Complaint·April 14, 2023

A review of the hospice care notes from 5/05/20-6/25/20 found that hospice documented and provided services to R1, such as bed baths, incontinence needs, transfers with Hoyer lift, education of pressure ulcers and pain medication administration times, and developed plans for repositioning. R1’s refusal of assistance with daily living was also documented on the hospice care notes. On 6/12/20, R1 was discharged from hospice services because they could no longer meet R1’s needs. On 6/16/20, R1 was taken to the hospital for a foot pressure sore that had been treated by hospice care, and after an assessment from the doctor it was recommended that R1 would benefit from a rehab center due to R1’s history of abusing pain medications. Based on document review, it was found that the facility and hospice provided assistance with daily living to R1, and the facility completed the reappraisal in a timely manner, therefore the allegation, “Staff fail to provide aid with daily living” is deemed unsubstantiated. Allegation: Staff failed to address resident's change in medical condition It is alleged that R1 was admitted to Hospice Care on 4/06/20, and that R1 is now no longer receiving Hospice Care and R1 was not informed. An incident report received 5/9/20, was reported to Community Care Licensing (CCL) indicated Hospice Care was notified of R1’s fall and hospice was looking into alternative treatments or alternative facility types for R1 due to the increased demand for pain medication. Based on document review, it was found that R1 was discharged and notified by the hospice agency on 6/12/20 that Hospice Care services could no longer meet the needs of R1, and it was recommended by Hospice that R1 go to a different type of facility such as a pain clinic due to R1’s increased demand for pain medications. It was noted that Hospice explained the plan to R1 and R1 verbalized understanding. Based on document review, R1 was properly notified of changes, therefore the allegation, “Staff failed to address resident's change in medical condition,” is deemed unsubstantiated. Exit interview conducted. Copy of report delivered to Administrator.