Metro Medical Services, Inc.

“Observed in Record Review. In 14 of 14 patient records reviewed the organizations medical record did not reflect the care and revisions to the plan of care. There was no documentation in the clinical record as evidenced by the organization maintained a IDG log separate from the clinical record that included all patients. This finding was reviewed and validated with agency leadership. Observed in Record Review. In 1 out of 3 home visits conducted, the organization failed to ensure the medical record contained information to accurately reflect the patient’s care, treatment, and services. During the home observation for RRHV #2, it was noted that the medication list with the board and care did not match the hospice record. The hospice had Plavix that was ordered that the board and care did not have on their medication record. And the board of care had PRN orders for Imodium and Preparation H that were not on the hospice medication list. This finding was reviewed and validated with agency leadership including the DCPS who was present for the visit.”

“Observed in Record Review. In 14 out of 14 patient records reviewed, the organization used clerical staff to receive a verbal order from the physician. Agency policy states that a verbal order may only be taken by licensed staff. On interview with the physician, he stated that the intake coordinator is who usually calls him for updates on the patient. On review of all records it was noted in every chart in the communication notes that the intake coordinator, who is not licensed, took orders for medications from the physician. This finding was reviewed and validated with leadership team.”

“Observed in Record Review. In 1 out of 2 patient records reviewed, where patient death occurred, the organization failed to ensure that the patient’s pronouncement follow California statute. On review of RRBR #1, the patient expired while on hospice service, with the LVN attending to the death. The LVN did not provide patient care with the scope of their license. For example, the surveyor noted the LVN pronounced the patient’s death as evidenced by LVN documentation SN pronounced death at 5:49pm.. There had been no documentation that the Physician was notified. This finding was reviewed and validated with leadership team.”

“Observed in Record Review. In 3 of 10 active patient records reviewed, the organization failed to complete a comprehensive reassessment every 15 days. On RRNHV #3, it was observed in chart review that on 2 separate 15 days periods there was a gap of 17 and 21 days for RN reassessment. On RRHV #1, it was noted that the RN had not seen the patient for reassessment for 17 days in the month of March. On RRHV #2, it was noted that on two separate timeframes in the last two months the nurse had gaps of 16 and 19 days between RN assessments. This finding was discussed and validated with agency leadership.”

“Observed in Record Review. In 9 of 10 active patient records reviewed, the organization did not develop a plan of care that included the scope and frequency of services for the patient. On RRHV #1, RRHV #2, RRHV #3, RRNHV # 1, RRNHV #2, and RRNHV #6, it was noted that there were no signed plan of care and no physician orders for any of the disciplines providing care. On RRNHV #3, RRNHV #4, it was observed on record review that there was no signed plan of care including signed orders for chaplain and social work who have been actively seeing patient. On RRNHV #5, observed in chart review that patient had a MSW visit but there were no orders for the visit after the initial admission visit. This finding was discussed and validated with agency leadership.”

“Observed in Record Review. In 6 of 10 active patient records reviewed, the plan of care was not updated to reflect a change in care. On RRHV #1, it was noted that the plan of care had not been updated to reflect a wound to the eyebrow that has healed. On RRHV #2, it was noted that patient had a healed coccyx wound during the home visit but the plan of care had not been updated to reflect this change. On RRHV #3, it was noted that patient had a wound that has also healed over the course of care and the care plan had not been updated to reflect these conditions. On RRNHV #4, it was noted that patient had multiple medication changes of Bumex and Lasix but the plan of care was not modified to reflect the changes in care. On RRNHV #5, it was noted that goals had not been updated to reflect current assessment including removing teaching goals from a year ago and updating the goals when patient got a respiratory infection that was treated with antibiotics. On RRNHV #7, goals had not been updated to reflect changes in care including medication changes for mood and antibiotics on several different timeframes for infection. This finding was discussed and validated with agency leadership.”

“Observed in Record Review. In 2 of 2 bereavement records reviewed, the organization did not follow the bereavement plan of care. On RRBR #1, it was noted that the sent date in the medical record documents that the bereavement letters for 9, 6, and 3 months were all generated on the same date earlier this month. On RRBR #2, it was noted that the sent date in the medical record documents that the bereavement letters for 3 month follow up was sent 3 months late. This finding was reviewed and validated with leadership team. Observed in Patient Home. In 2 of 3 home visits conducted, the surveyor noted that organization did not provide the patient with care, treatment, or services according to the patient plan of care. On RRHV #1, it was noted that the patient had orders for wound care for a left eye wound but the nurse did not perform wound care during home visit because wound has been healed. On RRHV #3, it was noted that the patient had orders for wound care for a right forearm wound and the nurse did not perform the wound care on the home visit as ordered because the wound was healed. This finding was reviewed and validated with agency leadership.”

“Observed in Record Review. In 3 of 10 active patient records reviewed, that had aide services, the organization did not conduct a hospice aide supervision every 14 days. On RRHV #1, it was noted that in March there was a gap of 17 days between supervisory visits. On RRHV #2, it was noted on 2 separate time periods in the last 2 months the aide supervision had a gap of 16 day and 19 days between supervisory visits. On RRNHV #3, there was a gap of 21 days between aide supervision during current benefit period. This finding was reviewed and validated with agency leadership.”

“Observed in Record Review. In 7 of 10 active patient records reviewed, all entries were not appropriately authenticated and dated in accordance with hospice policy and currently accepted standards of practice. Agency policy for notes to be appropriately authenticated and notes turned in within three days. On RRNHV #1 it was noted that all nursing and aide visit notes in the medical record have not been authenticated and patient has been on service for a month. On RRNHV #2, it was observed on record review that notes in the medical record had not been authenticated for notes dating back to admission over a month ago. On RRNHV #3, RRNHV #4, RRNHV #5, RRNHV #6 and RRNHV #7, it was observed that notes in the medical record had not been authenticated for notes dating back 4 months. This finding was reviewed and validated with agency leadership.”