The hospice aide also confirmed she was assigned to Patient 13 and had visited her twice per week for many months. A review of Patient 13's 'Visiting Frequency Grid' printed on 9/13/22 indicated the hospice aide visits were scheduled for twice per week since 7/15/22. A review of the agency's 'Hospice Aide...' procedure dated 1/20/22 indicated, "Hospice aides are assigned to a specific patient by a registered nurse ... 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 ... Task frequency is every visit unless the RN specifies a specific frequency for a task." During an interview with the Patient Care Administrator (PCA) on 9/14/22, at 3 p.m., she stated the hospice aide for Patient 13 should have cleaned her dentures and followed the care plan instructions.

Based on observation, interview and record review, the agency's Hospice Aide (HA) failed to follow the care plan instructions for one of 18 sampled patients (Patient 13) when she did not clean her dentures during visits. This failure had the risk potential for Patient 13's oral health to be compromised. Findings: According to Patient 13's 'Initial Assessment' dated 4/21/21, the Registered Nurse (RN)documented she had both upper and lower dentures. Patient 13's hospice aide services care plan dated 7/12/21 was reviewed and directed the hospice aide to clean the dentures during home visits. During a home visit on 9/14/22, starting from 9:15 a.m., the hospice aide was observed providing a shower to Patient 13. The hospice aide did not clean Patient 13's dentures as directed by the care plan. An interview conducted with the hospice aide on 9/14/22, shortly after 9:15 a.m., she stated Patient 13 had her own teeth and she used toothettes to clean her teeth during visits. The hospice aide stated she stored the toothettes in her car and did not bring them to the house during this visit. When the hospice aide was asked if Patient 13 had teeth or dentures, she stated she had her own teeth. A care-giver at the home confirmed Patient 13 had dentures and opened a cupboard located in the shower room where the dentures cleaning supplies were stored. The hospice aide validated that she did not clean Patient 13's dentures and she was not aware the patient had dentures. The hospice aide also confirmed she was assigned to Patient 13 and had visited her twice per week for many months. A review of Patient 13's 'Visiting Frequency Grid' printed on 9/13/22 indicated the hospice aide visits were scheduled for twice per week since 7/15/22. A review of the agency's 'Hospice Aide...' procedure dated 1/20/22 indicated, "Hospice aides are assigned to a specific patient by a registered nurse ... 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 ... Task frequency is every visit unless the RN specifies a specific frequency for a task." During an interview with the Patient Care Administrator (PCA) on 9/14/22, at 3 p.m., she stated the hospice aide for Patient 13 should have cleaned her dentures and followed the care plan instructions.

Based on interview and record review, the agency failed to ensure there was a clear communication process included in their policy on staffing for patients on continuous care for one of 3 sampled patients (Patient 1) when the family was not notified a nurse was not scheduled to cover the night shift. This failure resulted in Patient 1's family being unable to make a determination to stay with her on the night she passed away. Findings: A review of the an 'Intake Information' received by the Department early this year, in part indicated, "... we had RN [agency's name] nurses around the clock for 3 days ... My wife and I were there most of the day and night until 9:30pm ... that is the only reason my wife and I left that night ...[the night Patient 1 died]" According to Patient 1's 'Case Sheet' she was admitted under hospice care on 8/10/21 with a terminal diagnoses of heart failure. A 'Physician Order' dated 8/11/21 indicated to discontinue the routine level of care and begin ICC (Intensive Comfort Care) level of care at 4:15 p.m. as Patient 1 was having shortness of breath. During an interview and concurrent record review with the Clinical Manager (PCA) and the General Manger (GM) on 1/31/22 at 11:41 a.m., when the GM was asked how patients or their families were notified when a nurse was not scheduled for a certain shift, she stated the nurse normally called family prior to a visit. The PCA indicated the nursing schedule for patients on ICC was not planned that far out and was determined a couple of hours prior to the next shift based on staff availability and based on whether the 8 hours guaranteed for ICC in 24 hours was met. The PCA further indicated if the patient had an urgent need, regardless of the ICC order, the patient or family are made aware to call the after hours phone number for assistance. An interview conducted with the agency's Physician on 2/1/22 at 2:10 p.m., she stated the intent of ICC was to manage a difficult symptom to a level the patient can tolerate. The Physician stated some of the patients might need ICC for a few hours and others a longer period. The Physician stated ICC guaranteed a patient received a total of 8 hours in 24 hours. The Physician stated it would have been appropriate for the agency to notify Patient 1's family that an 8 hour shift was already covered and a nursing visit was not guaranteed for the night shift. Review of the agency's undated policy titled, "... Management Standard" under Continuous Care Staffing Need indicated, "Each program should make every effort to staff and confirm staffing on all CC shifts prior to turning the program over to CC After Hours ... Best Practice ... program should staff patients out 2-3 days .." The policy did not indicate how patients, families and/or caregivers would be notified if a ICC shift was not being covered.