DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION		 (X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER		 (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY COMPLETED
051725 A. BUILDING __________
B. WING ______________ 		05/21/2021
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
BRISTOL HOSPICE - BAKERSFIELD 4900 CALIFORNIA AVE, SUITE 110A, BAKERSFIELD, CA, 93309
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See reverse for further instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation
LABORATORY DIRECTOR’S OR PROVIDER/SUPPLIER REPRESENTATIVE’S SIGNATURE

 TITLE

 (X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
(X4) ID
PREFIX
TAG		 SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY SHOULD BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)
L0530      
34510 Based on observation, interview, and record review, the agency failed to complete a medication reconciliation for one of 16 sampled patients (Patient 14) when Registered Nurse (RN) 1 did not identify discontinued medications were still administered by the Caregiver. This failure had the potential for Patient 14 to continuously receive medications without a physician's order and result in adverse health outcomes. Findings: During a concurrent observation and interview on 5/20/21, at 3 PM, with RN 1 and Caregiver, in Patient 14's home, RN 1 was looking at the bottles of medications on top of the dresser. RN 1 asked the Caregiver if there were changes in Patient 14's medication. Caregiver responded to RN 1 and stated, there were no changes. RN 1 was getting ready to leave and she stated she had completed her home visit. During an interview on 5/20/21, at 3:04 PM, with the Caregiver, Caregiver was asked what were all the medications she was giving Patient 14. Caregiver pulled the drawer and showed three other bottles of prescription medications (two bottles of Carvedilol and one bottle of Amlodipine - both were medications to lower blood pressure). Caregiver stated, "These medications were refills from another pharmacy. These are not from the hospice agency. We still give it to her [Patient 14] routinely on top of the hospice medications." Caregiver stated, she was not aware those medications were discontinued. During a review of Patient 14's medications from the drawer, Patient 14 was given the following discontinued medications: a. Carvedilol 3/125 mg (milligram-unit of measurement) two times a day b. Amlodipine 5 mg at bedtime During a follow up interview and record review on 5/20/21, at 3:12 PM, with RN 1, Patient 14's "List of Medications (LM)," dated certification period 4/28/21 through 6/26/21 was reviewed. The LM indicated, there were no Carvedilol and Amlodipine listed. RN 1 stated, "Those blood pressure medications were discontinued long time ago. I am not aware they were still given." RN 1 stated, she did not look into all Patient 14's medication so the blood pressure medications were missed. RN 1 verified the finding and stated the LM was not accurate. During a review of agency's policy and procedure (P&P) titled, "Medication Profile", dated 5/20, the P&P indicated, "Patients receiving medications administered by the hospice will have a current, accurate medication profile in the clinical record. The medication profiles will be updated for each change to reflect current medications, and new and/or discontinued medications. . .8. During Subsequent home visits, the medication profile will be used as a care planning and teaching guide to ensure that the patient and family/caregiver, as well as other clinicians, understand the medications regimen. This includes, but will not be limited to: . . .B. Using medication profile to teach purpose of medication, dosages, routes, administration times, side effects, and contraindications."
L0579      
42167 Based on observation, interview, and record review, the agency failed to implement its infection control policies and procedures (P&P) when: 1. Manufacturer's guidelines for dwell time (time how long a disinfectant needs to stay wet on a surface in order to be effective, also known as "kill time") for disinfecting products was not followed. 2. Hand hygiene was not performed before and after dressing change for one of 16 sampled patients (Patient 12). These failures had the potential to transmit diseases to patients, family member, staff, and visitors. Findings: 1. During a concurrent observation and interview, on 5/19/21, at 1:05 PM, with Nurse Practitioner (NP), in Patient 13's home, NP was observed using CaviCide (a cleaning disinfectant wipe) to disinfect her computer and vital signs instruments (VSI - stethoscope, blood pressure cuff (BP cuff), thermometer, and pulse oximeter {an electronic device to check the oxygen saturation and heart rate}). NP used one wipe to disinfect all VSIs and immediately placed the VSIs inside her bag. NP did not wait for the dwell time to disinfect the VSIs. During a concurrent observation and interview, on 5/19/21, at 4:12 PM, with Licensed Vocational Nurse (LVN), in Patient 12's home, LVN was observed using CaviCide to disinfect her computer and VSI. LVN used one wipe to disinfect all her computer and VSIs and immediately placed the VSIs insider her bag. LVN stated, "I don't know what dwell time means. I haven't had any in-service or training on [CaviCide]." During an interview on 5/21/21, at 1:42 PM, with the Director of Patient Care Services (DPCS), DPCS stated, "I've never heard of kill times or dwell times. We've always told them to use the wipe and let it air dry." During a review of the manufacturer's guidelines for CaviCide, dated 7/27/2020, directions for use indicated, "For use as a disinfectant on non-critical medical devices [items that come in contact only with intact skin]. Instruments must be thoroughly cleaned to remove excess organic excess. . . in CaviCide for 3 minutes at room temperature. . . Kills Novel Coronavirus (COVID-19 - a highly contagious virus) after the 3 minute [dwell] time. . . " 2. During a review of Patient 12's "Medical Record" (MR), dated 5/21/21, the "MR" indicated, Patient 12 was admitted to the agency on 11/5/19. Upon admission, Patient 12 had multiple pressure ulcer injury (PUI - localized damage to the skin and/or underlying tissue that usually occurs over a bony area of the body, also known as "bed sores") and currently have four PUI to lower back, right buttock, right inner knee, and right inner ankle. During a review of Patient 12's, "Plan of Care" (POC), dated 4/28/21 to 6/26/21, the "POC" indicated, "WOUND PROTOCOL: Pressure Injury to: 1. Right inner knee 1. [Staff/caregiver] to cleanse the affected area with normal saline/wound cleanser. 2. Wound gel 3. Cover with dressing with alginate [absorbent wound dressing] added if there is moderate drainage. 4. Change dressing every [skilled nursing visit] until healed." 2. Right inner ankle: Cleanse wound with wound cleanser. Swipe with [Sureprep - no sting solution to use as a protective film over the skin] and cover with foam dressing wrapped with [Kerlix - gauze roll]. 3. Lower back: [Staff] to cleanse with wound cleanser. Pat dry. Apply thin layer of wound gel. Cover with foam and secure with tape every [skilled nursing visit]. . . 4. Right buttock: [Staff] to cleanse with wound cleanser. Spray with [Flagyl Wound Spray - a medication spray applied to a PUI to help prevent infection and reduces odor]. Apply small amount of wound gel. Lightly pack with [alginate]. Followed by a sacral dressing every [skilled nursing visit] and PRN [as needed] displaced or soilage." During an observation on 5/19/21, at 3:20 PM, in Patient 12's home, LVN did not perform hand hygiene during dressing changes when: a. LVN handled bed linen, repositioned patient, touched the bed remote to raise the bed, reached into a box of supplies, and proceeded to use the same pair of gloves to perform dressing change to Patient 12's right knee PUI. b. LVN used the same gloves to remove soiled dressing and to cleanse all four PUIs. c. LVN used the same gloves to perform wound dressing change for two separate PUIs (lower back and right buttock). d. LVN did not perform hand hygiene between glove change and after direct contact with Patient 12. During an interview on 5/19/21, at 4:12 PM, with LVN , LVN stated she should have performed hand hygiene after each glove removal, after removal of soiled dressing and used different gloves for each PUI. During an interview on 5/21/21, at 1:42 PM, with DPCS, DPCS stated, "It's not a sterile procedure, I don't expect them to change gloves in between wounds. . . They should perform hand hygiene after removing gloves, but not necessarily during dressing change." During a review of the agency's P&P titled, "Hand Hygiene", dated 5/2020, the P&P indicated, " . . .3. Hand decontamination using an alcohol-based hand rub should be performed: A. Before having direct contact with patients. . . C. After contact with a patient's intact skin (when taking a pulse, blood pressure or lifting a patient). . . G. After removing gloves." During a review of the agency's P&P titled, "Standard Precautions", dated 5/2020, the P&P indicated, "Hand Hygiene 1. Hand hygiene will be performed to prevent cross-contamination between the patient and personnel. . . C. Gloves are to be changed: 1. Between tasks and procedures on the same patient. . . 3. After removing an old dressing. . . "
L0585      
34510 Based on interview and record review, the agency failed to facilitate Family Member's (FM) understanding of one of 16 sampled patients (Patient 10's) health status when Registered Nurse (RN) 2 did not notify FM of Patient 10's health status upon admission to hospice care. This failure had the potential to result in FM becoming unprepared for Patient 10's impending death, resulting in emotional distress and mental anguish. Findings: During an interview on 4/16/21, at 8:18 AM, with FM, FM stated, "They [hospice agency] did not tell me how bad she was. I did not know she [Patient 10] will pass away the next day. She [Patient 10] died alone." FM stated, she was upset she was not able to visit Patient 10 prior to her death. During a review of Patient 10's Start of Care (SOC), dated 4/11/21, the SOC indicated, Patient 10 was admitted with hospice on 4/11/20. Patient 10's SN (Skilled Nurse) Clinical Note (SNCN), dated 4/12/20 (the next day), the SNCN indicated, "Pronouncement Findings: No pulse, Respirations, BP [Blood Pressure], pupils fixed and dilated. [Patient 10 expired]." During an interview on 5/20/21, with RN 2, RN 2 stated she does not remember if she called FM regarding Patient 10's health status. RN 2 reviewed Patient 10's SOC and stated, there is no documentation of notification of FM regarding Patient 10's health status. RN 2 stated, she only educated and spoke to the nurse in the skilled nursing facility and does not remember calling FM. During a review of the agency's policy and procedure (P&P) titled, "Patient Education Process", dated 5/20, the P&P indicated, "Patients and family/caregivers will receive education in verbal, visual, and written format, as appropriate. The scope of teaching will be determined by the assessed needs, abilities, learning preferences and readiness to learn patient and family/caregiver as well as by plan of care. Education will be the responsibility of each interdisciplinary group member and will focus on, as appropriate: 1. Facilitating the patient's and family/caregiver's understanding of his/her health status, health care options, and consequences of options. . .5. Increasing the patient's and family/caregiver's ability to cope with health status, prognosis, and outcomes. . .9. Assisting the patient's and family/caregiver's ability to cope with hospice care and the patient's impending death."