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. The hospice has a means to authenticate entries or to identify the author of each entry. If the hospice uses electronic records, electronic authentication utilizes a user ID and password protection. This standard was not met as evidenced by a review of clinical records and interviews. 7 of 13 (54%) clinical records reviewed, revealed that credentials for the hospice aide were not included in the entries made in the electronic record (EMR). Clinical Record 1: The EMR did not identify credentials for the hospice aide. Clinical Record 2: The EMR did not identify credentials for the hospice aide. Clinical Record 5: The EMR did not identify credentials for the hospice aide. Clinical Record 7: The EMR did not identify credentials for the hospice aide. Clinical Record 11: The EMR did not identify credentials for the hospice aide. Clinical Record 10: The EMR did not identify credentials for the hospice aide. Clinical Record 12: The EMR did not identify credentials for the hospice aide. An interview and record review with the Hospice Manager (RN) on 10/17/2022 at 2 pm confirmed this finding.
Every finding on record at Western Health Resources
Hanford, California · CCN 051670
1 finding across 1 survey, in the inspector's own words.
The inspector’s own words from form CMS-2567, unedited, including CMS’s own spacing. Names and some dates are redacted by CMS.
Survey of October 21, 2022
1 finding← Back to the Western Health Resources record
Federal survey findings only. State licensure findings for hospices are not shown.
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