Hospice & Palliative Care of California

“Upon patient record review, 2 of 14 (Patients #5,8) 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: Med Profile indicates Miralax 17 gm powder with no diluent ordered. Corrected on site. Patient #8: Med Profile indicates Miralax 17 gm powder with no diluent ordered. Corrected on site.”

“Upon patient record review, 2 of 14 (Patients #1,5) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient’s plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #1: MSW and SC visit frequency ordered on 09/29/23 indicated monthly visits, as needed for these disciplines. This frequency did not include a baseline visit frequency for the MSW or SC. Patient #5: MSW visit frequency on 11/24/23 indicated monthly visits, as needed by MSW. This frequency did not include a baseline visit frequency for the MSW.”

“Upon client record review, 4 of 14 (Patients #2,5,7,10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2: The POC listed MSW and SC visit frequency of 1 X’s per month. The SC made 2 routine visits on 11/23/23 and 11/28/23. The MSW made no visits during months of November and December. The MSW/SC visit frequencies per POC were not met. Patient #5: The POC listed SC visit frequency of 1 X’s per month. The SC made 2 routine visits on 11/27/23 and 11/28/23. Additionally, the SC made no visit during month of December. The SC visit frequencies per POC were not met Patient #7: The POC listed MSW visit frequency of 1X’s per month. On 11/10/23, the MSW mentioned in note to follow-up monthly. This visit frequency was not met by MSW for month of December. Patient #10: The POC listed MSW and SC visit frequency of 1 X’s per month. The SC made 3 routine visits in December 12/20/23, 12/26/23 and 12/27/23. Additionally, the SC made 2 routine visits in January on 1/11/24 and 1/12/24. The MSW made no visits during months of November and December. The MSW/SC visit frequencies per POC were not met.”

“Upon personnel record review, 1 of 13 (Personnel #9) did not have evidence in the personnel file that the following competency assessment did not indicate if method of evaluation (check marked complete only) was observed or demonstrated for the following tasks: ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient.”

“Upon patient record review 8 of 14 (Patients #1,2,4,5,6.7,8,10) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care Patient #1: The POC (9/29/23) listed Aide Visits 2X’s per week. During 1st Benefit week there were no visits made by the Aide. Patient #2: The POC (10/27/23) listed Aide Visits 3X’s per week. During 1st Benefit week there were no visits made by the Aide. Patient #4: The POC (12/2/23) listed Aide Visits 3X’s per week. During 1st Benefit week there were no visits made by the Aide. Patient #5: The POC (11/24/23) listed Aide Visits 3X’s per week. During 1st Benefit week there were no visits made by the Aide. During 2nd Benefit week there were two visits made by Aide on 12/1 and 12/4 only. Patient #6: The POC (11/8/23) listed Aide Visits 2X’s per week. During 1st Benefit week there were no visits made by the Aide. Patient #7: The POC (10/2/23) listed Aide Visits 2X’s per week. There were no visits made by the Aide until 11/6/23. Patient #8: The POC (9/14/23) listed Aide Visits 2X’s per week. During 1st Benefit week there was one visit made on 9/16/23 only. Patient #10: The POC (9/1/23) listed Aide Visits 2X’s per week. During 1st Benefit week there were no visits made by the Aide.”

“Upon patient record review, 1 of 14 (Patient #2) 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 #2: The Patient chose Dr. Lish as attending at SOC on 10/27/23. Dr. Lish declined to follow. The agency processed a Change of Attending on 1/17/24 to include the Hospice Medical Director.”

“Upon patient client record review, 8 of 14 (Patients #3,5,6,8,9,10,11,12) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patients#3,8,10,11,12: The Election Statement is an outdated form that does not include the following- BFCC-QIO contact information, Notice to Elect Addendum of Non-Covered Items and effective SOC date. Patient # 5: The Election Statement indicated to elect Addendum at SOC on 11/24/23. The addendum was not signed until 12/22/23. Patient #6: The Election Statement indicated to elect Addendum at SOC on 11/8/23. The addendum was not signed until 1/8/24. Additionally, The Election Statement did not include RN Credential following clinician signature in space provided on form. Patient #9: The Election Statement indicated to elect Addendum at SOC on 9/8/23. The addendum was not signed until 12/21/23. Patient #10: The Election Statement indicated to elect Addendum at SOC on 9/1/23. The addendum was not signed until 12/26/23.”