Every finding on record at VNA of Greater Los Angeles, Inc

Based on record review and staff interview, the agency staff failed to complete the comprehensive assessment by the interdisciplinary group (IDG) within 5 calendar days after the election for hospice for one of 12 patients (Patient 3). Findings: On 1/24/22, a review of Patient 3's clinical record indicated the start of care dated 12/18/21, with diagnoses taken as heart failure. During the certification period of 12/18/21 through 3/17/22, the agency's IDG review documented Patient 3's visit was as follows: Bereavement: 1 x week for 1 week starting 12/20/21 Chaplain: 1 x month for 3 months starting 12/20/21 HHA: 2 x week for 12 weeks starting 12/20/21 Hospice MSW: 1 x month for 3 months starting 12/20/21 Hospice SN (Skilled NUrse): 2 x week for 12 weeks starting 12/20/21, plus 3 visits (PRN) as needed visits for symptoms management start 12/18/21. End date 3/17/22. Patient 3 was visited by Medical Social Worker (MSW) on 12/31/21, as documented, 13 days after admission. On 1/26/22, at 1:15 p.m., an interview with Staff 1 ((Administrator) indicated that the IDG meeting was included in the CTI (certificate of terminal illness) upon start of care. However, the MSW (medical Social worker) documentation and visit was 13 days late instead of within 5 days.

Based on interview and record review the facility failed to provide services in accordance with the plan of care for two of twelve sample selected patients (Patient 3 and Patient 8). 1. The Skilled nurse (SN) failed to notify the physician of Patient 3's blood pressure that was beyond the parameter of 160/90. 2. The Medical Social Worker (MSW) did not visit Patient 8 once a month per plan of care. This deficient practice had the potential to negatively impact the quality of care received. Findings: 1.A review of Patient 3's patient profile indicated the Patient 3 was admitted to the hospice agency on 12/18/2021, with diagnosis of heart failure (heart is not pumping enough blood throughout the body). During an interview, on 1/26/2022 at 1:15 p.m., Staff 1 stated there was no documentation the physician was notified when Patient 3's blood pressure was high at 168/76. A record review of the SN visit note dated 1/13/2022 at 10:45 a.m., indicated Patient 3's blood pressure was 168/76. Patient 3 was taking the blood medications as follows: Metoprolol Tartrate 25 milligrams (mg) twice a day, Hydralazine 10 mg twice a day and Amlodipine Besylate 10 mg daily. 2. A review of Patient 8's patient profile indicated the Patient 8 was admitted to the hospice agency on 2/10/2021, with diagnosis of hypertensive (high blood pressure) heart disease (damage to the heart) with heart failure (heart is not pumping enough blood throughout the body). On 1/26/22 at 1:25 p.m., during an interview and record review with Staff A, Patient 8's medical record was reviewed. Medical record titled, "Hospice Plan of Care," dated 2/10/21, indicated MSN once (1X) a month for 12 months starting 2/10/21 and ending 5/1/21. Further record review of Patient 8's medical record titled, "Medical Social Services Assessment," dated 2/11/2021, indicated a visit was made. There was no other documentation the MSW had any other visits. Staff A stated, the MSW should have seen the Patient 8 in March, April, and May. Staff A stated, unless noted otherwise, visits should have occurred. Staff A stated the visits were missed. Staff A stated MSW visits should occur to assist the patient with psychosocial, assist family/resources and to observe for unusual activities that may fallen in the adult protective services (APS) bucket; it is an overall set of eyes to look at the home to make sure it is safe. A review of the facility's policies and procedures titled, "The Plan of Care," dated 10/2019, indicated, "The care provided to the patient must be in accordance with the plan of care."

Based on observation, interview and record review, the Hospice agency failed to ensure staff communicated a change of condition to the Registered Nurse (RN) for one of 12 sampled patient (Patient 12). The Home Health Aide (HHA) failed to inform RN 1 regarding two large areas of redness on Patient 12's upper back. This deficient practice had the potential of the area worsening without immediate assessment by the RN. Findings: A review of Patient 12's Patient Profile, indicated Patient 12 was admitted to the hospice on 12/17/2020, with a primary diagnosis of Alzheimer disease (a progressive disease that destroys memory and other important mental functions). During an observation of a joint home visit, on 1/25/2022 at 9:30 a.m., the HHA was bathing Patient 12. The HHA stated Patient 12 had redness on her back that was not there last week. The surveyor observed two large red areas on Patient 12's upper back on the right side. During an interview, on 1/25/2022 at 10:00 a.m., the HHA stated she will contact the RN and inform him of the redness on Patient 12's upper back. During an interview, on 1/26/2022 at 1:20 p.m., the Administrator stated she was not aware of Patient 12's redness and the RN should have been notified. During a telephone interview, on 1/26/2022 at 2:00 pm., RN 1 stated he was not notified of Patient 12's redness on her back. A review of Patient 12's, Plan of Care dated 1/19/2022, indicated the Skilled Nurse (SN) to visit twice a week for eight weeks, the hospice aide twice a week, and the Medical Social Worker (MSW) and Chaplain once a month.

Based on interview and record review, the facility failed to ensure a Registered Nurse (RN) made an on-site supervisory visit at the patients' home every 14 days for two of 12 sample selected patients (Patient 8 and Patient 9). This deficient practice had the potential to negatively impact the quality of care received due to missed evaluation of services being received. Findings: 1. On 1/26/2022 at 1:45 p.m., during an interview with Staff A, Patient 8's medical record was reviewed. Staff A stated the supervisory visit was late. Staff A did not provide a reason why the supervisory visit was late. A review of Patient 8's, "Hospice Plan of Care," dated 2/10/2021, indicated home health aide (HHA) once (x1) a week for 12 weeks starting 2/10/2021 ending date 5/1/2021. A record review of Patient 8's electronic medical record titled "HHA visits," dated 2/20/2021, indicated a visit was made. Further record review of Patient 8's electronic medical record titled, "Hospice Nursing Clinical Note," dated 3/8/2021, indicated a supervision visit was made. 2. A review of Patient 9's patient profile indicated the patient was admitted to the hospice agency on 7/24/2021, with diagnoses of cerebral infarction (when the brain does not receive enough blood). On 1/26/2022 at 1:50 p.m., during an interview Staff A stated the supervisory visit was late. Staff A did not provide a reason why the supervisory visit was late. A review of Patient 9's medical record titled, "Hospice Aide Assignment," dated 12/29/2021, indicated starting 12/29/2021 once a week for 1 week (1w1), then twice a week for 2 weeks (2w2), then 1w1 until the end of certification period. A review of Patient 9's medical record titled, "Hospice aide visit note," dated 12/30/2021, indicated a visit was made. Further record review of Patient 9's medical record titled, "Hospice Nursing Clinical Note," dated 1/14/2022, indicated a supervisory visit was made. A review of the facility's policies and procedures titled, "Hospice Aide Supervisory Visits," dated 12/2018 indicated "The frequency of supervisory visits will be based upon the needs of the patient after the plan of care is established. They must be conducted no less frequently than every 14 days."