Complaint Investigation Report

Interview with the administrator revealed that R1’s family was not able to visit the facility to sign the hospice consent forms in person, so R1’s family authorized S1 to sign the form. Interview with S1 confirmed they had signed R1’s hospice form. S1 stated S2 did not sign any resident forms. Interview with S2 revealed they had not signed any resident forms. Interview with R1’s family revealed they did authorize the facility staff to sign R1’s hospice form. Interview with R2 revealed they did not recall whether they signed paperwork. Record review of R1 and R2’s revealed their hospice care plans were signed by a registered nurse, a medical social worker, a spiritual counselor, and a medical director, but were not signed by the licensee, R1, R2, or their responsible parties. Additionally, records detailing facility personnel duties, hospice visits, personnel trainings, and roommate acknowledgements were not maintained or available. These deficiencies are addressed on a separate LIC 809 – Case Management visit. R1’s hospice consent form was signed on 07/12/2022. The signature does not match R1’s signature. The box “Beneficiary is unable to sign” is checked. Hospice consent forms of R2 appeared to be signed by R2. R1’s POLST from 09/30/2020 and R2’s POLST from 06/16/2020 appeared to be signed by R1 and R2 as well. Based on interviews and record reviews, S1 signed R1’s hospice consent form. Therefore, the allegation is deemed SUBSTANTIATED at this time. Deficiency cited on the attached LIC 9099-D page.

Regarding the allegation “Residents were signed up for hospice services without a physician's referral.” it was alleged R1 and R2 were enrolled in hospice services without a physician’s referral. Interview with the administrator revealed the facility was unable to arrange R1’s doctor’s appointment to obtain a referral. The administrator knew R1 had previously been enrolled in hospice, therefore the facility proceeded in assisting R1 in signing up for hospice services without the referral. Records revealed that R1 was previously enrolled in hospice services as of 10/14/2020. R1’s most recent hospice care plan indicated services began on 07/07/2023. R1’s most recent medical assessment on 08/18/2023 noted R1 was not enrolled in hospice services, and R1’s family signed forms discharging R1 from hospice on the same day. R2’s most recent medical assessment on 08/02/2023 noted R2 was enrolled in hospice services. Based on interview and record review, R1 did not have a physician’s referral for hospice services. Therefore, the allegation is deemed SUBSTANTIATED at this time. Deficiency cited on the attached LIC 9099-D page.

No immediate health or safety hazards were observed during today’s visit.

Exit interview conducted. Appeal rights discussed. Copy of report provided.