Solano Care

“Upon patient record review, 1 of 5 (Patient #5) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient 5: Patient has physician’s order for Cipro 500mg by mouth twice daily for 3 days for UTI. Order was written with a start date of 10/14/2024. This remained active on medication profile.”

“Upon patient record review, 2 of 5 (Patient #4,5) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 4,5: Patients have physician’s order for PRN oxygen. There is no evidence of oxygen as an intervention in the patients’ plan of care.”

“Upon patient record review 1 of 19 records reviewed (Patient #14) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient’s well-being, comfort, and dignity throughout the dying process. Patient #14: The record indicated an order on 2/22/24 (SOC) to complete a comprehensive psychosocial assessment with 5 days of admission. There was no evidence this assessment had been completed at the time of the survey.”

“Upon patient record review, 2 of 19 records reviewed (Patient #8, #13) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #8: The record indicated on the medication profile two orders for Tylenol/Acetaminophen. The first order was for Tylenol ES 500mg 1-2 tabs po prn pain not to exceed 4gm in 24 hours. The second order was for Acetaminophen 325 mg 2 tabs po Q6hours prn pain/fever 100F. There was no evidence of the maximum dose of 4gm on the acetaminophen q6 hours dose. COS. Patient #13: The record indicated on the medication profile Erythromycin 0.5% 3 grams one application 3 times a day times 14 days for an eye infection. There was no evidence of which eye or eye(s). COS.”

“Upon patient record review, 7 of 19 records reviewed (Patient #1, #2, #3, #4, #7, #11, #14) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #1: The record indicated the patient had increased agitation on 7/28/24, Seroquel was prescribed 25mg po BID. There was no evidence of an individualized written plan of care to include the goals and interventions for this symptom management issue. COS. Patient #2: The record indicated the patient was positive for Hepatitis C. There was no evidence of an individualized written plan of care for infection control. COS. Patient #3: The record indicated the patient was prescribed Augmentin 500mg one tab po BID X 7 days on 6/6/24. There was no evidence of an individualized written plan of care for this infection. COS. Patient #4: The record indicted the patient had an order for a foley catheter. There was no evidence of an individualized written plan of care for a foley catheter. COS. In addition, the patient was prescribed Morphine ER 15 mg po Q4hours prn, there was no evidence of an individualized written plan of care for pain management. COS. Patient #7: The record indicated in the assessment the patient had a problem of pain control. There was no evidence the plan of care was individualized to include the type of pain assessment necessary and no evidence that the goal for pain control was measurable. COS. Patient #11: The record indicated the patient was on Humulin N 10U SQ before dinner and 24U SQ before breakfast. There was no evidence on the plan of care of how often the patient should be checking the blood sugar and or what levels to report to the hospice nurse/hospice attending physician. COS. Patient #14: The record indicted the patient was on Eliquis at the start of care of 2/22/24. There was no evidence of an individualized care plan regarding bleeding precautions. COS.”

“Upon patient record review, 3 of 19 records reviewed (Patient #4, #8, #13) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #4: The record indicated an MD order for a 16F foley with a 10cc balloon. There was no evidence of what type of solution to put in the balloon. COS. Patient #8: The record indicated two MD orders for Tylenol/Acetaminophen. The first order was for Tylenol ES 500mg 1-2 tabs po prn pain not to exceed 4gm in 24 hours. The second order was for Acetaminophen 325 mg 2 tabs po Q6hours prn pain/fever 100F. There was no evidence of the maximum dose of 4gm on the acetaminophen q6 hours dose. COS. Patient #13: The record indicated an MD order for Erythromycin 0.5% 3 grams one application 3 times a day X 14 days for an eye infection. There was no evidence of which eye or eye(s). COS.”

“Upon patient record review, 3 of 19 records reviewed (Patient #6,#8, #19) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient #6: The record indicated the daughter raised concern about the patients pain on 8/12/24. There was no evidence the plan of care was individualized to include the type of pain assessment necessary for the patients memory loss and inability to communicate. There was no evidence of goals to achieve pain control that was measurable. COS. Patient #8: The record indicated the start of care was on 6/30/24. The patient had a reported fall on 7/1/24. There was no evidence of a plan of care noting progress towards outcome/goals for this fall incident at the time of the survey. COS. Patient #19: The record indicated the patient had a reported fall on 4/5/24. There was no evidence of a plan of care noting progress towards outcome/goals for this fall incident at the time of the survey. COS.”

“Upon patient record review, 4 of 19 records reviewed (Patient #2, #5, #11, #14) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #2: The record indicated the patient was on oxygen 2 LPM via NC prn. The care plan was not marked for oxygen safety for the hospice aide. COS. Patient #5: The record indicated an MD order was written on 8/19/24 to keep the HOB up 90 degrees while eating. There was no evidence the hospice aide plan of care was updated to reflect this MD order. COS. In addition, the patient was prescribed Eliquis 2.5 mg po Q Day, there was no evidence of bleeding precautions on the aide plan of care. COS. Patient #11: The record indicated a hoyer lift was ordered on 6/6/24. There was no evidence of the “hoyer lift”/mechanical lift added to the hospice aide care plan. COS. Patient #14: The record indicated the patient was receiving Eliquis at the time of hospice admission on 2/22/24. The Aide Care plan written on 2/23/24 did not have evidence of bleeding precautions. COS.”

“Upon patient record review 2 of 19 records reviewed (Patient #5, #9) did not have evidence documentation in the patient record that a Registered Nurse 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 #5: The record indicated the aide visits started on 08/06/24, there was an aide supervisory visit due on 8/20/24 and was not completed. Patient #9: The record indicated the aide visits started on 06/25/24, there was an aide supervisory visit due on 7/23/24 and was not completed.”

“Upon patient record review, 1 of 19 (Patient #1) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient’s life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination: • The primary terminal condition • Related diagnosis • Current subjective and objective medical findings • Current medication and treatment orders • Information about the medical management of any of the patient’s conditions unrelated to the terminal illness Patient #1: The record indicated the patient was in her 1st benefit period from 7/26/24 to 10/23/24. The narrative of the certifying physician does not support the clinical findings for a life expectancy as to why the patient has 6 months or less as the narrative was written by the nurse with physician indicating as stated as above.”

“Upon patient record review, 1 of 19 (Patient #2) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient’s clinical information and provide written documentation that it is anticipated that the patient’s life expectancy is 6 months or less. Patient #2: The record indicated the patient was in her second benefit period 7/3/24 to 9/30/24. The narrative of the certifying physician does not support the clinical findings for a life expectancy as to why the patient has 6 month or less with physician only listed the patient diagnosis. In addition, the certifying physician signed on 7/7/24 and there was no verbal certification documented by the RN.”

“Upon patient client record review, 4 of 19 records reviewed (Patient #4, #5, #7, #14) did not have evidence that each patient record contains Advance Directives. Patient #4: The record indicated the patient had advance directives and would provide a copy. There was no evidence of advance directive copies on the chart at the time of the survey. Patient #5: The record indicated the patient had a Medical Power of Attorney and would provide a copy There was no evidence of this document on the chart at the time of the survey. Patient #7: The record indicated the patient had a Medical Power of Attorney and would provide a copy There was no evidence of this document on the chart at the time of the survey. Patient #14: The record indicated the patient had a Medical Power of Attorney and would provide a copy There was no evidence of this document on the chart at the time of the survey.”

“Upon client record review, 1 of 19 (Patient #1,2,5) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient #1, #2, #5: The record indicated a written hospice plan of care was established without consultation with the SNF. There was no evidence of the hospice responsibilities vs the facility staff responsibilities in all of the generic care plans. COS.”