Bristol Hospice- Stockton

“It is required that each patient’s individualized written plan of care includes measurable outcomes anticipated from implementing and coordinating the plan of care. This standard was not met as evidenced by clinical record review and interview. In 2 of 23 (9%) clinical records reviewed revealed that the agency did not ensure the individualized written plan of care included measurable outcomes anticipated from implementing and coordinating the plan of care. CLINICAL RECORD 4: The patient elected hospice services on 01/28/2026 with a diagnosis of hypertensive heart disease. The plan of care for benefit period 03/29/2026-05/27/2026 documented wound care in part, “Wound #6: Posterior left gluteus maximus-cleanse wound gently with normal saline, pat dry, gently apply zinc ointment, cover with a foam dressing. Facility skilled nurse (SN) to change dressing daily and as needed if soiled or dislodged in collaboration with hospice SN. Wound #2 Arterial Ulcer, posterior left Achilles. Cleanse with NS, pat dry with gauze, apply ABD wrap with kerlix. Wound care to be provided daily or as needed if soiled or removed. Care to be provided by the facility wound care nurse in collaboration with the hospice SN. Wound #3 Arterial Ulcer, dorsal left 4th toe. Cleanse with NS and gently pat dry, apply betadine, and leave open to air. Wound care to be performed daily by facility SN for 14 days in collaboration with Hospice SN (Reassess on 04/30/2026). Wound #5 Arterial Ulcer, dorsal left 3rd toe. Cleanse with NS and gently pat dry, apply Betadine, and leave open to air. Wound care to be performed daily by facility SN for 14 days in collaboration with Hospice SN (Reassess on 04/30/2026).” The patient’s individualized written plan of care did not include goals related to the identified wounds and the wound care interventions implemented. CLINICAL RECORD 21: The patient elected hospice services on 04/27/2025 with a diagnosis of Parkinson’s disease. The plan of care for benefit period 07/26/2025 through 10/23/2025 documented wound care in part, “Pressure injury-posterior lumbar area. Cleanse the affected area with normal saline, pat dry, apply Iodine, and cover with a dry dressing. To be done daily via family and by hospice during SN visits until healed.” The patient’s individualized written plan of care did not include goals related to the identified wound and the wound care interventions implemented. During a joint record review and interview on 04/23/2026, the Director of Patient Care Services (Personnel Record 9) confirmed that clinical records 4 and 9 did not include patient and family goals related to the identified wound and the wound care interventions implemented.”

“It is required that hospice aides are supervised by a registered nurse who makes 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 (IDG) meet the patient’s needs. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 3 of 20 (15%) clinical records reviewed for patients receiving hospice aide services, it was revealed that the agency did not ensure hospice aide supervisory visits were completed by a Registered Nurse at least every 14 days. CLINICAL RECORD 6: The patient elected hospice services on 08/29/2025 with a diagnosis of atherosclerotic heart disease. The plan of care dated 08/29/2025 through 11/26/2025 ordered hospice aide services twice (2) times weekly beginning 08/29/2025. The hospice aide visits were provided as ordered, beginning 08/29/2025. The hospice aide supervisory visits were provided on 10/14/2025 and then on 11/11/2025 (14 days outstanding). CLINICAL RECORD 13: The patient elected hospice services on 12/17/2025 with a diagnosis of Alzheimer’s disease. The plan of care dated 12/17/2025 through 02/07/2026 ordered hospice aide services twice (2) times weekly beginning 12/17/2025. The hospice aide visits were provided as ordered, beginning 12/17/2025. The hospice aide supervisory visits were provided on 12/26/2025 and then on 01/16/2026 (7 days outstanding). CLINICAL RECORD 14: The patient elected hospice services on 11/12/2025 with a diagnosis of senile degeneration of the brain. The plans of care dated 11/12/2025 through 01/11/2026 and 01/12/2026 through 03/11/2026 ordered hospice aide services one (2) time weekly beginning 11/12/2025. The hospice aide visits were provided as ordered, beginning 11/12/2025. The hospice aide supervisory visits were provided on 12/08/2025 and then on 01/19/2026 (28 days outstanding). In a joint record review and interview on 04/23/2026, the Director of Patient Care Services (Personnel Record 9) confirmed that hospice aide supervisory visits were not completed every 14 days.”

“It is required that volunteers are used in day-to-day administrative and/or direct patient care roles. Volunteer services provided to patients/families are in a defined role and under the supervision of a designated hospice employee. Volunteer services are noted in the plan of care and are documented in the patient record, including the time spent. This standard was not met as evidenced by clinical record review and interview. In 5 of 6 (83%) clinical records reviewed in which a volunteer was accepted, the agency did not ensure that the volunteer services were provided. CLINICAL RECORD 1: The patient elected hospice services on 10/28/2025 with a diagnosis of Alzheimer’s Disease. The comprehensive assessment completed by the registered nurse on 10/28/2025 documented, “HCA Accepted Hospice Clergy, Accepted MSW, Volunteer Accepted.” A clinical record review revealed no documented evidence that volunteer services were provided, a follow-up assessment was completed, or a care plan was initiated to address volunteer needs. CLINICAL RECORD 5: The patient elected hospice services on 10/16/2025 with a diagnosis of malignant neoplasm of the thyroid gland. The comprehensive assessment completed by the registered nurse on 10/16/2025 documented, “Accepted the following: SN, HCA, MSW, Clergy, Volunteers.” The volunteer services evaluation was completed on 03/25/2026. A clinical record review revealed no documented evidence that volunteer services were provided during the first election period through the date of review (04/23/2026), or that a care plan was initiated to address volunteer needs. CLINICAL RECORD 8: The patient elected hospice services on 11/20/2025 with a diagnosis of Alzheimer’s Disease. The comprehensive assessment completed by the registered nurse on 11/20/2025 documented “Volunteer Accepted for companionship respite errands.” A clinical record review revealed no documented evidence that volunteer services were provided, a follow-up assessment was completed, or a care plan was initiated to address volunteer needs. CLINICAL RECORD 11: The patient elected hospice services on 12/16/2025 with a diagnosis of chronic obstructive pulmonary disease. The comprehensive assessment completed by the registered nurse on 12/16/2025 documented “Volunteer Accepted for companionship, errands, life review.” A clinical record review revealed no documented evidence that volunteer services were provided, a follow-up assessment was completed, or a care plan was initiated to address volunteer needs. CLINICAL RECORD 17: The patient elected hospice services on 06/16/2025 with a diagnosis of unspecified cirrhosis of the liver. The comprehensive assessment completed by the registered nurse on 06/16/2025 documented “Volunteer Accepted for companionship.” A clinical record review revealed no documented evidence that volunteer services were provided, a follow-up assessment was completed, or a care plan was initiated to address volunteer needs. During the joint record review and interview on 04/24/2026, the Executive Director (Personnel Record 7) confirmed that the clinical records did not include evidence that volunteer services were implemented based on needs identified in the comprehensive assessment.”

“It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview. DOCUMENT 5: A joint review of the “Volunteer Hours” report dated 04/01/2025 through 03/31/2026 with the Administrator and Volunteer Coordinator on 04/24/2026 revealed that volunteers provided 3.4% of day-to-day administrative and/or direct patient care services. The Volunteer Coordinator confirmed that volunteer utilization was below the required 5% for 04/01/2025 through 03/31/2026, stating, “When I came back late last year, there was only 1 (one) volunteer; we are up to 7 (seven). The focus is recruitment.” During an interview on 04/24/2026, the Administrator (Personnel Record 7) confirmed that volunteer utilization was below 5% for 04/01/2025 through 03/31/2026, and stated, “Our Volunteer Coordinator started back at the end of 2025 and has been focusing on recruitment and retention. We have also increased our discipline frequencies for Hospice Aides and the psychosocial staff to meet the companionship needs of the patient when unable to match a volunteer.” The hospice agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff.”

“It is required that the designated IDG member provide the SNF/NF or ICF/IID with the following information for each patient/resident: the most recent hospice plan of care and the physician certification and recertification of the terminal illness. This standard was not met as evidenced by document review, interview, and observation. In 1 of 5 (20%) clinical records reviewed, which resided in a skilled nursing facility, the agency did not ensure the skilled nursing facility was provided the most recent hospice plan of care and the recertification of terminal illness. HOME VISIT 4/ CLINICAL RECORD 4: The patient was admitted to hospice on 01/28/2026 with the diagnosis of hypertensive heart disease with heart failure. During the home visit observation on 04/22/2026 with the registered nurse (RN) (Personnel Record 4), the facility’s medical record was reviewed. The facility’s medical record included the hospice plan of care and certification of terminal illness for the election period 01/28/2026 through 03/28/2026. The facility’s medical record did not include the most recent plan of care and recertification of terminal illness for the election period 03/29/2026-05/27/2026. In an interview with the RN (Personnel Record 4) on 04/22/2026, the facility’s medical record was reviewed. The RN confirmed that the facility’s medical record did not include the most recent plan of care and recertification and stated in part, “The facility sometimes thins the chart, but the documents might also be in my mailbox at the office.” In an interview on 04/23/2026, the Director of Patient Care Services (Personnel Record 9) confirmed the findings and stated in part, “The nurse told me they thin the chart and thinks they may have removed those documents.””

“It is required that the designated IDG member provide the SNF/NF or ICF/IID with the following information for each patient/resident: the most recent hospice plan of care and the physician certification and recertification of the terminal illness. This standard was not met as evidenced by document review, interview, and observation. In 1 of 5 (20%) clinical records reviewed, which resided in a skilled nursing facility, the agency did not ensure the skilled nursing facility was provided the most recent hospice plan of care and the recertification of terminal illness. HOME VISIT 4/ CLINICAL RECORD 4: The patient was admitted to hospice on 01/28/2026 with the diagnosis of hypertensive heart disease with heart failure. During the home visit observation on 04/22/2026 with the registered nurse (RN) (Personnel Record 4), the facility’s medical record was reviewed. The facility’s medical record included the hospice plan of care and certification of terminal illness for the election period 01/28/2026 through 03/28/2026. The facility’s medical record did not include the most recent plan of care and recertification of terminal illness for the election period 03/29/2026-05/27/2026. In an interview with the RN (Personnel Record 4) on 04/22/2026, the facility’s medical record was reviewed. The RN confirmed that the facility’s medical record did not include the most recent plan of care and recertification and stated in part, “The facility sometimes thins the chart, but the documents might also be in my mailbox at the office.” In an interview on 04/23/2026, the Director of Patient Care Services (Personnel Record 9) confirmed the findings and stated in part, “The nurse told me they thin the chart and thinks they may have removed those documents.””