Hospice of Santa Cruz County

“Upon patient record review, 2 of 25 (Patients #15 and 16) did not contain evidence that a Registered Nurse was designated to ensure continuous assessment of the patient and family’s needs, and to coordinate activities with other members of the interdisciplinary group: Patient #15: The 01/06/24 RN SOC assessment included, “Wound. Breast folds and groin. Using Nystatin and Z-Quest” The Subsequent SN visits of 01/07/24, 01/09/24, and 01/12/24 documented that, “Skin integrity not evaluated/not addressed.” Patient #16: A verbal order was obtained on 02/15/24 for, “Patient to check their FBS every morning, to determine appropriateness of Insulin medication.” There was no documented evidence that the nurse had instructed the patient to do this; nor that the Hospice nurse had reported any such daily FBS results to the ordering Physician.”

“Upon patient record review, 1 of 25 (Patient #8) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including the following: A detailed statement of both the frequency and scope of disciplines/services necessary to meet the specific patient and family needs: Patient #8: SOC was 01/12/24. There were multiple documented phone calls by the Spiritual Counselor attempting to contact the patient/family to arrange for a home visit to conduct the initial 5-day spiritual aspect of the Comprehensive Assessment. The last documented phone call was 02/27/24, in which the contact stated, “They had company and could not speak now.” The Next IDG Meeting was the following day 02/28/24. The resultant POC included a SC frequency of, “SC- 2 prn. Urgent SCC needs”; without a baseline visit frequency having been established.”

“Upon patient record review, 3 of 25 (Patients #1, 2, and 3) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, specifically equipment and supply needs: Patient #1: During Surveyor-attended home visit on 03/11/24, it was noted that the patient had the following DME: 1) Bed; 2) Over-bed table; and 3) WC. These DME were not included in their Plan of Care. Patient #2: During Surveyor-attended home visit on 03/11/24, it was noted that the patient had the following DME: 1) Bed; and 2) Over-bed table. These DME were not included in their Plan of Care. Patient #3: During Surveyor-attended home visit on 03/11/24, it was noted that the patient had the following DME: 1) Bed; 2) Over-bed table; and 3) WC. These DME were not included in their Plan of Care.”

“Upon patient record review, 1 of 25 (Patients #6) did not contain evidence that a revised Plan of Care included information from the patient’s updated Comprehensive Assessment(s): Patient #6: The clinical record reflected that the patient had verbally reported his Advance Directive(s) of a DNR and a POLST. The record reflects that the patient did not wish to provide a copy of such to the Hospice. The Hospice Plan of Care, the Advance Directive section, intended to reflect the patient’s Advance Directive status, or the absence of, had been left blank.”

“Upon personnel record review, 1 of 12 (Personnel #8) did not contain evidence that their Aide Skills Competency Assessment contained all CMS-required content. An RN conducted an Aide Skills Competency Assessment on 06/23/23. However, the following skills were not evaluated/documented for: • Maintenance of a clean, safe, and healthy environment • The physical, emotional, and developmental needs of and ways to work with the populations served by the hospice, including the need for respect for the patient, his or her privacy and his or her property • Adequate nutrition and fluid intake The following competencies must be evaluated while the Aide is performing the tasks with a patient or pseudo-patient: • Reading and recording temperature, pulse, and respiration • Safe transfer techniques”

“Upon patient record review 1 of 25 (Patient #11) did not contain documented evidence that the Hospice Aide had provided care/services that were: • Ordered by the Interdisciplinary Group • Included in the Plan of Care Patient #11: SOC 01/15/24. A verbal order was obtained on 01/21/24 for Aide services at a frequency of, “2x per week until 04/06/24.” There were no Aide visits made/documented for the week(s) of 01/21-01/27/24, and 01/28/24-02/03/24. A verbal order was obtained on 02/11/24 for Aide services at a frequency of, “2x per week x9”. There was only (1) Aide visit the week of 02/11-02/17/24.”

“Upon patient record review 3 of 25 (Patients #3, 5, and 15) did not contain evidence that a Registered Nurse had made an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the Hospice Aide, and to ensure that services ordered by the Hospice Interdisciplinary Group meet the patient’s needs: Patient #3: An Aide Supervisory visit was made on 01/16/24, and then not again until 02/02/24, for an interim period of 17 days. Patient #5: An Aide Supervisory visit was made on 11/21/23, and then not again until 12/06/23, for an interim period of 15 days. Patient #15: An Aide Supervisory visit was made on 02/12/23, and then not again until 02/27/24, for an interim period of 15 days.”

“Upon patient record review, 1 of 5 (Patient #4) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #4: Did not have evidence of Bereavement Risk Assessment had been completed. There were multiple attempts to reach son and patients friend with no avail.”