California Correctional Institution Cycle 6 Medical Inspection Report

Roy W. Wesley, Inspector General Bryan B. Beyer, Chief Deputy Inspector General OIG OFFICE of the INSPECTOR GENERAL Independent Prison Oversight November 2021 Cycle 6 Medical Inspection Report nnoo ccoommmmaa nneeeeddeedd aafftteerr California Correctional PPrriissoonn,, ffoorr tthhoossee tthhaatt hhaavvee iitt,, Institution ppeerr ssttyyllee eessttaabblliisshheedd wwiitthh tthhee ootthheerrss iinn tthhiiss ccyyccllee;; ffoolllloowwiinngg tthhee ee--oo--lliinnee ssttyyllee ooff mmaannyy ootthheerr ppuubbss.. Return to Contents Return to Contents Electronic copies of reports published by the Office of the Inspector General are available free in portable document format (PDF) on our website. We also offer an online subscription service. For information on how to subscribe, visit www.oig.ca.gov. For questions concerning the contents of this report, please contact Shaun Spillane, Public Information Officer, at 916-255-1131. Return to Contents Return to Contents California Correctional Institution iii Contents Introduction 1 Summary 3 Overall Rating: Inadequate 3 Medical Inspection Results 7 (cid:38)eficiencies I(cid:70)entifie(cid:70) (cid:38)(cid:87)rin(cid:73) Case (cid:52)e(cid:88)ie(cid:89) (cid:25) Case (cid:52)e(cid:88)ie(cid:89) (cid:52)es(cid:87)lts (cid:25) Co(cid:79)pliance (cid:54)estin(cid:73) (cid:52)es(cid:87)lts (cid:26) (cid:50)op(cid:87)lation(cid:15)(cid:36)ase(cid:70) (cid:47)etrics (cid:26) (cid:42)(cid:39)(cid:38)IS (cid:52)es(cid:87)lts (cid:27) ttoo ddoo:: (cid:52)eco(cid:79)(cid:79)en(cid:70)ations (cid:19)(cid:19) In(cid:70)icators (cid:19)(cid:23) SSeeaarrcchh ffoorr bbaassiicc ppaarraaggrraapphh (cid:35)ccess to Care (cid:19)(cid:23) ssttyyllee.. aaddjjuusstt aass nneeeeddeedd.. Diagnostic Services 20 cchheecckkeedd.. CChheecckk aaggaaiinn aatt tthhee Emergency Services 23 eenndd.. SSoommeettiimmeess iitt aarrrriivveess wwiitthh Health Information Management 26 iimmppoorrtt.. Health Care Environment 30 (cid:54)ransfers (cid:21)(cid:27) (cid:52)(cid:52)ee(cid:88)(cid:88)iissee aallll (cid:74)(cid:74)(cid:91)(cid:91)ppeerrlliinn(cid:77)(cid:77)ss aann(cid:70)(cid:70) Medication Management 46 bbooookkmmaarrkkss,, ffoolliiooss iinn TTooCC aanndd (cid:50)re(cid:88)enti(cid:88)e Ser(cid:88)ices (cid:23)(cid:21) IIlllluuss,, aanndd aadddd nneeww pphhoottooss aatt aa (cid:48)(cid:87)rsin(cid:73) (cid:50)erfor(cid:79)ance (cid:23)(cid:23) hhiigghh rreessoolluuttiioonn,, aanndd tthheenn ccaann Provider Performance 62 ssttyyllee tthheemm wwiitthh ssttrrookkeess aanndd Speciali(cid:92)e(cid:70) (cid:47)e(cid:70)ical (cid:42)o(cid:87)sin(cid:73) (cid:24)(cid:25) gglloowwss.. GGeett tthheemm ddiirreeccttllyy iinnttoo Specialt(cid:91) Ser(cid:88)ices (cid:24)(cid:26) tthhiiss ssppaaccee ffrroomm tthhee ddrriivvee.. (cid:35)(cid:70)(cid:79)inistrati(cid:88)e Operations (cid:25)(cid:20) Appendix A: Methodology 75 Case (cid:52)e(cid:88)ie(cid:89)s (cid:25)(cid:24) Co(cid:79)pliance (cid:54)estin(cid:73) (cid:25)(cid:27) In(cid:70)icator (cid:52)atin(cid:73)s an(cid:70) t(cid:74)e O(cid:88)erall (cid:47)e(cid:70)ical (cid:51)(cid:87)alit(cid:91) (cid:52)atin(cid:73) (cid:26)(cid:18) Appendix B: Case Review Data 81 Appendix C: Compliance Sampling Methodology 84 California Correctional Health Care Services’ Response 91 Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents iv C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Illustrations uuppddaattee aallll Tables ffoolliiooss wwhheenn tthhee rreeppoorrtt iiss (cid:19)(cid:16) CCI S(cid:87)(cid:79)(cid:79)ar(cid:91) (cid:54)a(cid:68)le (cid:21) ccoommpplleettee.. 2. CCI Policy Compliance Scores 4 (cid:21)(cid:16) CCI (cid:47)aster (cid:52)e(cid:73)istr(cid:91) (cid:38)ata as of (cid:38)ece(cid:79)(cid:68)er (cid:20)(cid:18)(cid:20)(cid:18) (cid:23) (cid:22)(cid:16) CCI (cid:42)ealt(cid:74) Care Staffin(cid:73) (cid:52)eso(cid:87)rces as of (cid:38)ece(cid:79)(cid:68)er (cid:20)(cid:18)(cid:20)(cid:18) (cid:24) (cid:23)(cid:16) CCI (cid:52)es(cid:87)lts Co(cid:79)pare(cid:70) (cid:57)it(cid:74) State (cid:42)(cid:39)(cid:38)IS Scores (cid:19)(cid:18) (cid:24)(cid:16) (cid:35)ccess to Care (cid:19)(cid:26) (cid:25)(cid:16) Ot(cid:74)er (cid:54)ests (cid:52)elate(cid:70) to (cid:35)ccess to Care (cid:19)(cid:27) (cid:26)(cid:16) (cid:38)ia(cid:73)nostic Ser(cid:88)ices (cid:20)(cid:20) (cid:27)(cid:16) (cid:42)ealt(cid:74) Infor(cid:79)ation (cid:47)ana(cid:73)e(cid:79)ent (cid:20)(cid:26) (cid:19)(cid:18)(cid:16) Ot(cid:74)er (cid:54)ests (cid:52)elate(cid:70) to (cid:42)ealt(cid:74) Infor(cid:79)ation (cid:47)ana(cid:73)e(cid:79)ent (cid:20)(cid:27) (cid:19)(cid:19)(cid:16) (cid:42)ealt(cid:74) Care (cid:39)n(cid:88)iron(cid:79)ent (cid:21)(cid:26) (cid:19)(cid:20)(cid:16) (cid:54)ransfers (cid:22)(cid:22) (cid:19)(cid:21)(cid:16) Ot(cid:74)er (cid:54)ests (cid:52)elate(cid:70) to (cid:54)ransfers (cid:22)(cid:23) (cid:19)(cid:22)(cid:16) (cid:47)e(cid:70)ication (cid:47)ana(cid:73)e(cid:79)ent (cid:23)(cid:19) (cid:19)(cid:23)(cid:16) Ot(cid:74)er (cid:54)ests (cid:52)elate(cid:70) to (cid:47)e(cid:70)ication (cid:47)ana(cid:73)e(cid:79)ent (cid:23)(cid:20) (cid:19)(cid:24)(cid:16) (cid:50)re(cid:88)enti(cid:88)e Ser(cid:88)ices (cid:23)(cid:22) (cid:19)(cid:25)(cid:16) Specialt(cid:91) Ser(cid:88)ices (cid:25)(cid:18) (cid:19)(cid:26)(cid:16) Ot(cid:74)er (cid:54)ests (cid:52)elate(cid:70) to Specialt(cid:91) Ser(cid:88)ices (cid:25)(cid:19) (cid:19)(cid:27)(cid:16) (cid:35)(cid:70)(cid:79)inistrati(cid:88)e Operations (cid:25)(cid:21) (cid:35)(cid:115)(cid:19)(cid:16) Case (cid:52)e(cid:88)ie(cid:89) (cid:38)efinitions (cid:25)(cid:24) (cid:36)(cid:115)(cid:19)(cid:16) Case (cid:52)e(cid:88)ie(cid:89) Sa(cid:79)ple Sets (cid:26)(cid:19) (cid:36)(cid:115)(cid:20)(cid:16) Case (cid:52)e(cid:88)ie(cid:89) C(cid:74)ronic Care (cid:38)ia(cid:73)noses (cid:26)(cid:20) (cid:36)(cid:115)(cid:21)(cid:16) Case (cid:52)e(cid:88)ie(cid:89) (cid:39)(cid:88)ents (cid:68)(cid:91) (cid:50)ro(cid:73)ra(cid:79) (cid:26)(cid:21) (cid:36)(cid:115)(cid:22)(cid:16) Case (cid:52)e(cid:88)ie(cid:89) Sa(cid:79)ple S(cid:87)(cid:79)(cid:79)ar(cid:91) (cid:26)(cid:21) Figures (cid:35)(cid:115)(cid:19)(cid:16) Inspection In(cid:70)icator (cid:52)e(cid:88)ie(cid:89) (cid:38)istri(cid:68)(cid:87)tion for CCI (cid:25)(cid:23) (cid:35)(cid:115)(cid:20)(cid:16) Case (cid:52)e(cid:88)ie(cid:89) (cid:54)estin(cid:73) (cid:25)(cid:26) (cid:35)(cid:115)(cid:21)(cid:16) Co(cid:79)pliance Sa(cid:79)plin(cid:73) (cid:47)et(cid:74)o(cid:70)olo(cid:73)(cid:91) (cid:25)(cid:27) Photographs (cid:19)(cid:16) (cid:40)acilit(cid:91) (cid:36) Clinic (cid:47)ain O(cid:87)t(cid:70)oor (cid:57)aitin(cid:73) (cid:35)rea (cid:21)(cid:18) (cid:20)(cid:16) (cid:40)acilit(cid:91) (cid:36) Clinic Secon(cid:70)ar(cid:91) (cid:57)aitin(cid:73) (cid:35)rea (cid:21)(cid:19) (cid:21)(cid:16) (cid:40)acilit(cid:91) (cid:39) In(cid:70)oor (cid:57)aitin(cid:73) (cid:35)rea (cid:21)(cid:19) (cid:22)(cid:16) (cid:40)acilit(cid:91) (cid:36) (cid:39)(cid:90)a(cid:79)ination (cid:52)oo(cid:79) (cid:57)it(cid:74) (cid:56)entilation (cid:21)(cid:20) (cid:23)(cid:16) (cid:39)(cid:90)pire(cid:70) (cid:47)e(cid:70)ical S(cid:87)ppl(cid:91) (cid:21)(cid:21) (cid:24)(cid:16) (cid:39)(cid:90)pire(cid:70) (cid:47)e(cid:70)ical S(cid:87)ppl(cid:91) (cid:21)(cid:21) (cid:25)(cid:16) (cid:38)isor(cid:73)ani(cid:92)e(cid:70) (cid:47)e(cid:70)ical S(cid:87)pplies (cid:21)(cid:21) (cid:26)(cid:16) (cid:39)(cid:90)pire(cid:70) (cid:47)e(cid:70)ical S(cid:87)ppl(cid:91) (cid:21)(cid:22) (cid:27)(cid:16) (cid:47)e(cid:70)ical S(cid:87)ppl(cid:91) (cid:57)it(cid:74) Co(cid:79)pro(cid:79)ise(cid:70) Sterile (cid:50)ac(cid:77)a(cid:73)in(cid:73) (cid:21)(cid:23) (cid:19)(cid:18)(cid:16) (cid:47)e(cid:70)ical S(cid:87)ppl(cid:91) (cid:57)it(cid:74) Co(cid:79)pro(cid:79)ise(cid:70) Sterile (cid:50)ac(cid:77)a(cid:73)in(cid:73) (cid:21)(cid:23) Cover: Rod of Asclepius courtesy of Thomas Shafee Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:19) Introduction Pursuant to California Penal Code section 6126 et seq., the Office of the Inspector General (OIG) is responsible for periodically reviewing and reporting on the delivery of the ongoing medical care provided to incarcerated persons1 in the California Department of Corrections and Rehabilitation (the department).2 In Cycle 6, the OIG continues to apply the same assessment methodologies used in Cycle 5, including clinical case review and compliance testing. These methods provide an accurate assessment of how the institution’s health care systems function regarding patients with the highest medical risk who tend to access services at the highest rate. This information helps to assess the performance of the institution in providing sustainable, adequate care.3 We continue to review institutional care using 15 indicators, as in prior cycles. Using each of these indicators, our compliance inspectors collect data in answer to compliance- and performance-related questions as established in the medical inspection tool (MIT).4 We determine a total compliance score for each applicable indicator and consider the MIT scores in the overall conclusion of the institution’s performance. In addition, our clinicians complete document reviews of individual cases and also perform on-site inspections, which include interviews with staff. In reviewing the cases, our clinicians examine whether providers used sound medical judgment in the course of caring for a patient. In the event we find errors, we determine whether such errors were clinically significant or led to a significantly increased risk of harm to the patient.5 At the same time, our clinicians examine whether the institution’s medical system mitigated the error. The OIG rates the indicators as proficient, adequate, or inadequate. 1. In this report, we use the terms patient and patients to refer to incarcerated persons. 2. The OIG’s medical inspections are not designed to resolve questions about the constitutionality of care, and the OIG explicitly makes no determination regarding the constitutionality of care the department provides to its population. 3. In addition to our own compliance testing and case reviews, the OIG continues to offer selected Healthcare Effectiveness Data and Information Set (HEDIS) measures for comparison purposes. 4. The department regularly updates its policies. The OIG updates our policy-compliance testing to reflect the department’s updates and changes. 5. If we learn of a patient needing immediate care, we notify the institution’s chief executive officer. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 2 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport The OIG has adjusted Cycle 6 reporting in two ways. First, commencing with this reporting period, we interpret compliance and case review results together, providing a more holistic assessment of the care; and, second, we consider whether institutional medical processes lead to identifying and correcting provider or system errors. The review assesses the institution’s medical care on both system and provider levels. As in Cycle 5, our office continues to inspect both those institutions remaining under federal receivership and those delegated back to the department. There is no difference in the standards used for assessing a delegated institution versus an institution not yet delegated. At the time of the Cycle 6 inspection of the California Correctional Institution (CCI), the receiver had delegated this institution back to the department. We completed our sixth inspection of CCI and herein present our assessment of the health care provided at CCI during the inspection period between May 2020 and October 2020.6 Our case reviews encompassed patients during the COVID-19 pandemic. The inspection was otherwise completed with no further adjustments. The California Correctional Institution (CCI) is located in Cummings Valley, west of the city of Tehachapi in Kern County. CCI consists of five separate facilities, housing incarcerated persons of varying security levels, from minimum to maximum security. The institution runs five medical clinics where staff members handle nonurgent requests for medical services. Each of the five facilities has a minor procedure room that functions as a triage and treatment area (TTA). The TTA is used for urgent and emergency care. CCI has been designated by California Correctional Health Care Services (CCHCS) as a basic care institution. Basic care institutions are located in rural areas, away from tertiary care centers and specialty care providers whose services would likely be used frequently by high-risk patients. Basic care institutions are capable of providing limited specialty medical services and consultation for a generally healthy patient population. 6. Samples are obtained per case review methodology shared with stakeholders in prior cycles. The case reviews include death reviews that occurred between February 2020 and July 2020, emergency CPR reviews that occurred between January 2020 and June 2020, diabetes reviews that occurred between April 2020 and October 2020, transfer reviews that occurred between February 2020 and October 2020, and RN sick call reviews that occurred between April 2020 and November 2020. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution 3 Summary We completed the Cycle 6 inspection of the California Correctional Institution (CCI) in February 2021. OIG inspectors monitored the institution’s delivery of medical Overall care that occurred between May 2020 and October 2020. Rating The OIG rated the overall quality of health care at CCI as Inadequate inadequate. We list the individual indicators and ratings applicable to this institution in Table 1 below. Table 1. CCI Summary Table Ratings Proficient Adequate Inadequate Cycle 6 Ratings Change Since Health Care Indicators Case Review Compliance Overall Cycle 5 * Access to Care Diagnostic Services Emergency Services N/A Health Information Management Health Care Environment N/A Transfers Medication Management Prenatal and Postpartum Care N/A N/A N/A N/A Preventive Services N/A Nursing Performance N/A Provider Performance N/A Reception Center N/A N/A N/A N/A Specialized Medical Housing N/A N/A N/A N/A Specialty Services Administrative Operations † N/A * The symbols in this column correspond to changes that occurred in indicator ratings between t(cid:74)e (cid:79)e(cid:70)ical inspections con(cid:70)(cid:87)cte(cid:70) (cid:70)(cid:87)rin(cid:73) C(cid:91)cle (cid:23) an(cid:70) C(cid:91)cle(cid:124)(cid:24)(cid:16) (cid:54)(cid:74)e e(cid:83)(cid:87)als si(cid:73)n (cid:79)eans t(cid:74)ere was no change in the rating. The single arrow means the rating rose or fell one level, and the double arrow means the rating rose or fell two levels (green, from inadequate to proficient; pink, from proficient to inadequate). † Administrative Operations is a secondary indicator and is not considered when rating the instit(cid:87)tion(cid:111)s o(cid:88)erall (cid:79)e(cid:70)ical (cid:83)(cid:87)alit(cid:91)(cid:16) So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 4 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport To test the institution’s policy compliance, our compliance inspectors (a team of registered nurses) monitored the institution’s compliance with its medical policies by answering a standardized set of questions that measure specific elements of health care delivery. Our compliance inspectors examined 369 patient records and 1,071 data points and used the data to answer 83 policy questions. In addition, we observed CCI’s processes during an on-site inspection in January 2021. Table 2 below lists CCI’s average scores from Cycles 4, 5, and 6. Table 2. CCI Policy Compliance Scores Scoring Ranges 100% – 85.0% 84.9% – 75.0% 74.9% – 0 Average Score Medical Inspection Tool (MIT) Policy Compliance Category Cycle 4 Cycle 5 Cycle 6 (cid:19) Access to Care 81.1% 70.1% 74.3% 2 Diagnostic Services 84.4% 69.4% 53.0% 4 Health Information Management 78.2% 75.5% 87.4% (cid:23) Health Care Environment 84.4% 58.9% 66.7% 6 Transfers 84.1% 77.1% 53.8% (cid:25) Medication Management 93.2% 61.7% 72.1% (cid:26) Prenatal and Postpartum Care N/A N/A N/A (cid:27) Preventive Services 88.8% 87.1% 55.3% (cid:19)(cid:20) Reception Center N/A N/A N/A (cid:19)(cid:21) Specialized Medical Housing 100% 89.2% N/A (cid:19)(cid:22) Specialty Services 85.7% 68.1% 61.4% (cid:19)(cid:23) Administrative Operations 83.8%* 87.7% 74.0% (cid:12) In C(cid:91)cle (cid:22), t(cid:74)ere (cid:89)ere t(cid:89)o secon(cid:70)ar(cid:91) (cid:10)a(cid:70)(cid:79)inistrati(cid:88)e(cid:11) in(cid:70)icators, an(cid:70) t(cid:74)is score re(cid:387)ects t(cid:74)e a(cid:88)era(cid:73)e of t(cid:74)ose t(cid:89)o scores(cid:16) In C(cid:91)cle (cid:23) an(cid:70) (cid:79)o(cid:88)in(cid:73) for(cid:89)ar(cid:70), t(cid:74)e t(cid:89)o in(cid:70)icators were merged into one, with only one score as the result. So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:23) The OIG clinicians (a team of physicians and nurse consultants) reviewed 45 cases, which contained 761 patient-related events. After examining the medical records, our clinicians conducted a follow-up on-site inspection in February 2021 to verify their initial findings. The OIG physicians rated the quality of care for 20 comprehensive case reviews. Of these 20 cases, our physicians rated zero proficient, 12 adequate, and eight inadequate. Our physicians found no adverse deficiencies during this inspection. The OIG then considered the results from both case review and compliance testing and drew overall conclusions, which we report in the 12 health care indicators.7 Multiple OIG physicians and nurses performed quality control reviews; their subsequent collective deliberations ensured consistency, accuracy, and thoroughness. Our OIG clinicians acknowledged institutional structures that catch and resolve mistakes that may occur throughout the delivery of care. As noted above, we listed the individual indicators and ratings applicable to this institution in the CCI Summary Table. In July 2020, the Health Care Services Master Registry showed that CCI had a total population of 2,970. A breakdown of the medical risk level of the CCI population as determined by the department is set forth in Table 3 below.8 Table 3. CCI Master Registry Data as of December 2020 Medical Risk Level Number of Patients Percentage (cid:42)i(cid:73)(cid:74) (cid:19) 36 (cid:19)(cid:16)(cid:20)(cid:7) High 2 (cid:19)(cid:22)(cid:19) (cid:22)(cid:16)(cid:25)(cid:7) Medium (cid:19),(cid:21)(cid:22)(cid:20) (cid:22)(cid:23)(cid:16)(cid:20)(cid:7) Low (cid:19),(cid:22)(cid:23)(cid:19) (cid:22)(cid:26)(cid:16)(cid:27)(cid:7) Total 2,970 100% Source: Data for the population medical risk level were obtained from t(cid:74)e CC(cid:42)CS (cid:47)aster (cid:52)e(cid:73)istr(cid:91) (cid:70)ate(cid:70) (cid:19)(cid:20)(cid:15)(cid:19)(cid:20)(cid:15)(cid:20)(cid:18)(cid:16) 7. The indicators for Reception Center and Prenatal Care did not apply to CCI. 8. For a definition of medical risk, see CCHCS HCDOM 1.2.14, Appendix 1.9. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 6 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Based on staffing data the OIG obtained from California Correctional Health Care Services (CCHCS), as identified in Table 4 below, CCI had zero executive leadership vacancies, 1.5 vacant primary care provider positions, 0.2 vacant nursing supervisor positions, and 8.8 vacant nursing staff positions. Table 4. CCI Health Care Staffing Resources as of December 2020 Executive Primary Care Nursing Nursing Positions Leadership * Providers Supervisors Staff † Total Authorized Positions (cid:23) (cid:19)(cid:18) (cid:19)(cid:19)(cid:16)(cid:20) (cid:19)(cid:19)(cid:20)(cid:16)(cid:27) (cid:19)(cid:21)(cid:27)(cid:16)(cid:19) (cid:40)ille(cid:70) (cid:68)(cid:91) Ci(cid:88)il Ser(cid:88)ice (cid:23) (cid:27)(cid:16)(cid:23) (cid:19)(cid:18) (cid:19)(cid:18)(cid:22)(cid:16)(cid:19) (cid:19)(cid:20)(cid:26)(cid:16)(cid:24) (cid:56)acant 0 (cid:19)(cid:16)(cid:23) 0.2 (cid:26)(cid:16)(cid:26) (cid:19)(cid:18)(cid:16)(cid:23) (cid:50)ercenta(cid:73)e (cid:40)ille(cid:70) (cid:68)(cid:91) Ci(cid:88)il Ser(cid:88)ice (cid:19)(cid:18)(cid:18)(cid:7) (cid:27)(cid:23)(cid:16)(cid:18)(cid:7) (cid:26)(cid:27)(cid:16)(cid:18)(cid:7) (cid:27)(cid:20)(cid:16)(cid:18)(cid:7) (cid:27)(cid:20)(cid:16)(cid:18)(cid:7) (cid:40)ille(cid:70) (cid:68)(cid:91) (cid:54)ele(cid:79)e(cid:70)icine 0 2 0 0 2 (cid:50)ercenta(cid:73)e (cid:40)ille(cid:70) (cid:68)(cid:91) (cid:54)ele(cid:79)e(cid:70)icine 0 (cid:19)(cid:23)(cid:16)(cid:18)(cid:7) 0 0 (cid:19)(cid:16)(cid:18)(cid:7) (cid:40)ille(cid:70) (cid:68)(cid:91) (cid:52)e(cid:73)istr(cid:91) 0 (cid:19) 0 (cid:19)(cid:26) (cid:19)(cid:27) (cid:50)ercenta(cid:73)e (cid:40)ille(cid:70) (cid:68)(cid:91) (cid:52)e(cid:73)istr(cid:91) 0 (cid:25)(cid:16)(cid:18)(cid:7) 0 (cid:19)(cid:21)(cid:16)(cid:18)(cid:7) (cid:19)(cid:19)(cid:16)(cid:18)(cid:7) Total Filled Positions 5 (cid:19)(cid:21) 11.2 130.9 160.1 Total Percentage Filled 100% 96.0% 2.0% 7.0% 7.0% (cid:35)ppoint(cid:79)ents in (cid:46)ast (cid:19)(cid:20) (cid:47)ont(cid:74)s 0 (cid:19) (cid:23) 33 (cid:21)(cid:27) (cid:52)e(cid:70)irecte(cid:70) Staff 0 0 0 0 0 Staff on (cid:39)(cid:90)ten(cid:70)e(cid:70) (cid:46)ea(cid:88)e ‡ 0 0 2 (cid:25) (cid:27) Adjusted Total: Filled Positions 5 13 9.2 123.9 151.1 Adjusted Total: Percentage Filled 100% 100% 82.0% 95.0% 94.0% (cid:12) (cid:39)(cid:90)ec(cid:87)ti(cid:88)e (cid:46)ea(cid:70)ers(cid:74)ip incl(cid:87)(cid:70)es t(cid:74)e C(cid:74)ief (cid:50)(cid:74)(cid:91)sician an(cid:70) S(cid:87)r(cid:73)eon(cid:16) † (cid:48)(cid:87)rsin(cid:73) Staff incl(cid:87)(cid:70)es t(cid:74)e classifications of Senior (cid:50)s(cid:91)c(cid:74)iatric (cid:54)ec(cid:74)nician an(cid:70) (cid:50)s(cid:91)c(cid:74)iatric (cid:54)ec(cid:74)nician(cid:16) ‡ In Authorized Positions. (cid:48)otes(cid:28) (cid:54)(cid:74)e OIG (cid:70)oes not in(cid:70)epen(cid:70)entl(cid:91) (cid:88)ali(cid:70)ate staffin(cid:73) (cid:70)ata recei(cid:88)e(cid:70) fro(cid:79) t(cid:74)e (cid:70)epart(cid:79)ent(cid:16) (cid:50)ositions are (cid:68)ase(cid:70) on fractional ti(cid:79)e(cid:15)(cid:68)ase e(cid:83)(cid:87)i(cid:88)alents(cid:16) So(cid:87)rce(cid:28) C(cid:91)cle (cid:24) (cid:79)e(cid:70)ical inspection preinspection (cid:83)(cid:87)estionnaire recei(cid:88)e(cid:70) (cid:38)ece(cid:79)(cid:68)er (cid:20)(cid:18)(cid:20)(cid:18), fro(cid:79) California Correctional Health Care Services. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:25) Medical Inspection Results Deficiencies Identified During Case Review Deficiencies are medical errors that increase the risk of patient harm. Deficiencies can be minor or significant, depending on the severity of the deficiency. An adverse event occurs when the deficiency caused harm to the patient. All major health care organizations identify and track adverse events. We identify deficiencies and adverse events to highlight concerns regarding the provision of care and for the benefit of the institution’s quality improvement program to provide an impetus for improvement.9 The OIG did not find any adverse events at CCI during the Cycle 6 inspection. Case Review Results OIG case reviewers (a team of physicians and nurse consultants) assessed nine of the 12 indicators applicable to CCI. Of these nine indicators, OIG clinicians rated four adequate and five inadequate. The OIG physicians also rated the overall adequacy of care for each of the 20 detailed case reviews they conducted. Of these 20 cases, 12 were adequate, and eight were inadequate. In the 761 events reviewed, there were 296 deficiencies, 53 of which the OIG clinicians considered to be of such magnitude that, if left unaddressed, would likely contribute to patient harm. Our clinicians found the following strengths at CCI: • During urgent and emergent events, nurses responded quickly and provided prompt treatment of drug overdoses. • In spite of the COVID-19 pandemic, nurses continued to evaluate patients’ sick call requests. • The pharmacy promptly filled medications and ensured delivery of the medications to the medication areas. In addition, the pharmacist-in-charge performed frequent safety measures to ensure controlled substances were accounted for. Our clinicians found the following weaknesses at CCI: • We found the executive team lacked cohesiveness and initiative. • Medical providers did not consistently document communication with nurses regarding patient care plans. • Nursing leadership did not stay abreast of COVID-19 policies and procedures and evaluate nurses to ensure competency. 9. For a further discussion of an adverse event, see Table A-1. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:26) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport • Providers did not directly care for patients who were in quarantine or isolation. Compliance Testing Results Our compliance inspectors assessed nine of the 12 indicators applicable to CCI. Of these nine indicators, the compliance inspectors rated one proficient, and eight inadequate. We tested policy compliance in the Health Care Environment, Preventative Services, and Administrative Operations indicators, as these indicators do not have a case review component. CCI demonstrated a high rate of policy compliance in the following area: • The institution’s staff scanned health care screening forms, community hospital discharge reports, and requests for health care services into patients’ electronic medical records in a timely manner. CCI demonstrated a low rate of policy compliance in the following areas: • Providers at CCI did not often communicate the results of diagnostic services timely. Most patient letters communicating these results were missing the date of the diagnostic service, the date of the results, and whether the results were within normal limits. • CCI staff frequently failed to maintain medication continuity for chronic care patients and patients discharged from a hospital. There was poor medication continuity for patients transferring into the institution and patients did not timely receive their newly ordered medications within specified time frames. • CCI often did not ensure specialty service reports were received timely. Furthermore, providers often did not review those reports within the required time frames. Population-Based Metrics In addition to our own compliance testing and case reviews, as noted above, the OIG presents selected measures from the Healthcare Effectiveness Data and Information Set (HEDIS) for comparison purposes. The HEDIS is a set of standardized quantitative performance measures designed by the National Committee for Quality Assurance to ensure that the public has the data it needs to compare the performance of health care plans. Because the Veterans Administration no longer publishes its individual HEDIS scores, we removed them from our comparison for Cycle 6. Likewise, Kaiser (commercial plan) no longer publishes HEDIS scores. However, through the California Department of Health Care Services’ Medi-Cal Managed Care Technical Report, the OIG obtained Kaiser Medi-Cal HEDIS scores to use in conducting our analysis, and we present them here for comparison. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:27) HEDIS Results We considered CCI’s performance with population-based metrics to assess the macroscopic view of the institution’s health care delivery. CCI’s results compared favorably with those found in State health plans for diabetic care measures. We list the HEDIS measures in Table 5. Comprehensive Diabetes Care When compared with statewide Medi-Cal programs (California Medi- Cal, Kaiser Northern California (Medi-Cal), and Kaiser Southern California (Medi-Cal), CCI outperformed the other health care systems in three of five diabetic measures: HbA1c screening, poor HbA1c control, and HbA1c control. CCI had the second highest percentage for blood pressure control, and scored lower than all three State health care programs for eye examinations. Immunizations Statewide comparative data were not available for immunization measures; however, we include this data for informational purposes. CCI had a 65 percent influenza immunization rate for adults 18 to 64 years old and a 92 percent influenza immunization rate for adults 65 years of age and older. The pneumococcal vaccination rate was 88 percent.10 Colorectal Cancer Screening Statewide comparative data were not available for colorectal cancer screening; however, we include this data for informational purposes. CCI had a 90 percent colorectal cancer screening rate. 10. The pneumococcal vaccines administered are the 13 valent pneumococcal vaccine (PCV13) or the 23 valent pneumococcal vaccine (PPSV23), depending on the patient’s medical conditions. For the adult population, the influenza or pneumococcal vaccine may have been administered at a different institution other than where the patient was housed during the inspection period. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:19)(cid:18) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Table 5. CCI Results Compared With State HEDIS Scores California California CCI Kaiser Kaiser California NorCal SoCal Cycle 6 Medi-Cal Medi-Cal Medi-Cal HEDIS Measure Results * 2018 † 2018 † 2018 † (cid:42)(cid:68)(cid:35)(cid:19)c Screenin(cid:73) 100% (cid:26)(cid:26)(cid:7) (cid:27)(cid:22)(cid:7) (cid:27)(cid:23)(cid:7) (cid:50)oor (cid:42)(cid:68)(cid:35)(cid:19)c Control (cid:10)(cid:32) (cid:27)(cid:16)(cid:18)(cid:7)(cid:11) ‡,§ 18% (cid:21)(cid:22)(cid:7) (cid:20)(cid:22)(cid:7) (cid:20)(cid:18)(cid:7) (cid:42)(cid:68)(cid:35)(cid:19)c Control (cid:10)(cid:30) (cid:26)(cid:16)(cid:18)(cid:7)(cid:11) ‡ 71% (cid:23)(cid:23)(cid:7) (cid:24)(cid:20)(cid:7) (cid:25)(cid:18)(cid:7) (cid:36)loo(cid:70) (cid:50)ress(cid:87)re Control (cid:10)(cid:30) (cid:19)(cid:22)(cid:18)(cid:17)(cid:27)(cid:18)(cid:11) ‡ (cid:26)(cid:19)(cid:7) (cid:24)(cid:25)(cid:7) (cid:25)(cid:23)(cid:7) (cid:26)(cid:23)(cid:7) (cid:39)(cid:91)e (cid:39)(cid:90)a(cid:79)inations (cid:19)(cid:22)(cid:7) (cid:24)(cid:21)(cid:7) (cid:25)(cid:25)(cid:7) (cid:26)(cid:21)(cid:7) In(cid:387)(cid:87)en(cid:92)a (cid:115) (cid:35)(cid:70)(cid:87)lts (cid:10)(cid:19)(cid:26) (cid:115) (cid:24)(cid:22)(cid:11) (cid:24)(cid:23)(cid:7) – – – In(cid:387)(cid:87)en(cid:92)a (cid:115) (cid:35)(cid:70)(cid:87)lts (cid:10)(cid:24)(cid:23) (cid:13)(cid:11) (cid:27)(cid:20)(cid:7) – – – (cid:50)ne(cid:87)(cid:79)ococcal (cid:115) (cid:35)(cid:70)(cid:87)lts (cid:10)(cid:24)(cid:23) (cid:13)(cid:11) || (cid:26)(cid:26)(cid:7) – – – Colorectal Cancer Screening (cid:27)(cid:18)(cid:7) – – – Notes and Sources * Unless otherwise stated, data were collected in December 2020 by reviewing medical records from a sample of CCI’s population of applicable patients. These random statistical sample sizes were based on a (cid:27)(cid:23)(cid:124)percent confi(cid:70)ence le(cid:88)el (cid:89)it(cid:74) a (cid:19)(cid:23) percent (cid:79)a(cid:90)i(cid:79)(cid:87)(cid:79) (cid:79)ar(cid:73)in of error(cid:16) † HEDIS Medi-Cal data were obtained from the California Department of Health Care Services publication titled, Medi-Cal Managed Care External Quality Review Technical Report, dated (cid:44)(cid:87)l(cid:91)(cid:124)(cid:19),(cid:124)(cid:20)(cid:18)(cid:19)(cid:26) (cid:115) (cid:44)(cid:87)ne (cid:21)(cid:18), (cid:20)(cid:18)(cid:19)(cid:27) (cid:10)p(cid:87)(cid:68)lis(cid:74)e(cid:70) (cid:44)(cid:87)ne (cid:20)(cid:18)(cid:20)(cid:18)(cid:11)(cid:16) ‡ (cid:40)or t(cid:74)is in(cid:70)icator, t(cid:74)e entire applica(cid:68)le CCI pop(cid:87)lation (cid:89)as teste(cid:70)(cid:16) § (cid:40)or t(cid:74)is (cid:79)eas(cid:87)re onl(cid:91), a lo(cid:89)er score is (cid:68)etter(cid:16) So(cid:87)rce(cid:28) Instit(cid:87)tion infor(cid:79)ation pro(cid:88)i(cid:70)e(cid:70) (cid:68)(cid:91) t(cid:74)e California (cid:38)epart(cid:79)ent of Corrections an(cid:70) (cid:52)e(cid:74)a(cid:68)ilitation(cid:16) (cid:42)ealt(cid:74) care plan (cid:70)ata (cid:89)ere o(cid:68)taine(cid:70) fro(cid:79) t(cid:74)e CC(cid:42)CS (cid:47)aster (cid:52)e(cid:73)istr(cid:91)(cid:16) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:19)(cid:19) Recommendations As a result of our assessment of CCI’s performance, we offer the following recommendations to the department: Access to Care • Medical leadership should ensure all canceled appointments are rescheduled as soon as safely possible. In addition, providers should document the result of chart reviews to improve communication and collaboration with other primary health care team members. Furthermore, to improve patients’ access to care, CCI should consider expanding its telemedicine utilization. • Medical leadership should determine the cause(s) of untimely chronic care follow-up appointments with providers, clinician follow-up visits, and nurse-to-provider referrals and implement remedial measures as appropriate. Diagnostic Services • Medical leadership should ascertain causative factors related to the untimely provision of laboratory services and implement remedial measures as appropriate. • Medical leadership should determine the root cause(s) of challenges in reviewing and endorsing pathology reports timely and implement remedial measures as appropriate. Emergency Services • Medical leadership should consider implementing periodic audits to ensure providers appropriately document patient care plans. • Nursing leadership should ensure nurses are updated with the most current guidance, including COVID-19 symptoms and provide thorough patient screening. Health Information Management • The department should consider developing and implementing a patient results letter template that autopopulates with all elements required per CCHCS policy. Health Care Environment • Nursing leadership should consider performing random spot checks to ensure staff follow equipment and medical supply management protocols. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:19)(cid:20) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport • Nursing leadership should have each clinic nurse supervisor review the monthly EMRB logs to ensure EMRBs are regularly inventoried and sealed. Transfers • The department should consider developing and implementing an electronic alert to ensure receiving and release (R&R) nurses properly and thoroughly complete initial health screening questions and follow up as needed. • The department should consider defining a clear requirement regarding which fields within the EHRS transfer-out powerform must be completed for any patients transferring out. • Health care leadership should identify why medication continuity was not maintained for newly arrived patients to the institution and for patients returning from hospitalizations or emergency rooms and implement remedial measures as appropriate. • Nursing leadership should develop and implement internal staff auditing to ensure assessments are complete and thorough, and medications and hospital recommendations are reconciled for patients returning from hospitalizations and emergency room visits. Medication Management • Nursing leadership should develop a process to ensure all newly prescribed keep-on-person (KOP) “as needed” medications are offered timely to patients and that the medications are included on their daily “pick-up” distribution lists. This new work flow should be audited and reported to the Medication Management Subcommittee.11 • CCI’s chief medical executive, chief nursing executive, and pharmacist-in-charge should ensure antipyretic medications to treat a fever are available in medical isolation areas when ordered. In addition, medical leadership should train staff to order that the course of these medications begin promptly when patients are symptomatic. • The EHRS team should evaluate the KOP medication refill process to ensure medications appear on the nurses’ task list prior to exhaustion of medications. 11. KOP means “keep on person” and refers to medications in which a patient can keep and self-administer according to the directions provided. PRN means “as needed” and the patient can take a medication as needed according to the directions provided. A medication can be ordered as both KOP and PRN. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:19)(cid:21) • The institution should consider developing and implementing measures to ensure medications are made available and administered in a timely manner and that summaries are documented in the medication administration record (MAR) as described in CCHCS policies and procedures. Preventive Services • Nursing leadership should consider developing and implementing measures to ensure nursing staff timely screen patients for tuberculosis (TB) and completely address signs and symptoms in their TB screening. • Medical leadership should determine the cause(s) of untimely chronic care vaccinations. • Nursing leadership should consider developing and implementing measures to ensure nursing staff document patient refusals on the correct forms. Nursing Performance • The CEO should consider directing nursing leadership to effectively communicate and provide clear expectations for the nursing staff. • Nursing leadership should work towards improving patient care coordination with medical providers. • Nursing leadership should ensure patients are aware when newly prescribed PRN medications are available in the medication administration areas. Provider Performance • Medical leadership should ensure providers document patient- related calls and management plans in the electronic medical health record for clear communication and collaboration with the patient care team and for the continuity of patient care. Specialty Services • Medical leadership should consider expanding the telemedicine provision in each medical clinic to include specialty services. • Medical leadership should review the causes of the untimely provider review of specialty reports; medical leadership should implement remedial measures as appropriate. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:19)(cid:22) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport (This page left blank for reproduction purposes.) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:19)(cid:23) Access to Care Access to Care Overall Rating In this indicator, OIG inspectors evaluated the institution’s ability to In this indicator, OIG inspectors evaluated the institution’s ability to Inadequate provide patients with timely clinical appointments. Our inspectors provide patients with timely clinical appointments. Our inspectors reviewed the scheduling and appointment timeliness for newly arrived reviewed the scheduling and appointment timeliness for newly arrived Case Review patients, sick calls, and nurse follow-up appointments. We examined patients, sick calls, and nurse follow-up appointments. We examined Rating referrals to primary care providers, provider follow-ups, and specialists. referrals to primary care providers, provider follow-ups, and specialists. Inadequate Furthermore, we evaluated the follow-up appointments for patients who Furthermore, we evaluated the follow-up appointments for patients who received specialty care or returned from an off-site hospitalization. received specialty care or returned from an off-site hospitalization. Compliance Score Results Overview Inadequate (74.3%) Similar to Cycle 5, CCI performed poorly overall in providing access to care. Compliance testing showed low scores for provider chronic care appointments and nurse-to-provider referrals. Access to specialists was OOnnccee (cid:91)(cid:91)oo(cid:87)(cid:87)(cid:111)(cid:111)(cid:88)(cid:88)ee ii(cid:79)(cid:79)ppoorrttee(cid:70)(cid:70) tt(cid:74)(cid:74)ee ttee(cid:90)(cid:90)tt ffrroo(cid:79)(cid:79) tt(cid:74)(cid:74)ee (cid:57)(cid:57)oorr(cid:70)(cid:70) (cid:70)(cid:70)oocc,, ffoorr eeaacc(cid:74)(cid:74) iinn(cid:70)(cid:70)iiccaattoorr,, also poor. On the other hand, access to nurses was good. We recognize aanncchhoorr iitt ttoo tthhee nneewwllyy iimmppoorrtteedd hheeaaddiinngg.. IItt wwiillll ssttiillll bbee aanncchhoorreedd ttoo tthhee access to care was impacted by rescheduled appointments during the (cid:68)(cid:68)oo(cid:90)(cid:90) aa(cid:68)(cid:68)oo(cid:88)(cid:88)ee ttoooo,, tt(cid:74)(cid:74)ee ooppeenniinn(cid:73)(cid:73) ppaarraa(cid:73)(cid:73)rraapp(cid:74)(cid:74) ooff tt(cid:74)(cid:74)ee iinn(cid:70)(cid:70)iiccaattoorr,, (cid:89)(cid:89)(cid:74)(cid:74)iicc(cid:74)(cid:74) sseerr(cid:88)(cid:88)eess COVID-19 pandemic. However, some medically necessary appointments aass aa gguuiiddee hheerree iinn llaayyoouutt aanndd aass aa mmaarrkkeerr ffoorr tthhee TTooCC.. DDoo tthhiiss ffoorr eeaacchh were not kept, which led to a delay in care. After reviewing all aspects of iinn(cid:70)(cid:70)iiccaattoorr aass nneeee(cid:70)(cid:70)ee(cid:70)(cid:70)(cid:16)(cid:16) (cid:38)(cid:38)oo nnoott (cid:70)(cid:70)eelleettee tt(cid:74)(cid:74)ee (cid:68)(cid:68)oo(cid:90)(cid:90) aa(cid:68)(cid:68)oo(cid:88)(cid:88)ee (cid:87)(cid:87)nnttiill (cid:91)(cid:91)oo(cid:87)(cid:87)(cid:111)(cid:111)rree cceerrttaaiinn this indicator, the OIG rated it inadequate. tthhee TTooCC iiss ccoommpplleettee.. AAddjjuusstt aallll iinnffoo bbyy hhaanndd iinn tthhee iinnddiiccaattoorrss’’ rraattiinnggss (cid:68)(cid:68)oo(cid:90)(cid:90)eess ppeerr tt(cid:74)(cid:74)ee iinnffoo lliissttee(cid:70)(cid:70) iinn tt(cid:74)(cid:74)ee (cid:57)(cid:57)oorr(cid:70)(cid:70) (cid:70)(cid:70)oocc(cid:16)(cid:16) Case Review and Compliance Testing Results We reviewed 140 provider, nursing, specialty, and hospital events that required the institution to generate appointments. We identified 19 deficiencies relating to Access to Care, eight of which were significant.12 Access to Clinic Providers CCI did not perform well in managing referrals to providers and requests for provider follow-up. Failure to ensure provider appointment availability can cause lapses in care. Compliance testing found that 60.0 percent of chronic care follow-up appointments occurred on time (MIT 1.001), 100 percent of provider-ordered follow-up sick call appointments occurred within the required time frame (MIT 1.006), and 62.5 percent of nurse-to-provider sick call referrals occurred within the required time frame (MIT 1.005). OIG clinicians reviewed 70 outpatient provider encounters in 25 cases and identified 12 deficiencies in 10 cases.13 Two examples follow: • In case 1, a provider requested a chronic care appointment with a clinic provider to occur in 46 days, but the appointment did not occur. • In case 16, a provider requested a follow-up with a patient but the appointment did not occur. 12. Deficiencies occurred in cases 1, 2, 3, 4, 7, 10, 16, 17, 19, 21, 23, 26, and 28. Cases 1, 2, 7, 16, 23, and 28 had significant deficiencies. 13. Deficiencies occurred in cases 1, 3, 7, 10, 16, 17, 19, 21, 23, and 28. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:19)(cid:24) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Access to Clinic Nurses CCI performed well in providing access to nurse sick call and provider- to-nurse referrals. Compliance testing found that all nurse sick call requests were reviewed on the same day they were received (MIT 1.003, 100%) and nursing staff completed a face-to-face visit within one day of the request (MIT 1.004, 93.3%). OIG clinicians reviewed 63 nursing sick call requests in 30 cases and identified six deficiencies in five cases related to clinic nurse access.14 Access to Specialty Services CCI provided adequate specialty access. Compliance testing found that 86.7 percent of high-priority specialty appointments occurred within the required time frame (MIT 14.001), 66.7 percent of medium- priority specialty appointments occurred as requested (MIT 14.004), and 53.3 percent of the routine-priority specialty appointments occurred as requested (MIT 14.007). OIG clinicians reviewed 24 specialty events and identified no deficiencies related to access to specialty services. Follow-Up After Specialty Services In general, CCI performed poorly in providing follow-up appointments with providers after specialty appointments (MIT 1.008, 65.8%). OIG clinicians reviewed 24 specialty events and patients attended provider follow-up appointments after specialty consultations in all but one case; in this case, the patient refused to see the provider and instead followed up with the specialist.15 Follow-Up After Hospitalization In general, CCI performed adequately in providing follow-up appointments with providers after patients returned from hospitalizations. Compliance testing found that most provider appointments occurred within the required time frame (MIT 1.007, 80.0%). OIG clinicians reviewed 19 hospital returns and identified three deficiencies.16 The following is an example. • In case 23, a patient returned from the hospital with COVID-19 pneumonia. However, the follow-up appointment with the clinic provider did not occur until 21 days later. Follow-Up After Urgent or Emergent Care (TTA) CCI generally performed adequately in ensuring patients followed up with their clinic providers at the triage and treatment area (TTA) after 14. Deficiencies occurred in cases 2, 4, 19, 26, and 28. 15. The patient refused to see the clinic provider after the specialist visit in case 24. 16. Deficiencies occurred in cases 7 and 23. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:19)(cid:25) receiving urgent or emergent care. OIG clinicians assessed 15 TTA events and did not identify any significant deficiencies. Follow-Up After Transferring Into the Institution Compliance testing showed poor performance in providing appointments for newly arrived patients within the required time frames (MIT 1.002, 24.0%). In contrast, OIG clinicians reviewed 10 transfer-in events and identified one deficiency: • In case 28, a patient transferred to CCI from another institution, but the provider appointment was canceled due to a provider shortage. The new-arrival appointment occurred over eight months later. Clinician On-Site Inspection CCI has five main clinics: facilities A, B, C, D and E. Each clinic is staffed with two primary care providers. Medical leadership reported that at the beginning of the COVID-19 pandemic, one provider retired and another was on medical leave. The chief medical executive (CME) issued an institutional memorandum informing staff that there would be only one provider working on-site at each facility and that Facility B would have no provider working on-site on Fridays.17 After normal clinic hours, Friday coverage for Facility B would be handled by the providers on-site and the provider on-call. One provider worked on-site at each facility and the others performed telemedicine from home. While working remotely from home, the providers consulted by phone, checked messages in the electronic health record system (EHRS), reconciled medications, and reviewed charts. As a consequence, on-site provider availability was reduced. Nurses were involved in direct patient monitoring for COVID-19 quarantine and isolation rounding, especially during outbreaks in the institution. Nursing leadership and scheduling supervisors reported that when nurses consulted a provider, an appointment was generated for the co-consult and was immediately completed even though the provider did not see the patient. This was a former practice that was no longer supported by nursing leadership. Recommendations • Medical leadership should ensure all canceled appointments are rescheduled as soon as safely possible. In addition, providers should document the result of chart reviews to improve communication and collaboration with other primary health care team members. Furthermore, to improve patients’ access to care, CCI should consider expanding its telemedicine utilization. 17. Provider Schedule Change due to Social Distancing practices in response to COVID-19. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:19)(cid:26) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport • Medical leadership should determine the cause(s) of untimely chronic care follow-up appointments with providers, clinician follow-up visits, and nurse-to-provider referrals and implement remedial measures as appropriate. Compliance Testing Results Table 6. Access to Care Scored Answer FFoorr aallll ttaabblleess,, Compliance Questions Yes No N/A Yes % ccaarreeffuullllyy C(cid:74)ronic care follo(cid:89)(cid:15)(cid:87)p appoint(cid:79)ents(cid:28) (cid:57)as t(cid:74)e patient(cid:111)s (cid:79)ost uuppddaattee tthhee recent c(cid:74)ronic care (cid:88)isit (cid:89)it(cid:74)in t(cid:74)e (cid:74)ealt(cid:74) care (cid:73)(cid:87)i(cid:70)eline(cid:111)s (cid:79)a(cid:90)i(cid:79)(cid:87)(cid:79) ddaattaa.. MMoosstt (cid:19)(cid:23) (cid:19)(cid:18) 0 (cid:24)(cid:18)(cid:16)(cid:18)(cid:7) allowable interval or within the ordered time frame, whichever is ddaattaa ccaann bbee s(cid:74)orter(cid:33) (cid:10)(cid:19)(cid:16)(cid:18)(cid:18)(cid:19)(cid:11) (cid:12) ccooppiieedd aanndd (cid:40)or en(cid:70)orse(cid:70) patients recei(cid:88)e(cid:70) fro(cid:79) anot(cid:74)er C(cid:38)C(cid:52) instit(cid:87)tion(cid:28) ppaasstteedd ffrroomm Based on the patient’s clinical risk level during the initial health 6 (cid:19)(cid:27) 0 (cid:20)(cid:22)(cid:16)(cid:18)(cid:7) tthhee WWoorrdd screenin(cid:73), (cid:89)as t(cid:74)e patient seen (cid:68)(cid:91) t(cid:74)e clinician (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)e(cid:33) (cid:10)(cid:19)(cid:16)(cid:18)(cid:18)(cid:20)(cid:11) (cid:12) ddoocc.. DDoouubbllee-- Clinical appointments: Did a registered nurse review the patient’s cchheecckk aallll yyoouurr 30 0 0 (cid:19)(cid:18)(cid:18)(cid:7) re(cid:83)(cid:87)est for ser(cid:88)ice t(cid:74)e sa(cid:79)e (cid:70)a(cid:91) it (cid:89)as recei(cid:88)e(cid:70)(cid:33) (cid:10)(cid:19)(cid:16)(cid:18)(cid:18)(cid:21)(cid:11) (cid:12) wwoorrkk.. OOnnllyy tthhiiss ttaabbllee’’ss Clinical appointments: Did the registered nurse complete a face-to- ddaattaa aarree face (cid:88)isit (cid:89)it(cid:74)in one (cid:68)(cid:87)siness (cid:70)a(cid:91) after t(cid:74)e C(cid:38)C(cid:52) (cid:40)or(cid:79) (cid:25)(cid:21)(cid:24)(cid:20) (cid:89)as (cid:20)(cid:26) 2 0 (cid:27)(cid:21)(cid:16)(cid:21)(cid:7) re(cid:88)ie(cid:89)e(cid:70)(cid:33) (cid:10)(cid:19)(cid:16)(cid:18)(cid:18)(cid:22)(cid:11) (cid:12) hhiigghhlliigghhtteedd.. FFoollllooww tthhiiss Clinical appointments: If the registered nurse determined a referral oonnee aass yyoouurr to a primary care provider was necessary, was the patient seen within (cid:23) 3 22 (cid:24)(cid:20)(cid:16)(cid:23)(cid:7) t(cid:74)e (cid:79)a(cid:90)i(cid:79)(cid:87)(cid:79) allo(cid:89)a(cid:68)le ti(cid:79)e or t(cid:74)e or(cid:70)ere(cid:70) ti(cid:79)e fra(cid:79)e, (cid:89)(cid:74)ic(cid:74)e(cid:88)er is mmooddeell ffoorr tthhee t(cid:74)e s(cid:74)orter(cid:33) (cid:10)(cid:19)(cid:16)(cid:18)(cid:18)(cid:23)(cid:11) (cid:12) rreemmaaiinnddeerr.. Sick call follow-up appointments: If the primary care provider ordered a follow-up sick call appointment, did it take place within the time (cid:19) 0 (cid:20)(cid:27) (cid:19)(cid:18)(cid:18)(cid:7) fra(cid:79)e specifie(cid:70)(cid:33) (cid:10)(cid:19)(cid:16)(cid:18)(cid:18)(cid:24)(cid:11) (cid:12) Upon the patient’s discharge from the community hospital: Did the patient recei(cid:88)e a follo(cid:89)(cid:15)(cid:87)p appoint(cid:79)ent (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e 20 (cid:23) 0 (cid:26)(cid:18)(cid:16)(cid:18)(cid:7) fra(cid:79)e(cid:33) (cid:10)(cid:19)(cid:16)(cid:18)(cid:18)(cid:25)(cid:11) (cid:12) Specialty service follow-up appointments: Did the clinician follow-up (cid:88)isits occ(cid:87)r (cid:89)it(cid:74)in re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:19)(cid:16)(cid:18)(cid:18)(cid:26)(cid:11) * ,† (cid:20)(cid:23) (cid:19)(cid:21) (cid:25) (cid:24)(cid:23)(cid:16)(cid:26)(cid:7) Clinical appointments: Do patients have a standardized process to (cid:23) (cid:19) 0 (cid:26)(cid:21)(cid:16)(cid:21)(cid:7) o(cid:68)tain an(cid:70) s(cid:87)(cid:68)(cid:79)it (cid:74)ealt(cid:74) care ser(cid:88)ices re(cid:83)(cid:87)est for(cid:79)s(cid:33) (cid:10)(cid:19)(cid:16)(cid:19)(cid:18)(cid:19)(cid:11) Overall percentage (MIT 1): 74.3% (cid:12) (cid:54)(cid:74)e OIG clinicians consi(cid:70)ere(cid:70) t(cid:74)ese co(cid:79)pliance tests alon(cid:73) (cid:89)it(cid:74) t(cid:74)eir case re(cid:88)ie(cid:89) fin(cid:70)in(cid:73)s (cid:89)(cid:74)en (cid:70)eter(cid:79)inin(cid:73) t(cid:74)e (cid:83)(cid:87)alit(cid:91) ratin(cid:73) for t(cid:74)is in(cid:70)icator(cid:16) † CC(cid:42)CS c(cid:74)an(cid:73)e(cid:70) its specialt(cid:91) policies in (cid:35)pril (cid:20)(cid:18)(cid:19)(cid:27), re(cid:79)o(cid:88)in(cid:73) t(cid:74)e re(cid:83)(cid:87)ire(cid:79)ent for pri(cid:79)ar(cid:91) care p(cid:74)(cid:91)sician follo(cid:89)(cid:15)(cid:87)p (cid:88)isits follo(cid:89)in(cid:73) specialt(cid:91) ser(cid:88)ices(cid:16) (cid:35)s a res(cid:87)lt, (cid:89)e teste(cid:70) (cid:47)I(cid:54) (cid:19)(cid:16)(cid:18)(cid:18)(cid:26) onl(cid:91) for (cid:74)i(cid:73)(cid:74)(cid:15)priorit(cid:91) specialty services or when staff ordered follow-ups. The OIG continued to test the clinical appropriateness of specialty follow-ups through its case review testing. So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:19)(cid:27) Table 7. Other Tests Related to Access to Care Scored Answer Compliance Questions Yes No N/A Yes % (cid:40)or patients recei(cid:88)e(cid:70) fro(cid:79) a co(cid:87)nt(cid:91) (cid:76)ail(cid:28) If, (cid:70)(cid:87)rin(cid:73) t(cid:74)e assess(cid:79)ent, t(cid:74)e nurse referred the patient to a provider, was the patient seen within the (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)e(cid:33) (cid:10)(cid:19)(cid:20)(cid:16)(cid:18)(cid:18)(cid:21)(cid:11) (cid:12) (cid:40)or patients recei(cid:88)e(cid:70) fro(cid:79) a co(cid:87)nt(cid:91) (cid:76)ail(cid:28) (cid:38)i(cid:70) t(cid:74)e patient recei(cid:88)e a history and physical by a primary care provider within seven calendar (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:70)a(cid:91)s(cid:33) (cid:10)(cid:19)(cid:20)(cid:16)(cid:18)(cid:18)(cid:22)(cid:11) (cid:12) (cid:40)or C(cid:54)C an(cid:70) S(cid:48)(cid:40) onl(cid:91) (cid:10)effecti(cid:88)e (cid:22)(cid:17)(cid:20)(cid:18)(cid:19)(cid:27), incl(cid:87)(cid:70)e O(cid:42)(cid:55)(cid:11)(cid:28) (cid:57)as a (cid:89)ritten (cid:74)istor(cid:91) an(cid:70) p(cid:74)(cid:91)sical e(cid:90)a(cid:79)ination co(cid:79)plete(cid:70) (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) fra(cid:79)e(cid:33) (cid:10)(cid:19)(cid:21)(cid:16)(cid:18)(cid:18)(cid:20)(cid:11) (cid:12) (cid:40)or O(cid:42)(cid:55), C(cid:54)C, S(cid:48)(cid:40), an(cid:70) (cid:42)ospice (cid:10)applica(cid:68)le onl(cid:91) for sa(cid:79)ples prior to (cid:22)(cid:17)(cid:20)(cid:18)(cid:19)(cid:27)(cid:11)(cid:28) (cid:38)i(cid:70) t(cid:74)e pri(cid:79)ar(cid:91) care pro(cid:88)i(cid:70)er co(cid:79)plete t(cid:74)e S(cid:87)(cid:68)(cid:76)ecti(cid:88)e, O(cid:68)(cid:76)ecti(cid:88)e, (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) Assessment, and Plan notes on the patient at the minimum intervals re(cid:83)(cid:87)ire(cid:70) for t(cid:74)e t(cid:91)pe of facilit(cid:91) (cid:89)(cid:74)ere t(cid:74)e patient (cid:89)as treate(cid:70)(cid:33) (cid:10)(cid:19)(cid:21)(cid:16)(cid:18)(cid:18)(cid:21)(cid:11) * ,† Did the patient receive the high-priority specialty service within (cid:19)(cid:22)(cid:124)calen(cid:70)ar (cid:70)a(cid:91)s of t(cid:74)e pri(cid:79)ar(cid:91) care pro(cid:88)i(cid:70)er or(cid:70)er or t(cid:74)e (cid:50)(cid:74)(cid:91)sician (cid:19)(cid:21) 2 0 (cid:26)(cid:24)(cid:16)(cid:25)(cid:7) (cid:52)e(cid:83)(cid:87)est for Ser(cid:88)ice(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:19)(cid:11) (cid:12) (cid:38)i(cid:70) t(cid:74)e patient recei(cid:88)e t(cid:74)e s(cid:87)(cid:68)se(cid:83)(cid:87)ent follo(cid:89)(cid:15)(cid:87)p to t(cid:74)e (cid:74)i(cid:73)(cid:74)(cid:15)priorit(cid:91) specialty service appointment as ordered by the primary care provider? (cid:25) (cid:19) (cid:25) (cid:26)(cid:25)(cid:16)(cid:23)(cid:7) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:21)(cid:11) (cid:12) Did the patient receive the medium-priority specialty service within (cid:19)(cid:23)(cid:15)(cid:22)(cid:23) calen(cid:70)ar (cid:70)a(cid:91)s of t(cid:74)e pri(cid:79)ar(cid:91) care pro(cid:88)i(cid:70)er or(cid:70)er or t(cid:74)e (cid:50)(cid:74)(cid:91)sician (cid:19)(cid:18) (cid:23) 0 (cid:24)(cid:24)(cid:16)(cid:25)(cid:7) (cid:52)e(cid:83)(cid:87)est for Ser(cid:88)ice(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:22)(cid:11) (cid:12) (cid:38)i(cid:70) t(cid:74)e patient recei(cid:88)e t(cid:74)e s(cid:87)(cid:68)se(cid:83)(cid:87)ent follo(cid:89)(cid:15)(cid:87)p to t(cid:74)e (cid:79)e(cid:70)i(cid:87)(cid:79)(cid:15) priority specialty service appointment as ordered by the primary care (cid:23) 4 6 (cid:23)(cid:23)(cid:16)(cid:24)(cid:7) pro(cid:88)i(cid:70)er(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:24)(cid:11) (cid:12) Did the patient receive the routine-priority specialty service within (cid:27)(cid:18)(cid:124)calen(cid:70)ar (cid:70)a(cid:91)s of t(cid:74)e pri(cid:79)ar(cid:91) care pro(cid:88)i(cid:70)er or(cid:70)er or (cid:50)(cid:74)(cid:91)sician (cid:26) (cid:25) 0 (cid:23)(cid:21)(cid:16)(cid:21)(cid:7) (cid:52)e(cid:83)(cid:87)est for Ser(cid:88)ice(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:25)(cid:11) (cid:12) (cid:38)i(cid:70) t(cid:74)e patient recei(cid:88)e t(cid:74)e s(cid:87)(cid:68)se(cid:83)(cid:87)ent follo(cid:89)(cid:15)(cid:87)p to t(cid:74)e ro(cid:87)tine(cid:15)priorit(cid:91) specialty service appointment as ordered by the primary care provider? 3 2 (cid:19)(cid:18) (cid:24)(cid:18)(cid:16)(cid:18)(cid:7) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:27)(cid:11) (cid:12) (cid:12) (cid:54)(cid:74)e OIG clinicians consi(cid:70)ere(cid:70) t(cid:74)ese co(cid:79)pliance tests alon(cid:73) (cid:89)it(cid:74) t(cid:74)eir case re(cid:88)ie(cid:89) fin(cid:70)in(cid:73)s (cid:89)(cid:74)en (cid:70)eter(cid:79)inin(cid:73) t(cid:74)e (cid:83)(cid:87)alit(cid:91) ratin(cid:73) for t(cid:74)is in(cid:70)icator(cid:16) † CCHCS changed its policies and removed mandatory minimum rounding intervals for patients located in speciali(cid:92)e(cid:70) (cid:79)e(cid:70)ical (cid:74)o(cid:87)sin(cid:73)(cid:16) (cid:35)fter (cid:35)pril (cid:20), (cid:20)(cid:18)(cid:19)(cid:27), (cid:47)I(cid:54) (cid:19)(cid:21)(cid:16)(cid:18)(cid:18)(cid:21) onl(cid:91) applie(cid:70) to C(cid:54)Cs t(cid:74)at still (cid:74)a(cid:70) state(cid:15) mandated rounding intervals. OIG case reviewers continued to test the clinical appropriateness of provider follow-ups within specialized medical housing units through case reviews. So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 20 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Diagnostic Services Overall Diagnostic Services Rating In this indicator, OIG inspectors evaluated the institution’s ability Adequate In this indicator, OIG inspectors evaluated the institution’s ability to timely complete radiology, laboratory, and pathology tests. Our to timely complete radiology, laboratory, and pathology tests. Our inspectors determined whether the institution properly retrieved the Case Review inspectors determined whether the institution properly retrieved the resultant reports and whether providers reviewed the results correctly. Rating resultant reports and whether providers reviewed the results correctly. In addition, in Cycle 6, we examined the institution’s ability to timely Adequate In addition, in Cycle 6, we examined the institution’s ability to timely complete and review stat (immediate) laboratory tests. complete and review stat (immediate) laboratory tests. Compliance Results Overview Score Inadequate CCI’s performance in this indicator was mixed. CCI performed (53.0%) adequately in completing and retrieving radiology tests. However, compliance testing showed poor performance in completing laboratory tests within the ordered time frames. Providers also performed poorly in notifying their patients of laboratory or radiology results. Case review noted that providers informed patients of test results with incomplete letters. Case review found CCI’s performance in routine test completion to be adequate. Clinically, the deficiencies overall did not significantly impact patient care. Factoring compliance testing and case reviews, the OIG rated the Diagnostic Services indicator adequate. Case Review and Compliance Testing Results OIG clinicians reviewed 157 diagnostic events and found 89 deficiencies, of which one was significant.18 Eighty deficiencies were related to health information management; four involved delays in scheduling; two involved delays in the completion of diagnostic tests; and two were due to providers’ failure to create patient notification letters after endorsing laboratory results.19 Of the health information management deficiencies, one was related to late retrieval of reports, two were due to late endorsement by providers, one was due to providers’ failure to endorse the report, and one occurred when the EHRS date of service was incorrect.20 For health information management, we considered test reports that were never retrieved or reviewed to be a problem as severe as tests that were never performed. Test Completion CCI performed excellently in completing radiology services (MIT 2.001, 100%), but less so in completing laboratory services within 18. Deficiencies occurred in cases 1, 2, 3, 5, 6, 7, 8, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, and 24. Case 5 had minor and significant deficiencies. 19. Deficiencies related to health information management occurred in cases 1, 2, 5, 6, 7, 8, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, and 24. 20. In case 8, a diagnostic report was retrieved late and scanned into the EHRS with an incorrect date of service. Diagnostic reports were signed late in cases 5, 16, and 24. A diagnostic report was not signed in case 24. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:20)(cid:19) the required time frames (MIT 2.004, 30.0%). Case reviewers found seven deficiencies, with one significant deficiency related to test completion.21 • In case 5, a provider requested a time-sensitive INR monitoring laboratory test to be collected within one week; however, the test was performed one month later.22 There were no stat laboratory samples in compliance testing and OIG clinicians did not encounter any cases with stat laboratory tests. Health Information Management Compliance testing showed excellent performance in the timely review and endorsement of x-rays (MIT 2.002, 90.0%) and routine laboratory results (MIT 2.005, 90.0%), and with the retrieval of pathology results (MIT 2.010, 90.0%). However, performance in pathology review was lower (MIT 2.011, 66.7%). Compliance testing identified that providers communicated results for radiology, laboratory, and pathology tests at rates of zero percent, 10.0 percent, and zero percent respectively (MIT 2.003, 2.006, and 2.012). OIG clinicians reviewed 156 diagnostic events and identified 81 health information management deficiencies, which were nearly 50 percent of the events. Most of the deficiencies (68 out of 81) were due to incomplete information in patient notification letters.23 However, OIG clinicians also identified other types of deficiencies in the following cases: • In case 5, a provider reviewed and endorsed laboratory reports two days late. • In case 8, an infection control registered nurse reported a negative COVID-19 test result, but the result was retrieved and scanned into the electronic health record system 10 months later. • In case 16, a provider reviewed and endorsed laboratory reports three days late. Clinician On-Site Inspection OIG clinicians interviewed leadership, providers, nurses, supervisors, and laboratory staff. The supervisor indicated the institution was short-staffed with phlebotomists, as the phlebotomists were unable to complete all the laboratory requests on the same day. In addition, the unique institutional layout that includes five facilities made it difficult for staff to complete the daily workload. Although all laboratory requests were completed, there were some delays. 21. Deficiencies related to test completion occurred in cases 1, 3, 5, and 26 and a significant deficiency occurred in case 5. 22. The INR is a laboratory test to measure how quickly the blood clots. This test is used to monitor patients who take blood thinning medications. 23. Deficiencies in completing patient notification letters occurred in cases 1, 2, 5, 6, 7, 8, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, and 24. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 22 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Recommendations • Medical leadership should ascertain causative factors related to the untimely provision of laboratory services and implement remedial measures as appropriate. • Medical leadership should determine the root cause(s) of challenges in reviewing and endorsing pathology reports timely and implement remedial measures as appropriate. Compliance Testing Results Table 8. Diagnostic Services Scored Answer Compliance Questions Yes No N/A Yes % (cid:52)a(cid:70)iolo(cid:73)(cid:91)(cid:28) (cid:57)as t(cid:74)e ra(cid:70)iolo(cid:73)(cid:91) ser(cid:88)ice pro(cid:88)i(cid:70)e(cid:70) (cid:89)it(cid:74)in t(cid:74)e ti(cid:79)e fra(cid:79)e (cid:19)(cid:18) 0 0 (cid:19)(cid:18)(cid:18)(cid:7) specifie(cid:70) in t(cid:74)e (cid:74)ealt(cid:74) care pro(cid:88)i(cid:70)er(cid:111)s or(cid:70)er(cid:33) (cid:10)(cid:20)(cid:16)(cid:18)(cid:18)(cid:19)(cid:11) (cid:12) (cid:52)a(cid:70)iolo(cid:73)(cid:91)(cid:28) (cid:38)i(cid:70) t(cid:74)e or(cid:70)erin(cid:73) (cid:74)ealt(cid:74) care pro(cid:88)i(cid:70)er re(cid:88)ie(cid:89) an(cid:70) en(cid:70)orse (cid:27) (cid:19) 0 (cid:27)(cid:18)(cid:16)(cid:18)(cid:7) t(cid:74)e ra(cid:70)iolo(cid:73)(cid:91) report (cid:89)it(cid:74)in specifie(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:20)(cid:16)(cid:18)(cid:18)(cid:20)(cid:11) (cid:12) (cid:52)a(cid:70)iolo(cid:73)(cid:91)(cid:28) (cid:38)i(cid:70) t(cid:74)e or(cid:70)erin(cid:73) (cid:74)ealt(cid:74) care pro(cid:88)i(cid:70)er co(cid:79)(cid:79)(cid:87)nicate t(cid:74)e res(cid:87)lts of t(cid:74)e ra(cid:70)iolo(cid:73)(cid:91) st(cid:87)(cid:70)(cid:91) to t(cid:74)e patient (cid:89)it(cid:74)in specifie(cid:70) ti(cid:79)e 0 (cid:19)(cid:18) 0 0 frames? (2.003) (cid:46)a(cid:68)orator(cid:91)(cid:28) (cid:57)as t(cid:74)e la(cid:68)orator(cid:91) ser(cid:88)ice pro(cid:88)i(cid:70)e(cid:70) (cid:89)it(cid:74)in t(cid:74)e ti(cid:79)e 3 (cid:25) 0 (cid:21)(cid:18)(cid:16)(cid:18)(cid:7) fra(cid:79)e specifie(cid:70) in t(cid:74)e (cid:74)ealt(cid:74) care pro(cid:88)i(cid:70)er(cid:111)s or(cid:70)er(cid:33) (cid:10)(cid:20)(cid:16)(cid:18)(cid:18)(cid:22)(cid:11) (cid:12) Laboratory: Did the health care provider review and endorse the (cid:27) (cid:19) 0 (cid:27)(cid:18)(cid:16)(cid:18)(cid:7) la(cid:68)orator(cid:91) report (cid:89)it(cid:74)in specifie(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:20)(cid:16)(cid:18)(cid:18)(cid:23)(cid:11) (cid:12) Laboratory: Did the health care provider communicate the results of t(cid:74)e la(cid:68)orator(cid:91) test to t(cid:74)e patient (cid:89)it(cid:74)in specifie(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:19) (cid:27) 0 (cid:19)(cid:18)(cid:16)(cid:18)(cid:7) (2.006) Laboratory: Did the institution collect the STAT laboratory test and (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) recei(cid:88)e t(cid:74)e res(cid:87)lts (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:20)(cid:16)(cid:18)(cid:18)(cid:25)(cid:11) (cid:12) (cid:46)a(cid:68)orator(cid:91)(cid:28) (cid:38)i(cid:70) t(cid:74)e pro(cid:88)i(cid:70)er ac(cid:77)no(cid:89)le(cid:70)(cid:73)e t(cid:74)e S(cid:54)(cid:35)(cid:54) res(cid:87)lts, O(cid:52) (cid:70)i(cid:70) n(cid:87)rsin(cid:73) staff notif(cid:91) t(cid:74)e pro(cid:88)i(cid:70)er (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:10)(cid:20)(cid:16)(cid:18)(cid:18)(cid:26)(cid:11) (cid:12) Laboratory: Did the health care provider endorse the STAT laboratory (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) res(cid:87)lts (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:20)(cid:16)(cid:18)(cid:18)(cid:27)(cid:11) (cid:50)at(cid:74)olo(cid:73)(cid:91)(cid:28) (cid:38)i(cid:70) t(cid:74)e instit(cid:87)tion recei(cid:88)e t(cid:74)e final pat(cid:74)olo(cid:73)(cid:91) report (cid:27) (cid:19) 0 (cid:27)(cid:18)(cid:16)(cid:18)(cid:7) (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:20)(cid:16)(cid:18)(cid:19)(cid:18)(cid:11) (cid:12) Pathology: Did the health care provider review and endorse the 6 3 (cid:19) (cid:24)(cid:24)(cid:16)(cid:25)(cid:7) pat(cid:74)olo(cid:73)(cid:91) report (cid:89)it(cid:74)in specifie(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:20)(cid:16)(cid:18)(cid:19)(cid:19)(cid:11) (cid:12) Pathology: Did the health care provider communicate the results of t(cid:74)e pat(cid:74)olo(cid:73)(cid:91) st(cid:87)(cid:70)(cid:91) to t(cid:74)e patient (cid:89)it(cid:74)in specifie(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) 0 (cid:27) (cid:19) 0 (cid:10)(cid:20)(cid:16)(cid:18)(cid:19)(cid:20)(cid:11) Overall percentage (MIT 2): 53.0% (cid:12) (cid:54)(cid:74)e OIG clinicians consi(cid:70)ere(cid:70) t(cid:74)ese co(cid:79)pliance tests alon(cid:73) (cid:89)it(cid:74) t(cid:74)eir case re(cid:88)ie(cid:89) fin(cid:70)in(cid:73)s (cid:89)(cid:74)en (cid:70)eter(cid:79)inin(cid:73) t(cid:74)e (cid:83)(cid:87)alit(cid:91) ratin(cid:73) for t(cid:74)is in(cid:70)icator(cid:16) So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution 23 Emergency Services Overall Rating In this indicator, OIG clinicians evaluated the quality of emergency Adequate medical care. Our clinicians reviewed emergency medical services by examining the timeliness and appropriateness of clinical decisions Emergency Services Case Review made during medical emergencies. Our evaluation included examining the emergency medical response, cardiopulmonary resuscitation (CPR) Rating In this indicator, OIG clinicians evaluated the quality of emergency quality, triage and treatment area (TTA) care, provider performance, Adequate medical care. Our clinicians reviewed emergency medical services by and nursing performance. Our clinicians also evaluated the Emergency examining the timeliness and appropriateness of clinical decisions Medical Response Review Committee’s (EMRRC) ability to identify Compliance made during medical emergencies. Our evaluation included examining Score problems with its emergency services. The OIG assessed the institution’s the emergency medical response, cardiopulmonary resuscitation (CPR) (N/A) emergency services through case review only; we did not perform quality, triage and treatment area (TTA) care, provider performance, compliance testing for this indicator. and nursing performance. Our clinicians also evaluated the Emergency Medical Response Review Committee’s (EMRRC) ability to identify problems with its emergency services. The OIG assessed the institution’s Results Overview emergency services through case review only; we did not perform compliance testing for this indicator. CCI delivered satisfactory emergency care. Nurses timely responded to medical emergencies and activated emergency medical services appropriately. However, OIG clinicians identified a pattern of incomplete nursing assessments, documentation, and interventions. While providers were available for consultation in person or by phone, they often they did not document the communication. Although we identified opportunities for improvement, most deficiencies were not clinically significant. We rated this indicator adequate. Case Review and Compliance Testing Results We reviewed 18 urgent and emergent events and found 30 emergency care deficiencies. Of these 30 deficiencies, five were significant.24 Emergency Medical Response CCI staff responded promptly to emergencies throughout the institution. They initiated CPR, activated emergency medical services (EMS), and notified TTA staff in a timely manner. One opportunity for improvement was identified and is noted below. • In case 10, custody staff initiated CPR and activated a medical alarm. However, EMS was not requested until five minutes after CPR was initiated. The first medical responding nurse arrived promptly in three minutes. Provider Performance CCI providers performed adequately in urgent and emergent situations. For patients who presented emergently in the TTA, providers made appropriate decisions. Providers were available for consultation with TTA staff. However, we noted in 12 of the 18 urgent and emergent events, 24. Deficiencies occurred in cases 1, 2, 3, 6, 7, 8, 9, 10, 11, 15, 19, 20, 21, 22, and 23. Cases 1, 2, 15, and 19 had significant deficiencies. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 24 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport providers did not document information such as communication with the nurse, the decision-making rationale, and the plan of management. Although documentation-related deficiencies are considered minor, complete and accurate documentation is an essential part of patient care. Detailed documentation can also support and ensure the accuracy of providers’ decisions. Nursing Performance CCI’s nurses promptly responded to emergent events and appropriately initiated interventions for opioid overdoses. However, on several occasions, nurses did not thoroughly assess patients, initiate appropriate interventions, or consult with providers. • In case 2, a patient complained of shortness of breath and nausea. A nurse responded to the housing unit but did not obtain vital signs, perform a physical assessment, or arrange a follow- up. This is concerning, as these symptoms arose during the COVID-19 pandemic. • In case 15, a patient was in quarantine due to the COVID-19 pandemic and had shortness of breath and elevated blood pressure. A nurse did not assess for additional signs of COVID-19, initiate isolation, reassess the elevated blood pressure, or consult a provider. Nursing Documentation Although nursing documentation at the institution was acceptable, it was not always thorough. We found opportunities for improvement in six of the 18 cases,25 including the following two examples: • In case 3, a nurse responded to an alert from a housing unit where a patient was found hanging with a noose around the neck. The nurse did not document the neck’s appearance. • In case 11, a patient had an altered mental state and was suspected of a drug overdose. A nurse did not document the amount of oxygen administered to the patient. Emergency Medical Response Review Committee CCI staff regularly conducted clinical reviews of nonscheduled emergency transports. The supervising registered nurse frequently conducted the initial review on the day of the event. In addition, the Emergency Medical Response Review Committee (EMRRC) reviewed the cases and identified most of the opportunities for improvement. 25. Documentation deficiencies occurred in cases 3, 7, 9, 11, 20, and 22. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:20)(cid:23) Clinician On-Site Inspection At CCI, each facility has a designated area that serves as a minor treatment room and also functions as a TTA. An RN is present on each shift and responds to medical emergencies. Due to the unique institutional layout, in addition to responding to medical emergencies, RNs evaluate patients arriving from other institutions or returning after community hospitalizations, emergency room evaluations, and off- site specialist appointments. Each treatment area is equipped with an automated external defibrillator, a well-stocked emergency crash cart, and a gurney. Most of the minor treatment rooms are located within the medical clinics. During business hours, nurses consult the medical clinic provider. During the height of the COVID-19 pandemic, staff were able to reach providers for phone consultation. After hours, one on-call provider managed the entire institution. Recommendations • Medical leadership should consider implementing a periodic audit to ensure providers are appropriately documenting patient care plans. • Nursing leadership should ensure nurses are updated with the most current guidance, including COVID-19 symptoms, and provide thorough patient screening. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 26 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Health Information Management Health Information Management Overall Rating In this indicator, OIG inspectors evaluated the flow of health In this indicator, OIG inspectors evaluated the flow of health Adequate information, a crucial link in high-quality medical care delivery. Our information, a crucial link in high-quality medical care delivery. Our inspectors examined whether the institution retrieved and scanned inspectors examined whether the institution retrieved and scanned Case Review critical health information (progress notes, diagnostic reports, specialist critical health information (progress notes, diagnostic reports, specialist Rating reports, and hospital-discharge reports) into the medical record in a reports, and hospital-discharge reports) into the medical record in a Adequate timely manner. Our inspectors also tested whether clinicians adequately timely manner. Our inspectors also tested whether clinicians adequately reviewed and endorsed those reports. In addition, our inspectors reviewed and endorsed those reports. In addition, our inspectors Compliance checked whether staff labeled and organized documents in the medical checked whether staff labeled and organized documents in the medical Score record correctly. record correctly. Proficient (87.4%) Results Overview The OIG found that CCI staff generally retrieved and scanned hospital discharge records and specialty reports timely. However, providers did not always document progress notes in the electronic health record system, and did not include all elements required by CCHCS policy in patient notification results letters. This will be discussed further in the Provider Performance indicator. Although the case reviewers and compliance team had different ratings, we took all factors into account and rated this indicator adequate. Case Review and Compliance Testing Results The OIG clinicians reviewed 761 events and found 84 deficiencies related to health information management, none of which were significant.26 Hospital Discharge Reports CCI staff performed well in retrieving and scanning hospital records. Compliance testing found that CCI staff retrieved and scanned hospital discharge records within the required time frames (MIT 4.003, 90.0%) and providers reviewed the records within five calendar days of a patient’s discharge (MIT 4.005, 96.0%). OIG clinicians reviewed 19 off-site emergency department and hospital records and identified two minor deficiencies due to delays in retrieving hospital records, of which none were significant.27 • In case 23, a patient was discharged from a hospital and the discharge records were retrieved and scanned into the EHRS one day late. Specialty Reports CCI performed poorly in managing specialty reports. Although compliance testing showed staff retrieved specialty reports adequately 26. Deficiencies occurred in cases 1, 2, 5, 6, 7, 8, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, and 24. 27. Deficiencies occurred in cases 8 and 23. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:20)(cid:25) (MIT 4.002, 80.0%), providers received and reviewed specialty service reports within the required time frame for high-priority specialty reports at a rate of 66.7 percent (MIT 14.002), medium-priority specialty reports at a rate of 46.2 percent (MIT 14.005), and routine-priority specialty reports at a rate of 41.7 percent (MIT 14.008). OIG clinicians reviewed 23 specialty reports and identified only one minor deficiency in scanning a specialty report. We also discuss these findings in the Specialty Services indicator. Diagnostic Reports CCI performed poorly in managing diagnostic reports. Compliance testing found providers did not communicate the results of pathology studies to patients in a timely manner (MIT 2.012, zero). Providers did not always review pathology reports within the specified time frames (MIT 2.011, 66.7%). There were no stat laboratory cases in compliance testing (MIT 2.008, n/a) or in case review. OIG clinicians reviewed 179 diagnostic events and identified 81 diagnostic health information management deficiencies, of which none were significant. Most deficiencies (67 of 81 deficiencies) were related to missing elements in patient notification letters and others were related to delays in provider endorsements. These deficiencies are further discussed in the Diagnostic Services indicator. Urgent and Emergent Records OIG clinicians reviewed 37 emergency care events and found that communication between nurses and providers was not well documented. In addition, providers did not always document progress notes. This is further discussed in the Emergency Services indicator. One example is listed below: • In case 1, a TTA nurse consulted with a provider regarding a patient, but the provider did not document their recommended plan of care in the EHRS. Scanning Performance CCI’s scanning performance was mixed. Compliance testing found that staff did not always properly scan, label, or place medical records in the correct patients’ files (MIT 4.004, 70.8%). OIG clinicians did not identify any mislabeled or misfiled records during the case reviews. Clinician On-Site Inspection We discussed health information management processes with CCI office technicians, the health information management supervisor, utilization management staff, diagnostic staff, nurses, and providers. The medical records supervisor described the processes of retrieving Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:20)(cid:26) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport on-site and off-site reports. Health information management staff collected medical records during regular hours on weekdays. Utilization management nursing staff retrieved hospital and specialty records. During the construction of Facility B, the outpatient housing unit (OHU) was temporarily closed. Prior to the closure, stat laboratory results were phoned to the OHU RN. Staff reported that because of the closure, the after-hours stat laboratory results were faxed to the nurse scheduling office instead of being reported directly to nursing staff by phone. Having stat laboratory results faxed to a nonclinical area may lead to a delay in handling after-hours stat laboratory results because nonclinical staff may not understand the significance of the laboratory result. Recommendations • The department should consider developing and implementing a patient results letter template that autopopulates with all elements required per CCHCS policy. Compliance Testing Results Table 9. Health Information Management Scored Answer Compliance Questions Yes No N/A Yes % (cid:35)re (cid:74)ealt(cid:74) care ser(cid:88)ice re(cid:83)(cid:87)est for(cid:79)s scanne(cid:70) into t(cid:74)e patient(cid:111)s electronic health record within three calendar days of the encounter 20 0 (cid:19)(cid:18) (cid:19)(cid:18)(cid:18)(cid:7) (cid:70)ate(cid:33) (cid:10)(cid:22)(cid:16)(cid:18)(cid:18)(cid:19)(cid:11) Are specialty documents scanned into the patient’s electronic health 24 6 (cid:19)(cid:23) (cid:26)(cid:18)(cid:16)(cid:18)(cid:7) recor(cid:70) (cid:89)it(cid:74)in fi(cid:88)e calen(cid:70)ar (cid:70)a(cid:91)s of t(cid:74)e enco(cid:87)nter (cid:70)ate(cid:33) (cid:10)(cid:22)(cid:16)(cid:18)(cid:18)(cid:20)(cid:11) (cid:12) Are community hospital discharge documents scanned into the patient’s electronic health record within three calendar days of (cid:19)(cid:26) 2 (cid:23) (cid:27)(cid:18)(cid:16)(cid:18)(cid:7) hospital discharge? (4.003) * During the inspection, were medical records properly scanned, (cid:19)(cid:25) (cid:25) 0 (cid:25)(cid:18)(cid:16)(cid:26)(cid:7) la(cid:68)ele(cid:70), an(cid:70) incl(cid:87)(cid:70)e(cid:70) in t(cid:74)e correct patients(cid:111) files(cid:33) (cid:10)(cid:22)(cid:16)(cid:18)(cid:18)(cid:22)(cid:11) (cid:12) (cid:40)or patients (cid:70)isc(cid:74)ar(cid:73)e(cid:70) fro(cid:79) a co(cid:79)(cid:79)(cid:87)nit(cid:91) (cid:74)ospital(cid:28) (cid:38)i(cid:70) t(cid:74)e preli(cid:79)inar(cid:91) or final (cid:74)ospital (cid:70)isc(cid:74)ar(cid:73)e report incl(cid:87)(cid:70)e (cid:77)e(cid:91) ele(cid:79)ents 24 (cid:19) 0 (cid:27)(cid:24)(cid:16)(cid:18)(cid:7) an(cid:70) (cid:70)i(cid:70) a pro(cid:88)i(cid:70)er re(cid:88)ie(cid:89) t(cid:74)e report (cid:89)it(cid:74)in fi(cid:88)e calen(cid:70)ar (cid:70)a(cid:91)s of (cid:70)isc(cid:74)ar(cid:73)e(cid:33) (cid:10)(cid:22)(cid:16)(cid:18)(cid:18)(cid:23)(cid:11) (cid:12) Overall percentage (MIT 4): 87.4% (cid:12) (cid:54)(cid:74)e OIG clinicians consi(cid:70)ere(cid:70) t(cid:74)ese co(cid:79)pliance tests alon(cid:73) (cid:89)it(cid:74) t(cid:74)eir case re(cid:88)ie(cid:89) fin(cid:70)in(cid:73)s (cid:89)(cid:74)en (cid:70)eter(cid:79)inin(cid:73) t(cid:74)e (cid:83)(cid:87)alit(cid:91) ratin(cid:73) for t(cid:74)is in(cid:70)icator(cid:16) So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:20)(cid:27) Table 10. Other Tests Related to Health Information Management Scored Answer Compliance Questions Yes No N/A Yes % (cid:52)a(cid:70)iolo(cid:73)(cid:91)(cid:28) (cid:38)i(cid:70) t(cid:74)e or(cid:70)erin(cid:73) (cid:74)ealt(cid:74) care pro(cid:88)i(cid:70)er re(cid:88)ie(cid:89) an(cid:70) en(cid:70)orse (cid:27) (cid:19) 0 (cid:27)(cid:18)(cid:16)(cid:18)(cid:7) t(cid:74)e ra(cid:70)iolo(cid:73)(cid:91) report (cid:89)it(cid:74)in specifie(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:20)(cid:16)(cid:18)(cid:18)(cid:20)(cid:11) (cid:12) Laboratory: Did the health care provider review and endorse the (cid:27) (cid:19) 0 (cid:27)(cid:18)(cid:16)(cid:18)(cid:7) la(cid:68)orator(cid:91) report (cid:89)it(cid:74)in specifie(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:20)(cid:16)(cid:18)(cid:18)(cid:23)(cid:11) (cid:12) (cid:46)a(cid:68)orator(cid:91)(cid:28) (cid:38)i(cid:70) t(cid:74)e pro(cid:88)i(cid:70)er ac(cid:77)no(cid:89)le(cid:70)(cid:73)e t(cid:74)e S(cid:54)(cid:35)(cid:54) res(cid:87)lts, O(cid:52) (cid:70)i(cid:70) n(cid:87)rsin(cid:73) staff notif(cid:91) t(cid:74)e pro(cid:88)i(cid:70)er (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)e(cid:33) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:10)(cid:20)(cid:16)(cid:18)(cid:18)(cid:26)(cid:11) (cid:12) (cid:50)at(cid:74)olo(cid:73)(cid:91)(cid:28) (cid:38)i(cid:70) t(cid:74)e instit(cid:87)tion recei(cid:88)e t(cid:74)e final pat(cid:74)olo(cid:73)(cid:91) report (cid:89)it(cid:74)in (cid:27) (cid:19) 0 (cid:27)(cid:18)(cid:16)(cid:18)(cid:7) t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:20)(cid:16)(cid:18)(cid:19)(cid:18)(cid:11) (cid:12) Pathology: Did the health care provider review and endorse the 6 3 (cid:19) (cid:24)(cid:24)(cid:16)(cid:25)(cid:7) pat(cid:74)olo(cid:73)(cid:91) report (cid:89)it(cid:74)in specifie(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:20)(cid:16)(cid:18)(cid:19)(cid:19)(cid:11) (cid:12) Pathology: Did the health care provider communicate the results of the 0 (cid:27) (cid:19) 0 pat(cid:74)olo(cid:73)(cid:91) st(cid:87)(cid:70)(cid:91) to t(cid:74)e patient (cid:89)it(cid:74)in specifie(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:20)(cid:16)(cid:18)(cid:19)(cid:20)(cid:11) Did the institution receive and did the primary care provider review the (cid:74)i(cid:73)(cid:74)(cid:15)priorit(cid:91) specialt(cid:91) ser(cid:88)ice cons(cid:87)ltant report (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e (cid:19)(cid:18) (cid:23) 0 (cid:24)(cid:24)(cid:16)(cid:25)(cid:7) fra(cid:79)e(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:20)(cid:11) (cid:12) Did the institution receive and did the primary care provider review the (cid:79)e(cid:70)i(cid:87)(cid:79)(cid:15)priorit(cid:91) specialt(cid:91) ser(cid:88)ice cons(cid:87)ltant report (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) 6 (cid:25) 2 (cid:22)(cid:24)(cid:16)(cid:20)(cid:7) ti(cid:79)e fra(cid:79)e(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:23)(cid:11) (cid:12) Did the institution receive and did the primary care provider review the ro(cid:87)tine(cid:15)priorit(cid:91) specialt(cid:91) ser(cid:88)ice cons(cid:87)ltant report (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) (cid:23) (cid:25) 3 (cid:22)(cid:19)(cid:16)(cid:25)(cid:7) ti(cid:79)e fra(cid:79)e(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:26)(cid:11) (cid:12) (cid:12) (cid:54)(cid:74)e OIG clinicians consi(cid:70)ere(cid:70) t(cid:74)ese co(cid:79)pliance tests alon(cid:73) (cid:89)it(cid:74) t(cid:74)eir case re(cid:88)ie(cid:89) fin(cid:70)in(cid:73)s (cid:89)(cid:74)en (cid:70)eter(cid:79)inin(cid:73) t(cid:74)e (cid:83)(cid:87)alit(cid:91) ratin(cid:73) for t(cid:74)is in(cid:70)icator(cid:16) So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 30 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Health Care Environment Health Care Environment Overall Rating In this indicator, OIG compliance inspectors tested clinics’ waiting areas, In this indicator, OIG compliance inspectors tested clinics’ waiting areas, Inadequate infection control, sanitation procedures, medical supplies, equipment infection control, sanitation procedures, medical supplies, equipment management, and examination rooms. Inspectors also tested clinics’ management, and examination rooms. Inspectors also tested clinics’ Case Review ability to maintain auditory and visual privacy for clinical encounters. ability to maintain auditory and visual privacy for clinical encounters. Rating Compliance inspectors asked the institution’s health care administrators Compliance inspectors asked the institution’s health care administrators (N/A) to comment on their facility’s infrastructure and its ability to support to comment on their facility’s infrastructure and its ability to support health care operations. The OIG rated this indicator solely on the health care operations. The OIG rated this indicator solely on the Compliance compliance score, using the same scoring thresholds as in the Cycle 4 Score compliance score, using the same scoring thresholds as in the Cycle 4 and Cycle 5 medical inspections. Our case review clinicians do not rate Inadequate and Cycle 5 medical inspections. Our case review clinicians do not rate this indicator. this indicator. (66.7%) Results Overview For this indicator, CCI’s performance improved slightly compared with its performance in Cycle 5. In the present cycle, multiple aspects of CCI’s health care environment needed improvement: multiple clinics and the medical warehouse contained expired or compromised medical supplies; and emergency medical response bag (EMRB) logs either were missing staff verification or inventory was not performed. These factors resulted in an inadequate rating for this indicator. Compliance Testing Results Outdoor Waiting Areas We inspected CCI’s outdoor patient waiting areas. Only one clinic had an outdoor waiting area (see Photo 1, below). Health care and custody staff reported the existing outdoor waiting area had sufficient seating capacity. However, the main waiting area did not have an overhang to protect patients from inclement weather. (cid:50)(cid:74)oto (cid:19)(cid:16) (cid:40)acilit(cid:91) (cid:36) clinic (cid:79)ain o(cid:87)t(cid:70)oor (cid:89)aitin(cid:73) area (cid:10)p(cid:74)oto(cid:73)rap(cid:74)e(cid:70) on (cid:44)an(cid:87)ar(cid:91) (cid:24), (cid:20)(cid:18)(cid:20)(cid:19)(cid:11)(cid:16) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:21)(cid:19) Custody staff reported that during inclement weather they escort patients to a secondary waiting area that is fully covered (see Photo 2, right). (cid:50)(cid:74)oto (cid:20)(cid:16) (cid:40)acilit(cid:91) (cid:36) clinic secondary waiting area (photographed on (cid:44)an(cid:87)ar(cid:91) (cid:24), (cid:20)(cid:18)(cid:20)(cid:19)(cid:11)(cid:16) Indoor Waiting Areas We inspected CCI’s indoor waiting areas. Health care and custody staff reported the existing indoor waiting areas had sufficient seating capacity that provided patients protection from inclement weather (see Photo 3, left). Custody staff reported they bring in a few patients at a time to prevent overcrowding the indoor waiting areas and to maintain safe social distancing during the pandemic. During our inspection, we did not observe overcrowding in the clinics’ waiting areas. (cid:50)(cid:74)oto (cid:21)(cid:16) (cid:40)acilit(cid:91) (cid:39) in(cid:70)oor (cid:89)aitin(cid:73) area (cid:10)p(cid:74)oto(cid:73)rap(cid:74)e(cid:70) on (cid:44)an(cid:87)ar(cid:91) (cid:26), (cid:20)(cid:18)(cid:20)(cid:19)(cid:11)(cid:16) Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 32 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Clinic Environment All clinic environments were sufficiently conducive for medical care, providing reasonable auditory privacy, appropriate waiting areas, wheelchair accessibility, and nonexamination room workspace (MIT 5.109, 100%). Of the 10 clinics we observed, eight contained appropriate space, configuration, supplies, and equipment to allow clinicians to perform proper clinical examinations (MIT 5.110, 80.0%). In one clinic, examination rooms have open ventilation between rooms, which allowed sound from one office to disrupt conversations during patient encounters (see Photo 4, below). The remaining clinic lacked an examination room for each clinician on shift. (cid:50)(cid:74)oto (cid:22)(cid:16) (cid:40)acilit(cid:91) (cid:36) e(cid:90)a(cid:79)ination roo(cid:79) (cid:89)it(cid:74) (cid:88)entilation (cid:10)p(cid:74)oto(cid:73)rap(cid:74)e(cid:70) on (cid:44)an(cid:87)ar(cid:91) (cid:24), (cid:20)(cid:18)(cid:20)(cid:19)(cid:11)(cid:16) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution 33 (cid:50)(cid:74)oto (cid:23)(cid:16) (cid:47)e(cid:70)ical s(cid:87)ppl(cid:91) (cid:89)it(cid:74) an e(cid:90)piration (cid:50)(cid:74)oto (cid:24)(cid:16) (cid:47)e(cid:70)ical s(cid:87)ppl(cid:91) (cid:89)it(cid:74) an e(cid:90)piration date of September 2020 (photographed (cid:70)ate of (cid:44)(cid:87)ne (cid:27), (cid:20)(cid:18)(cid:20)(cid:18) (cid:10)p(cid:74)oto(cid:73)rap(cid:74)e(cid:70) on on (cid:44)an(cid:87)ar(cid:91) (cid:25), (cid:20)(cid:18)(cid:20)(cid:19)(cid:11)(cid:16) (cid:44)an(cid:87)ar(cid:91) (cid:26), (cid:20)(cid:18)(cid:20)(cid:19)(cid:11)(cid:16) Clinic Supplies Five of the 12 clinics followed adequate medical supply storage and management protocols (MIT 5.107, 41.7%). We found one or more of the following deficiencies in seven clinics: expired medical supplies (see Photos 5 and 6, above), unidentified medical supplies, inaccurately identified medical supplies, medical supplies stored directly on the floor, disorganized medical supplies (see Photo 7, left), and food belonging to staff stored with medical supplies. (cid:50)(cid:74)oto (cid:25)(cid:16) (cid:38)isor(cid:73)ani(cid:92)e(cid:70) an(cid:70) (cid:87)nla(cid:68)ele(cid:70) (cid:79)e(cid:70)ical s(cid:87)pplies (cid:10)p(cid:74)oto(cid:73)rap(cid:74)e(cid:70) on (cid:44)an(cid:87)ar(cid:91) (cid:24), (cid:20)(cid:18)(cid:20)(cid:19)(cid:11)(cid:16) Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 34 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Three of the 12 clinics met the requirements for essential core medical equipment and supplies (MIT 5.108, 25.0%). The remaining nine clinics lacked medical supplies or contained improperly calibrated or nonfunctional equipment. One examination room had missing items, such as an examination table and hemoccult cards. Staff had not properly calibrated an automated vital sign machine, nebulizer unit, oto-ophthalmoscope, and electrocardiogram. We found a nonfunctional oto-ophthalmoscope and expired hemoccult cards, and we found the Snellen chart was either not placed on the wall or did not have an identified distance line on the floor or wall. In addition, staff had failed to log results of the defibrillator performance test within the preceding 30 days. We examined emergency medical response bags (EMRBs) to determine whether they contained all essential items. We checked if staff inspected the bags daily and inventoried them monthly. Only two of the five EMRBs passed our test (MIT 5.111, 40.0%). In one location, staff had not inventoried EMRBs when the seal tags were replaced. In two locations, crash carts contained expired medical supplies and did not meet the minimum inventory level (see Photo 8, below). (cid:50)(cid:74)oto (cid:26)(cid:16) (cid:39)(cid:90)pire(cid:70) cras(cid:74) cart s(cid:87)ppl(cid:91) (cid:70)ate(cid:70) (cid:48)o(cid:88)e(cid:79)(cid:68)er (cid:20)(cid:18)(cid:20)(cid:18) (cid:10)p(cid:74)oto(cid:73)rap(cid:74)e(cid:70) on (cid:44)an(cid:87)ar(cid:91) (cid:25), (cid:20)(cid:18)(cid:20)(cid:19)(cid:11)(cid:16) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:21)(cid:23) Medical Supply Management None of the medical supply storage areas located outside the medical clinics stored medical supplies adequately (MIT 5.106, zero). We found medical supplies with compromised sterile packaging (see Photos 9 and 10, below). (cid:50)(cid:74)otos (cid:27) an(cid:70) (cid:19)(cid:18)(cid:16) (cid:47)e(cid:70)ical s(cid:87)ppl(cid:91) with compromised sterile packaging (cid:10)p(cid:74)oto(cid:73)rap(cid:74)e(cid:70) on (cid:44)an(cid:87)ar(cid:91) (cid:23), (cid:20)(cid:18)(cid:20)(cid:19)(cid:11)(cid:16) Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 36 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport According to the chief executive officer (CEO), and the medical warehouse manager, the institution did not have any concerns about the medical supply process. Every Monday, health care staff in each clinic performs an inventory of medical supplies and submits a form via email to the medical warehouse manager requesting any necessary medical supplies. Those medical supplies are then delivered to the clinics every Wednesday of the same week. If any medical supplies are needed urgently, health care staff calls the warehouse and the supplies are delivered immediately or on the same day. Health care managers expressed no concerns about the medical supply chain or their communication process with the existing system in place. Infection Control and Sanitation Staff appropriately cleaned, sanitized, and disinfected all clinics (MIT 5.101, 100%). Staff in eight of nine clinics (MIT 5.102, 88.9%) properly sterilized or disinfected medical equipment. In one clinic, staff did not change the examination table paper between patient encounters. We found operating sinks and hand hygiene supplies in the examination rooms in seven of 12 clinics (MIT 5.103, 58.3%). We found one or both of the following deficiencies in five clinics: patient restrooms lacked antiseptic soap and disposable towels and health care staff did not have access to an operational sink in the examination room or within a reasonable proximity. We observed patient encounters in five clinics. Clinicians followed good hand hygiene practices in all clinics (MIT 5.104, 100%). Health care staff in twelve clinics followed proper protocols to mitigate exposure to blood-borne pathogens and contaminated waste (MIT 5.105, 100%). Physical Infrastructure We gathered information to determine if the institution’s physical infrastructure was maintained in a manner that supported health care management’s ability to provide timely and adequate health care. When we interviewed health care managers, they did not have concerns about the facility’s infrastructure or its effect on staff’s ability to provide adequate health care. At the time of inspection, CCI had three infrastructure projects underway, which management staff felt would improve the delivery of care at the institution: • The Facility A primary care clinic renovation began in 2015 and is expected to be completed by February 2022. • The Facility B primary care and specialty clinic renovations began in 2015 and are expected to be completed by September 2021. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:21)(cid:25) • The Facility A and B medication distribution room construction began in 2020 and was completed by the time of our tour. However, at that time of the inspection, the institution was waiting for the fire alarm system to be repaired and was pending the fire marshal’s approval. The CEO did not believe this delay would negatively impact the institution’s ability to provide good patient care (MIT 5.999). Recommendations • Nursing leadership should consider performing random spot checks to ensure that staff follow equipment and medical supply management protocols. • Nursing leadership should have each clinic nurse supervisor review the monthly EMRB logs to ensure that the EMRBs are regularly inventoried and sealed. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:21)(cid:26) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Compliance Testing Results Table 11. Health Care Environment Scored Answer Compliance Questions Yes No N/A Yes % Infection control: Are clinical health care areas appropriately (cid:19)(cid:20) 0 (cid:19) (cid:19)(cid:18)(cid:18)(cid:7) (cid:70)isinfecte(cid:70), cleane(cid:70), an(cid:70) sanitar(cid:91)(cid:33) (cid:10)(cid:23)(cid:16)(cid:19)(cid:18)(cid:19)(cid:11) Infection control: Do clinical health care areas ensure that reusable in(cid:88)asi(cid:88)e an(cid:70) nonin(cid:88)asi(cid:88)e (cid:79)e(cid:70)ical e(cid:83)(cid:87)ip(cid:79)ent is properl(cid:91) sterili(cid:92)e(cid:70) or (cid:26) (cid:19) 4 (cid:26)(cid:26)(cid:16)(cid:27)(cid:7) (cid:70)isinfecte(cid:70) as (cid:89)arrante(cid:70)(cid:33) (cid:10)(cid:23)(cid:16)(cid:19)(cid:18)(cid:20)(cid:11) Infection control: Do clinical health care areas contain operable sinks (cid:25) (cid:23) (cid:19) (cid:23)(cid:26)(cid:16)(cid:21)(cid:7) an(cid:70) s(cid:87)fficient (cid:83)(cid:87)antities of (cid:74)(cid:91)(cid:73)iene s(cid:87)pplies(cid:33) (cid:10)(cid:23)(cid:16)(cid:19)(cid:18)(cid:21)(cid:11) Infection control: Does clinical health care staff adhere to universal (cid:23) 0 (cid:26) (cid:19)(cid:18)(cid:18)(cid:7) (cid:74)an(cid:70) (cid:74)(cid:91)(cid:73)iene preca(cid:87)tions(cid:33) (cid:10)(cid:23)(cid:16)(cid:19)(cid:18)(cid:22)(cid:11) Infection control(cid:28) (cid:38)o clinical (cid:74)ealt(cid:74) care areas control e(cid:90)pos(cid:87)re to (cid:19)(cid:20) 0 (cid:19) (cid:19)(cid:18)(cid:18)(cid:7) (cid:68)loo(cid:70)(cid:15)(cid:68)orne pat(cid:74)o(cid:73)ens an(cid:70) conta(cid:79)inate(cid:70) (cid:89)aste(cid:33) (cid:10)(cid:23)(cid:16)(cid:19)(cid:18)(cid:23)(cid:11) (cid:57)are(cid:74)o(cid:87)se, cone(cid:90), an(cid:70) ot(cid:74)er nonclinic stora(cid:73)e areas(cid:28) (cid:38)oes t(cid:74)e (cid:79)e(cid:70)ical s(cid:87)ppl(cid:91) (cid:79)ana(cid:73)e(cid:79)ent process a(cid:70)e(cid:83)(cid:87)atel(cid:91) s(cid:87)pport t(cid:74)e nee(cid:70)s 0 (cid:19) 0 0 of t(cid:74)e (cid:79)e(cid:70)ical (cid:74)ealt(cid:74) care pro(cid:73)ra(cid:79)(cid:33) (cid:10)(cid:23)(cid:16)(cid:19)(cid:18)(cid:24)(cid:11) Clinical areas(cid:28) (cid:38)oes eac(cid:74) clinic follo(cid:89) a(cid:70)e(cid:83)(cid:87)ate protocols for (cid:23) (cid:25) (cid:19) (cid:22)(cid:19)(cid:16)(cid:25)(cid:7) (cid:79)ana(cid:73)in(cid:73) an(cid:70) storin(cid:73) (cid:68)(cid:87)l(cid:77) (cid:79)e(cid:70)ical s(cid:87)pplies(cid:33) (cid:10)(cid:23)(cid:16)(cid:19)(cid:18)(cid:25)(cid:11) Clinical areas(cid:28) (cid:38)o clinic co(cid:79)(cid:79)on areas an(cid:70) e(cid:90)a(cid:79) roo(cid:79)s (cid:74)a(cid:88)e 3 (cid:27) (cid:19) (cid:20)(cid:23)(cid:16)(cid:18)(cid:7) essential core (cid:79)e(cid:70)ical e(cid:83)(cid:87)ip(cid:79)ent an(cid:70) s(cid:87)pplies(cid:33) (cid:10)(cid:23)(cid:16)(cid:19)(cid:18)(cid:26)(cid:11) Clinical areas: Are the environments in the common clinic areas (cid:19)(cid:18) 0 3 (cid:19)(cid:18)(cid:18)(cid:7) con(cid:70)(cid:87)ci(cid:88)e to pro(cid:88)i(cid:70)in(cid:73) (cid:79)e(cid:70)ical ser(cid:88)ices(cid:33) (cid:10)(cid:23)(cid:16)(cid:19)(cid:18)(cid:27)(cid:11) Clinical areas(cid:28) (cid:35)re t(cid:74)e en(cid:88)iron(cid:79)ents in t(cid:74)e clinic e(cid:90)a(cid:79) roo(cid:79)s (cid:26) 2 3 (cid:26)(cid:18)(cid:16)(cid:18)(cid:7) con(cid:70)(cid:87)ci(cid:88)e to pro(cid:88)i(cid:70)in(cid:73) (cid:79)e(cid:70)ical ser(cid:88)ices(cid:33) (cid:10)(cid:23)(cid:16)(cid:19)(cid:19)(cid:18)(cid:11) Clinical areas: Are emergency medical response bags and emergency cras(cid:74) carts inspecte(cid:70) an(cid:70) in(cid:88)entorie(cid:70) (cid:89)it(cid:74)in re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es, 2 3 (cid:26) (cid:22)(cid:18)(cid:16)(cid:18)(cid:7) an(cid:70) (cid:70)o t(cid:74)e(cid:91) contain essential ite(cid:79)s(cid:33) (cid:10)(cid:23)(cid:16)(cid:19)(cid:19)(cid:19)(cid:11) Does the institution’s health care management believe that all clinical This is a nonscored test. Please areas (cid:74)a(cid:88)e p(cid:74)(cid:91)sical plant infrastr(cid:87)ct(cid:87)res t(cid:74)at are s(cid:87)fficient to pro(cid:88)i(cid:70)e see the indicator for discussion of a(cid:70)e(cid:83)(cid:87)ate (cid:74)ealt(cid:74) care ser(cid:88)ices(cid:33) (cid:10)(cid:23)(cid:16)(cid:27)(cid:27)(cid:27)(cid:11) this test. Overall percentage (MIT 5): 66.7% (cid:12) (cid:54)(cid:74)e OIG clinicians consi(cid:70)ere(cid:70) t(cid:74)ese co(cid:79)pliance tests alon(cid:73) (cid:89)it(cid:74) t(cid:74)eir case re(cid:88)ie(cid:89) fin(cid:70)in(cid:73)s (cid:89)(cid:74)en (cid:70)eter(cid:79)inin(cid:73) t(cid:74)e (cid:83)(cid:87)alit(cid:91) ratin(cid:73) for t(cid:74)is in(cid:70)icator(cid:16) So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:21)(cid:27) Transfers Overall Transfers Rating In this indicator, OIG inspectors examined the transfer process for patients who transferred into the institution, as well as for those Inadequate In this indicator, OIG inspectors examined the transfer process for patients who transferred into the institution, as well as for those who transferred to other institutions. For newly arrived patients, our who transferred to other institutions. For newly arrived patients, our inspectors assessed the quality of health screenings and the continuity Case Review inspectors assessed the quality of health screenings and the continuity of provider appointments, specialist referrals, diagnostic tests, and Rating of provider appointments, specialist referrals, diagnostic tests, and medications. For patients who transferred out of the institution, Inadequate medications. For patients who transferred out of the institution, inspectors checked whether staff reviewed patient medical records and determined the patient’s need for medical holds. They also assessed if Compliance inspectors checked whether staff reviewed patient medical records and Score determined the patient’s need for medical holds. They also assessed if staff transferred patients with their medical equipment and gave correct Inadequate staff transferred patients with their medical equipment and gave correct medications before patients left. In addition, our inspectors evaluated the (53.8%) medications before patients left. In addition, our inspectors evaluated the ability of staff to communicate vital health transfer information, such as ability of staff to communicate vital health transfer information, such as preexisting health conditions, pending appointments, tests, and specialty preexisting health conditions, pending appointments, tests, and specialty referrals; and inspectors confirmed if staff sent complete medication referrals; and inspectors confirmed if staff sent complete medication transfer packages to the receiving institution. For patients who returned transfer packages to the receiving institution. For patients who returned from off-site hospitals or emergency rooms, inspectors reviewed whether from off-site hospitals or emergency rooms, inspectors reviewed whether staff appropriately implemented the recommended treatment plans, staff appropriately implemented the recommended treatment plans, administered necessary medications, and scheduled appropriate administered necessary medications, and scheduled appropriate follow-up appointments. follow-up appointments. Results Overview CCI performed poorly in this indicator. Compared with Cycle 5, our case reviewers identified more significant deficiencies. For patients transferring into the institution, compliance testing revealed nurses did not thoroughly complete initial health screening forms, did not ensure medication continuity, and did not ensure patients were seen timely for preapproved specialty appointments. Case review clinicians found that patients were seen timely during the transfer-in process but found lapses in medication continuity. In addition, case review clinicians found there were minor opportunities for improvement in assessments and documentation. Case review clinicians identified significant deficiencies in transfer-out cases. Both compliance and case review found problems when patients returned from the hospital. Considering all components of the transfer process, we rated the Transfers indicator inadequate. Case Review and Compliance Testing Results OIG clinicians reviewed 60 events in 21 cases in which patients transferred into or out of the institution or returned from an off-site hospital or emergency room. Of the 60 events, case reviewers identified 34 deficiencies, 12 of which were significant.28 Transfers In Compliance testing showed nursing staff did not complete initial health screenings or answer all screening questions within the required time 28. Deficiencies occurred in cases 3, 4, 6, 7, 8, 19, 21, 22, 23, 28, 40, 41, 43, 44, and 45. Cases 6, 7, 8, 19, 21, 23, 28, and 45 had significant deficiencies. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 40 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport frames (MIT 6.001, zero). Nursing staff did not address the signs and symptoms of fatigue when screening for TB, complete initial health screenings within the required time frame, and follow up with additional health care screening questions regarding conditions requiring explanation, such as mental illness. However, case review clinicians found newly arrived patients were evaluated within the required time frames and usually received appropriate assessments. We identified minor deficiencies related to incomplete vital signs, and in one case, a nurse did not follow up with additional health care screening questions. For patients who transferred in from another departmental institution, medication continuity was poor. Compliance testing found CCI did not administer or deliver medications without interruption (MIT 6.003, 61.5%). Analysis of compliance data shows that while medications were ordered, nurses did not administer them in a timely manner. Case review clinicians found similar deficiencies. In compliance testing, CCI scored low in managing patients transferring into CCI with preapproved specialty appointments (MIT 14.010, 22.2%). Our case review clinicians did not find any specialty transfer-in deficiencies. OIG clinicians found most newly arrived patients were evaluated within the required time frames and received appropriate assessments. However, we identified one significant deficiency related to a provider follow-up appointment not occurring. • In case 28, a patient transferred into CCI. A nurse requested that a provider evaluate the patient within 30 days, but the appointment did not occur within the requested time frame. Transfers Out CCI’s transfer-out process was not observed by the compliance team because no patients transferred out on the day of the OIG compliance on-site inspection (MIT 6.101, n/a). Our clinicians reviewed three transfer-out events and found none of the transfer forms were thoroughly completed by R&R nurses.29 Below is an example: • In case 45, nursing staff did not complete a transfer screening. At the time of transfer, the nurse did not document the patient’s two pending specialist appointments on the transfer forms and did not assess vital signs. Hospitalizations Patients returning from an off-site hospitalization or emergency room are at high risk for lapses in care. These patients typically experience severe illness or injury. They require more care and place strain on 29. Deficiencies in the transfer-out process occurred in cases 43, 44, and 45. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:22)(cid:19) the institution’s resources. Also, because these patients have complex medical issues, the successful transfer of health information is critical for good quality care. Any lapse can result in serious consequences for these patients. Our clinicians reviewed 19 hospital or emergency room returns in 16 cases.30 We identified 24 deficiencies, 10 of which were significant.31 We found multiple areas of concern. First, CCI providers and nurses did not always thoroughly review hospital discharge records. Consequently, specialty care recommendations were overlooked. In addition, because providers and nurses did not consistently reconcile new and previously prescribed medications, there were delays and breaks in continuity. Lastly, hospital follow-up appointments, which were recommended by the hospital providers, were inappropriately canceled or delayed. Notwithstanding the COVID-19 pandemic, these cases required follow- up that did not occur or was delayed. • In case 23, a patient was discharged from the hospital for pneumonia and evaluated by a nurse. The nurse ordered a provider follow-up appointment to occur in three days. However, the provider canceled the appointment. The patient was eventually seen nine days later, which caused a delay in care. In most cases, hospital discharge documents were scanned into the patient’s electronic health record within three calendar days of discharge (MIT 4.003, 90.0%). Compliance testing also found providers routinely reviewed and endorsed documents in a timely manner (MIT 4.005, 96.0%). In contrast, compliance testing showed CCI had room for improvement in medication continuity and hospital discharge recommendations. Ordered medications were administered, made available, or delivered to patients within the required time frames 54.2 percent of the time (MIT, 7.003). Both clinical case reviews and compliance testing found lapses in the continuity of essential medications. Our clinicians identified significant deficiencies in medication continuity and in addressing hospital discharge recommendations. Transfer medication continuity is also discussed in the Pharmacy and Medication Management indicators. Examples are listed below: • In case 6, a patient returned from a community hospital with recommendations for specialist care, diagnostic testing, and a medication to be discontinued. The provider did not address any of these recommendations. • In case 7, a patient returned from a hospital admission for COVID-19. A provider partially addressed the hospital provider’s medication recommendations but did not order an antiviral medication or document the reason why the medication was 30. Hospitalization/ER return deficiencies occurred in cases 2, 3, 4, 6, 7, 8, 10, 11, 19, 20, 21, 22, 23, and 24. 31. Hospitalization/ER return deficiencies occurred in cases 3, 6, 7, 8, 19, 21, 22, and 23. Significant deficiencies occurred in cases 6, 7, 8, 19, 21, and 23. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 42 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport not continued. During the same encounter, the provider ordered a blood thinner with instructions to administer it on the same day; the pharmacy promptly delivered the medication to the administration area, but the nurse did not administer it until the next day. In addition, a hospital follow-up with the provider was scheduled to occur within five days but did not occur for three weeks. • In case 8, a patient was discharged from a community hospital and had new medication orders for an antibiotic and Tylenol. The pharmacy filled and delivered both medications to the medication administration nurses, but the medications were not administered to the patient. • In case 19, a patient was discharged from a hospital with COVID-19 pneumonia. The hospital discharge summary included recommendations to start an antiviral medication. However, the receiving nurse incorrectly documented the antiviral medication did not need to be continued. Clinician On-Site Inspection The clinician team met with the receiving and release (R&R) nurse who evaluates patients departing from Facility B. We learned that CCI’s transfer process was unique in that CCI does not have a central R&R; instead, each facility processes new patients. As a result, the TTA RN at each facility evaluates newly arrived patients from other institutions and patients returning from community hospitals. The day shift R&R nurse’s primary role was to ensure paroling patients had their prescribed medications and transferring patients had their durable medical equipment and transfer envelopes complete with medications and the patient care summary form. The nurse indicated that, prior to the patient’s transfer, vital signs were obtained and the patient care summary was completed. While one R&R nurse completes the paperwork, another R&R nurse on a different shift is responsible for completing the transfer. The institution divides tasks among several staff rather than delegating them to a single person. Doing so causes incomplete documentation and verification prior to transfers. OIG clinicians also interviewed several nurses who evaluate patients returning from a higher level of care. The nurses reported patients generally returned to the institution with hospital discharge documentation following a hospital admission. However, when patients returned from an emergency room evaluation, emergency room records were sometimes not received. The nurses reported that during business hours, hospital paperwork was taken to the clinic provider for review except in Facility B, where the nurse and provider were not in close proximity. In Facility B, the nurse would call the provider instead. After hours for all facilities, nurses contacted the provider-on-call to review the hospital recommendations. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution 43 Recommendations • The department should consider developing and implementing an electronic alert to ensure the receiving and release (R&R) nurses properly and thoroughly complete the initial health screening questions and follow up as needed. • The department should consider defining a clear requirement regarding which fields within the EHRS transfer-out powerform must be completed for any patients transferring out. • Health care leadership should identify why medication continuity was not maintained for newly arriving patients to the institution and patients returning from hospitalizations or emergency rooms and implement remedial measures as appropriate. • Nursing leadership should develop and implement internal auditing to ensure assessments are complete and thorough, and medication and hospital recommendations are reconciled for patients returning from hospitalizations and emergency room visits. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 44 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Compliance Testing Results Table 12. Transfers Scored Answer Compliance Questions Yes No N/A Yes % (cid:40)or en(cid:70)orse(cid:70) patients recei(cid:88)e(cid:70) fro(cid:79) anot(cid:74)er C(cid:38)C(cid:52) instit(cid:87)tion or COC(cid:40)(cid:28) (cid:38)i(cid:70) n(cid:87)rsin(cid:73) staff co(cid:79)plete t(cid:74)e initial (cid:74)ealt(cid:74) screenin(cid:73) an(cid:70) 0 (cid:20)(cid:23) 0 0 ans(cid:89)er all screenin(cid:73) (cid:83)(cid:87)estions (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)e(cid:33) (cid:10)(cid:24)(cid:16)(cid:18)(cid:18)(cid:19)(cid:11) (cid:12) (cid:40)or en(cid:70)orse(cid:70) patients recei(cid:88)e(cid:70) fro(cid:79) anot(cid:74)er C(cid:38)C(cid:52) instit(cid:87)tion or COC(cid:40)(cid:28) (cid:57)(cid:74)en re(cid:83)(cid:87)ire(cid:70), (cid:70)i(cid:70) t(cid:74)e (cid:52)(cid:48) co(cid:79)plete t(cid:74)e assess(cid:79)ent an(cid:70) disposition section of the initial health screening form; refer the (cid:20)(cid:23) 0 0 (cid:19)(cid:18)(cid:18)(cid:7) patient to the TTA if TB signs and symptoms were present; and sign and date the form on the same day staff completed the health screening? (6.002) (cid:40)or en(cid:70)orse(cid:70) patients recei(cid:88)e(cid:70) fro(cid:79) anot(cid:74)er C(cid:38)C(cid:52) instit(cid:87)tion or COC(cid:40)(cid:28) If t(cid:74)e patient (cid:74)a(cid:70) an e(cid:90)istin(cid:73) (cid:79)e(cid:70)ication or(cid:70)er (cid:87)pon arri(cid:88)al, (cid:26) (cid:23) (cid:19)(cid:20) (cid:24)(cid:19)(cid:16)(cid:23)(cid:7) were medications administered or delivered without interruption? (6.003) * (cid:40)or patients transferre(cid:70) o(cid:87)t of t(cid:74)e facilit(cid:91)(cid:28) (cid:38)o (cid:79)e(cid:70)ication transfer pac(cid:77)a(cid:73)es incl(cid:87)(cid:70)e re(cid:83)(cid:87)ire(cid:70) (cid:79)e(cid:70)ications alon(cid:73) (cid:89)it(cid:74) t(cid:74)e correspon(cid:70)in(cid:73) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) transfer pac(cid:77)et re(cid:83)(cid:87)ire(cid:70) (cid:70)oc(cid:87)(cid:79)ents(cid:33) (cid:10)(cid:24)(cid:16)(cid:19)(cid:18)(cid:19)(cid:11) (cid:12) Overall percentage (MIT 6): 53.8% (cid:12) (cid:54)(cid:74)e OIG clinicians consi(cid:70)ere(cid:70) t(cid:74)ese co(cid:79)pliance tests alon(cid:73) (cid:89)it(cid:74) t(cid:74)eir case re(cid:88)ie(cid:89) fin(cid:70)in(cid:73)s (cid:89)(cid:74)en (cid:70)eter(cid:79)inin(cid:73) t(cid:74)e (cid:83)(cid:87)alit(cid:91) ratin(cid:73) for t(cid:74)is in(cid:70)icator(cid:16) So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:22)(cid:23) Table 13. Other Tests Related to Transfers Scored Answer Compliance Questions Yes No N/A Yes % (cid:40)or en(cid:70)orse(cid:70) patients recei(cid:88)e(cid:70) fro(cid:79) anot(cid:74)er C(cid:38)C(cid:52) instit(cid:87)tion(cid:28) (cid:36)ase(cid:70) on the patient’s clinical risk level during the initial health screening, was the 6 (cid:19)(cid:27) 0 (cid:20)(cid:22)(cid:16)(cid:18)(cid:7) patient seen (cid:68)(cid:91) t(cid:74)e clinician (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)e(cid:33) (cid:10)(cid:19)(cid:16)(cid:18)(cid:18)(cid:20)(cid:11) (cid:12) Upon the patient’s discharge from the community hospital: Did the patient receive a follow-up appointment with a primary care provider 20 (cid:23) 0 (cid:26)(cid:18)(cid:16)(cid:18)(cid:7) (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)e(cid:33) (cid:10)(cid:19)(cid:16)(cid:18)(cid:18)(cid:25)(cid:11) (cid:12) Are community hospital discharge documents scanned into the patient’s electronic health record within three calendar days of hospital (cid:19)(cid:26) 2 (cid:23) (cid:27)(cid:18)(cid:16)(cid:18)(cid:7) discharge? (4.003) * (cid:40)or patients (cid:70)isc(cid:74)ar(cid:73)e(cid:70) fro(cid:79) a co(cid:79)(cid:79)(cid:87)nit(cid:91) (cid:74)ospital(cid:28) (cid:38)i(cid:70) t(cid:74)e preli(cid:79)inar(cid:91) or final (cid:74)ospital (cid:70)isc(cid:74)ar(cid:73)e report incl(cid:87)(cid:70)e (cid:77)e(cid:91) ele(cid:79)ents an(cid:70) (cid:70)i(cid:70) a 24 (cid:19) 0 (cid:27)(cid:24)(cid:16)(cid:18)(cid:7) pro(cid:88)i(cid:70)er re(cid:88)ie(cid:89) t(cid:74)e report (cid:89)it(cid:74)in fi(cid:88)e calen(cid:70)ar (cid:70)a(cid:91)s of (cid:70)isc(cid:74)ar(cid:73)e(cid:33) (cid:10)(cid:22)(cid:16)(cid:18)(cid:18)(cid:23)(cid:11) (cid:12) (cid:55)pon t(cid:74)e patient(cid:111)s (cid:70)isc(cid:74)ar(cid:73)e fro(cid:79) a co(cid:79)(cid:79)(cid:87)nit(cid:91) (cid:74)ospital(cid:28) (cid:57)ere all ordered medications administered, made available, or delivered to the (cid:19)(cid:21) (cid:19)(cid:19) (cid:19) (cid:23)(cid:22)(cid:16)(cid:20)(cid:7) patient (cid:89)it(cid:74)in re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:25)(cid:16)(cid:18)(cid:18)(cid:21)(cid:11) (cid:12) (cid:55)pon t(cid:74)e patient(cid:111)s transfer fro(cid:79) one (cid:74)o(cid:87)sin(cid:73) (cid:87)nit to anot(cid:74)er(cid:28) (cid:57)ere (cid:19)(cid:27) 6 0 (cid:25)(cid:24)(cid:16)(cid:18)(cid:7) (cid:79)e(cid:70)ications contin(cid:87)e(cid:70) (cid:89)it(cid:74)o(cid:87)t interr(cid:87)ption(cid:33) (cid:10)(cid:25)(cid:16)(cid:18)(cid:18)(cid:23)(cid:11) (cid:12) (cid:40)or patients en ro(cid:87)te (cid:89)(cid:74)o la(cid:91) o(cid:88)er at t(cid:74)e instit(cid:87)tion(cid:28) If t(cid:74)e te(cid:79)poraril(cid:91) (cid:74)o(cid:87)se(cid:70) patient (cid:74)a(cid:70) an e(cid:90)istin(cid:73) (cid:79)e(cid:70)ication or(cid:70)er, (cid:89)ere (cid:79)e(cid:70)ications (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) a(cid:70)(cid:79)inistere(cid:70) or (cid:70)eli(cid:88)ere(cid:70) (cid:89)it(cid:74)o(cid:87)t interr(cid:87)ption(cid:33) (cid:10)(cid:25)(cid:16)(cid:18)(cid:18)(cid:24)(cid:11) (cid:12) (cid:40)or en(cid:70)orse(cid:70) patients recei(cid:88)e(cid:70) fro(cid:79) anot(cid:74)er C(cid:38)C(cid:52) instit(cid:87)tion(cid:28) If the patient was approved for a specialty services appointment at the 2 (cid:25) (cid:19) (cid:20)(cid:20)(cid:16)(cid:20)(cid:7) sending institution, was the appointment scheduled at the receiving instit(cid:87)tion (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:19)(cid:18)(cid:11) (cid:12) (cid:12) (cid:54)(cid:74)e OIG clinicians consi(cid:70)ere(cid:70) t(cid:74)ese co(cid:79)pliance tests alon(cid:73) (cid:89)it(cid:74) t(cid:74)eir case re(cid:88)ie(cid:89) fin(cid:70)in(cid:73)s (cid:89)(cid:74)en (cid:70)eter(cid:79)inin(cid:73) t(cid:74)e (cid:83)(cid:87)alit(cid:91) ratin(cid:73) for t(cid:74)is in(cid:70)icator(cid:16) So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 46 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Medication Management Overall Medication Management Rating In this indicator, OIG inspectors evaluated the institution’s ability to Inadequate administer prescription medications on time and without interruption. In this indicator, OIG inspectors evaluated the institution’s ability The inspectors examined this process from the time a provider to administer prescription medications on time and without Case Review prescribed medication until the nurse administered the medication to interruption. The inspectors examined this process from the time Rating the patient. When rating this indicator, the OIG strongly considered a provider prescribed medication until the nurse administered Inadequate the compliance test results, which tested medication processes to a the medication to the patient. When rating this indicator, the much greater degree than case review testing. In addition to examining OIG strongly considered the compliance test results, which tested Compliance medication administration, our compliance inspectors also tested many medication processes to a much greater degree than case review Score other processes, including medication handling, storage, error reporting, testing. In addition to examining medication administration, our Inadequate and other pharmacy processes. compliance inspectors also tested many other processes, including (72.1%) medication handling, storage, error reporting, and other pharmacy processes. Results Overview CCI performed poorly in this indicator. Areas for improvement included new medication prescriptions, chronic care medication continuity, hospital discharge medications, and transfer medication continuity. In addition, nurses did not always administer keep-on-person (KOP) medications timely and utilize the Omnicell when medications were not available.32 Both compliance and case review rated this indicator inadequate. Case Review and Compliance Testing Results We reviewed 28 cases related to medication management and found 25 medication management deficiencies,33 five of which were significant.34 New Medication Prescriptions Compliance testing showed newly prescribed medications were frequently provided late (MIT 7.002, 68.0%). OIG clinicians found four significant delays35 in newly prescribed medications. An example is listed below. • In case 4, a newly prescribed inhaler (Dulera) was not issued to a patient. Chronic Medication Continuity Compliance testing found patients did not receive most of their chronic care medications within the required time frames (MIT 7.001, 5.3%). We found patients received their KOP medications every 30 days; however, patients usually did not receive their refill medications at least 32. An Omnicell is an automated medication dispensing cabinet system. 33. Deficiencies occurred in cases 1, 2, 3, 4, 6, 7, 8, 18, 19, 20, 21, 22, 29, 40, and 41. 34. Significant deficiencies were found in cases 4, 7, 8, 19, and 21. 35. Significant delays were identified in cases 4, 7, 8, and 19. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:22)(cid:25) one business day prior to exhaustion. OIG clinicians did not identify significant lapses in chronic care medication continuity. Hospital Discharge Medications CCI performed poorly in ensuring patients received their needed medications when they returned from an off-site hospital or emergency room. Our clinicians reviewed 19 hospital returns and found five significant deficiencies.36 Below are examples: • In case 8, a patient returned to CCI after a five-day hospital admission. An antibiotic and acetaminophen were ordered and delivered to the pill line but not issued to the patient. • In case 21, a patient returned to CCI after an eight-day hospital admission. The discharge summary included the recommendation that the patient continue on several medications. However, the medications were not ordered. Compliance testing also found hospital-recommended medications were frequently not ordered timely or at all. (MIT 7.003, 54.2%). Transfer Medications For transfer medications, CCI showed opportunity for improvement. When patients arrived, interruptions in medication continuity were identified in both clinical and compliance reviews (MIT 6.003, 61.5%). Medication continuity was also interrupted when patients transferred from yard to yard (MIT 7.005, 76.0%). During our review period, patients did not transfer from CCI to other institutions and layovers from other institutions did not occur. Subsequently, MITs 6.101 and 7.006 were not tested. Medication Administration CCI performed excellently in administering TB medications (MIT 9.001, 100%). However, nurses did not monitor patients’ prescribed TB medications (MIT 9.002, zero). Clinician On-Site Inspection During our visit we met with the pharmacist in-charge (PIC), an acting supervising registered nurse III, and an acting chief nurse executive to discuss some of our case review findings. We discussed specific cases with medication-related deficiencies. The PIC verified medications were promptly provided to nurses for administration. However, those medications were not always administered or provided to patients timely. The pharmacist also stated newly ordered KOP, “as needed” medications were filled by the pharmacy. However, we learned the nurses did not 36. Significant deficiencies were identified in cases 6, 7, 8, and 21. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:22)(cid:26) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport issue those “as needed” medications unless patients came to the window and requested them. Nursing leadership indicated that because the provider should educate the patient when prescribing a new medication, the patient should come to the window and request the medication. Medications prescribed KOP “as needed” were also not provided to patients unless patients requested them; after three days, they were returned to the pharmacy. Unfortunately, those sealed medications were then disposed of. We visited medication administration areas and found nurses were knowledgeable about the medication administration process. Nurses also mentioned a newly implemented process to inform patients of the need to pick up essential medications. Each day, the nurse created a list of patients with KOP medications to pick up. The list was issued to the housing unit officers, who notified the patients to collect their medications. However, this list did not include medications prescribed “as-needed.” Compliance Testing Results Medication Practices and Storage Controls The institution adequately stored and secured narcotic medications in all clinic and medication line locations (MIT 7.101, 100%). CCI appropriately stored and secured nonnarcotic medications in 10 of 11 clinic and medication line locations (MIT 7.102, 90.9%). In one location, we found an opened bottle of over-the-counter medication stored in a medication cart and there was no identifiable area designated for refrigerated medications to be returned to the pharmacy. Staff kept medications protected from physical, chemical, and temperature contamination in three of the 11 clinic and medication line locations (MIT 7.103, 27.3%). In eight locations we found one or both of the following deficiencies: staff’s personal food items were stored with medications and staff did not store oral and topical medications separately. Staff successfully stored valid, unexpired medications in nine of the 11 applicable medication line locations (MIT 7.104, 81.8%). In one location, we found expired medication syringes. In another location, medication nurses did not label multi-use medication. Nurses exercised proper hand hygiene and contamination control protocols in five of six locations (MIT 7.105, 83.3%). In one location, some nurses neglected to wash or sanitize their hands when required, such as before regloving and before and after touching a patient’s skin. Staff in five of six medication preparation and administration areas demonstrated appropriate administrative controls and protocols (MIT 7.106, 83.3%). In one location, nurses did not maintain unissued medications in their original, labeled packaging. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:22)(cid:27) In five of six medication areas, staff used appropriate administrative controls and protocols when distributing medications to their patients (MIT 7.107, 83.3%). In one location, medication nurses did not reliably observe patients while they either swallowed direct observation therapy medications or did not ensure sublingual medications dissolved completely before patients left the medication line. Pharmacy Protocols Pharmacy staff followed general security, organization, and cleanliness management protocols in its pharmacy (MIT 7.108, 100%). Staff properly stored nonrefrigerated (MIT 7.109, 100%) and refrigerated medications (MIT 7.110, 100%). The PIC did not correctly review monthly inventories of controlled substances in the institution’s clinic and medication storage locations. Specifically, the PIC and staff did not correctly complete several medication area inspection checklists (CDCR Form 7477) and neglected to record the names, signatures, or dates on each inventory record. These errors resulted in a score of zero percent in this test (MIT 7.111). We examined 25 medication error reports. The PIC timely and correctly processed all of these reports (MIT 7.112, 100%). Nonscored Tests In addition to testing the institution’s self-reported medication errors, our inspectors followed up on any significant medication errors found during compliance testing. We did not score this test; we provide these results for informational purposes only. At CCI, the OIG did not find any applicable medication errors (MIT 7.998). The OIG interviewed patients in isolation units to determine whether they had immediate access to their prescribed asthma rescue inhalers or nitroglycerin medications. All of the 10 patients interviewed indicated they had access to their rescue medications (MIT 7.999). Recommendations • CCI nursing leadership should develop a process to ensure all newly prescribed keep-on-person (KOP) “as needed” (PRN) medications are offered timely to patients and include them in their daily “pick up” distribution lists. This new work flow should be audited and reported to the Medication Management Subcommittee. • CCI’s chief medical executive, chief nursing executive, and pharmacist in-charge should ensure antipyretic medications to treat a fever are available in medical isolation areas when ordered. In addition, medical leadership should train staff to order these medications to begin promptly when patients are symptomatic. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:23)(cid:18) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport • The EHRS team should evaluate the KOP medication refill process to ensure medications appear on the nurse’s tasks list prior to exhaustion of medications. • The institution should consider developing and implementing measures to ensure medications are made available and administered in a timely manner and that summaries are documented in the medication administration record (MAR) as described in CCHCS policies and procedures. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:23)(cid:19) Table 14. Medication Management Scored Answer Compliance Questions Yes No N/A Yes % (cid:38)i(cid:70) t(cid:74)e patient recei(cid:88)e all c(cid:74)ronic care (cid:79)e(cid:70)ications (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) time frames or did the institution follow departmental policy for refusals or (cid:19) (cid:19)(cid:26) 6 (cid:23)(cid:16)(cid:21)(cid:7) no(cid:15)s(cid:74)o(cid:89)s(cid:33) (cid:10)(cid:25)(cid:16)(cid:18)(cid:18)(cid:19)(cid:11) (cid:12) Did health care staff administer, make available, or deliver new order (cid:19)(cid:25) (cid:26) 0 (cid:24)(cid:26)(cid:16)(cid:18)(cid:7) prescription (cid:79)e(cid:70)ications to t(cid:74)e patient (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:25)(cid:16)(cid:18)(cid:18)(cid:20)(cid:11) (cid:55)pon t(cid:74)e patient(cid:111)s (cid:70)isc(cid:74)ar(cid:73)e fro(cid:79) a co(cid:79)(cid:79)(cid:87)nit(cid:91) (cid:74)ospital(cid:28) (cid:57)ere all or(cid:70)ere(cid:70) medications administered, made available, or delivered to the patient within (cid:19)(cid:21) (cid:19)(cid:19) (cid:19) (cid:23)(cid:22)(cid:16)(cid:20)(cid:7) re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:25)(cid:16)(cid:18)(cid:18)(cid:21)(cid:11) (cid:12) (cid:40)or patients recei(cid:88)e(cid:70) fro(cid:79) a co(cid:87)nt(cid:91) (cid:76)ail(cid:28) (cid:57)ere all (cid:79)e(cid:70)ications or(cid:70)ere(cid:70) (cid:68)(cid:91) the institution’s reception center provider administered, made available, or (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:70)eli(cid:88)ere(cid:70) to t(cid:74)e patient (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:25)(cid:16)(cid:18)(cid:18)(cid:22)(cid:11) (cid:12) (cid:55)pon t(cid:74)e patient(cid:111)s transfer fro(cid:79) one (cid:74)o(cid:87)sin(cid:73) (cid:87)nit to anot(cid:74)er(cid:28) (cid:57)ere (cid:19)(cid:27) 6 0 (cid:25)(cid:24)(cid:16)(cid:18)(cid:7) (cid:79)e(cid:70)ications contin(cid:87)e(cid:70) (cid:89)it(cid:74)o(cid:87)t interr(cid:87)ption(cid:33) (cid:10)(cid:25)(cid:16)(cid:18)(cid:18)(cid:23)(cid:11) (cid:12) (cid:40)or patients en ro(cid:87)te (cid:89)(cid:74)o la(cid:91) o(cid:88)er at t(cid:74)e instit(cid:87)tion(cid:28) If t(cid:74)e te(cid:79)poraril(cid:91) (cid:74)o(cid:87)se(cid:70) patient (cid:74)a(cid:70) an e(cid:90)istin(cid:73) (cid:79)e(cid:70)ication or(cid:70)er, (cid:89)ere (cid:79)e(cid:70)ications a(cid:70)(cid:79)inistere(cid:70) or (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:70)eli(cid:88)ere(cid:70) (cid:89)it(cid:74)o(cid:87)t interr(cid:87)ption(cid:33) (cid:10)(cid:25)(cid:16)(cid:18)(cid:18)(cid:24)(cid:11) (cid:12) All clinical and medication line storage areas for narcotic medications: Does the institution employ strong medication security controls over narcotic (cid:19)(cid:19) 0 2 (cid:19)(cid:18)(cid:18)(cid:7) (cid:79)e(cid:70)ications assi(cid:73)ne(cid:70) to its stora(cid:73)e areas(cid:33) (cid:10)(cid:25)(cid:16)(cid:19)(cid:18)(cid:19)(cid:11) All clinical and medication line storage areas for nonnarcotic medications: Does the institution properly secure and store nonnarcotic medications in the (cid:19)(cid:18) (cid:19) 2 (cid:27)(cid:18)(cid:16)(cid:27)(cid:7) assi(cid:73)ne(cid:70) stora(cid:73)e areas(cid:33) (cid:10)(cid:25)(cid:16)(cid:19)(cid:18)(cid:20)(cid:11) All clinical and medication line storage areas for nonnarcotic medications: Does the institution keep nonnarcotic medication storage locations free of 3 (cid:26) 2 (cid:20)(cid:25)(cid:16)(cid:21)(cid:7) conta(cid:79)ination in t(cid:74)e assi(cid:73)ne(cid:70) stora(cid:73)e areas(cid:33) (cid:10)(cid:25)(cid:16)(cid:19)(cid:18)(cid:21)(cid:11) All clinical and medication line storage areas for nonnarcotic medications: Does t(cid:74)e instit(cid:87)tion safel(cid:91) store nonnarcotic (cid:79)e(cid:70)ications t(cid:74)at (cid:74)a(cid:88)e (cid:91)et to e(cid:90)pire in (cid:27) 2 2 (cid:26)(cid:19)(cid:16)(cid:26)(cid:7) t(cid:74)e assi(cid:73)ne(cid:70) stora(cid:73)e areas(cid:33) (cid:10)(cid:25)(cid:16)(cid:19)(cid:18)(cid:22)(cid:11) Medication preparation and administration areas: Do nursing staff employ and follow hand hygiene contamination control protocols during medication (cid:23) (cid:19) (cid:25) (cid:26)(cid:21)(cid:16)(cid:21)(cid:7) preparation an(cid:70) (cid:79)e(cid:70)ication a(cid:70)(cid:79)inistration processes(cid:33) (cid:10)(cid:25)(cid:16)(cid:19)(cid:18)(cid:23)(cid:11) Medication preparation and administration areas: Does the institution employ appropriate administrative controls and protocols when preparing medications (cid:23) (cid:19) (cid:25) (cid:26)(cid:21)(cid:16)(cid:21)(cid:7) for patients(cid:33) (cid:10)(cid:25)(cid:16)(cid:19)(cid:18)(cid:24)(cid:11) Medication preparation and administration areas: Does the institution employ appropriate administrative controls and protocols when administering (cid:23) (cid:19) (cid:25) (cid:26)(cid:21)(cid:16)(cid:21)(cid:7) (cid:79)e(cid:70)ications to patients(cid:33) (cid:10)(cid:25)(cid:16)(cid:19)(cid:18)(cid:25)(cid:11) Pharmacy: Does the institution employ and follow general security, organization, and cleanliness management protocols in its main and remote (cid:19) 0 0 (cid:19)(cid:18)(cid:18)(cid:7) p(cid:74)ar(cid:79)acies(cid:33) (cid:10)(cid:25)(cid:16)(cid:19)(cid:18)(cid:26)(cid:11) Pharmacy: Does the institution’s pharmacy properly store nonrefrigerated (cid:19) 0 0 (cid:19)(cid:18)(cid:18)(cid:7) (cid:79)e(cid:70)ications(cid:33) (cid:10)(cid:25)(cid:16)(cid:19)(cid:18)(cid:27)(cid:11) Pharmacy: Does the institution’s pharmacy properly store refrigerated or frozen (cid:19) 0 0 (cid:19)(cid:18)(cid:18)(cid:7) (cid:79)e(cid:70)ications(cid:33) (cid:10)(cid:25)(cid:16)(cid:19)(cid:19)(cid:18)(cid:11) Pharmacy: Does the institution’s pharmacy properly account for narcotic 0 (cid:19) 0 0 (cid:79)e(cid:70)ications(cid:33) (cid:10)(cid:25)(cid:16)(cid:19)(cid:19)(cid:19)(cid:11) Pharmacy: Does the institution follow key medication error reporting (cid:20)(cid:23) 0 0 (cid:19)(cid:18)(cid:18)(cid:7) protocols(cid:33) (cid:10)(cid:25)(cid:16)(cid:19)(cid:19)(cid:20)(cid:11) (cid:50)(cid:74)ar(cid:79)ac(cid:91)(cid:28) (cid:40)or Infor(cid:79)ation (cid:50)(cid:87)rposes Onl(cid:91)(cid:28) (cid:38)(cid:87)rin(cid:73) co(cid:79)pliance testin(cid:73), (cid:70)i(cid:70) t(cid:74)e This is a nonscored test. Please OIG fin(cid:70) t(cid:74)at (cid:79)e(cid:70)ication errors (cid:89)ere properl(cid:91) i(cid:70)entifie(cid:70) an(cid:70) reporte(cid:70) (cid:68)(cid:91) t(cid:74)e see the indicator for discussion of instit(cid:87)tion(cid:33) (cid:10)(cid:25)(cid:16)(cid:27)(cid:27)(cid:26)(cid:11) this test. (cid:50)(cid:74)ar(cid:79)ac(cid:91)(cid:28) (cid:40)or Infor(cid:79)ation (cid:50)(cid:87)rposes Onl(cid:91)(cid:28) (cid:38)o patients in restricte(cid:70) (cid:74)o(cid:87)sin(cid:73) This is a nonscored test. Please units have immediate access to their KOP prescribed rescue inhalers and see the indicator for discussion of nitro(cid:73)l(cid:91)cerin (cid:79)e(cid:70)ications(cid:33) (cid:10)(cid:25)(cid:16)(cid:27)(cid:27)(cid:27)(cid:11) this test. Overall percentage (MIT 7): 72.1% (cid:12) (cid:54)(cid:74)e OIG clinicians consi(cid:70)ere(cid:70) t(cid:74)ese co(cid:79)pliance tests alon(cid:73) (cid:89)it(cid:74) t(cid:74)eir case re(cid:88)ie(cid:89) fin(cid:70)in(cid:73)s (cid:89)(cid:74)en (cid:70)eter(cid:79)inin(cid:73) t(cid:74)e (cid:83)(cid:87)alit(cid:91) ratin(cid:73) for t(cid:74)is in(cid:70)icator(cid:16) So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:23)(cid:20) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Table 15. Other Tests Related to Medication Management Scored Answer Compliance Questions Yes No N/A Yes % (cid:40)or en(cid:70)orse(cid:70) patients recei(cid:88)e(cid:70) fro(cid:79) anot(cid:74)er C(cid:38)C(cid:52) instit(cid:87)tion or COC(cid:40)(cid:28) If t(cid:74)e patient (cid:74)a(cid:70) an e(cid:90)istin(cid:73) (cid:79)e(cid:70)ication or(cid:70)er (cid:87)pon arri(cid:88)al, (cid:26) (cid:23) (cid:19)(cid:20) (cid:24)(cid:19)(cid:16)(cid:23)(cid:7) were medications administered or delivered without interruption? (6.003) * (cid:40)or patients transferre(cid:70) o(cid:87)t of t(cid:74)e facilit(cid:91)(cid:28) (cid:38)o (cid:79)e(cid:70)ication transfer pac(cid:77)a(cid:73)es incl(cid:87)(cid:70)e re(cid:83)(cid:87)ire(cid:70) (cid:79)e(cid:70)ications alon(cid:73) (cid:89)it(cid:74) t(cid:74)e correspon(cid:70)in(cid:73) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) transfer(cid:15)pac(cid:77)et re(cid:83)(cid:87)ire(cid:70) (cid:70)oc(cid:87)(cid:79)ents(cid:33) (cid:10)(cid:24)(cid:16)(cid:19)(cid:18)(cid:19)(cid:11) (cid:12) Patients prescribed TB medication: Did the institution administer the (cid:19)(cid:20) 0 0 (cid:19)(cid:18)(cid:18)(cid:7) (cid:79)e(cid:70)ication to t(cid:74)e patient as prescri(cid:68)e(cid:70)(cid:33) (cid:10)(cid:27)(cid:16)(cid:18)(cid:18)(cid:19)(cid:11) (cid:12) Patients prescribed TB medication: Did the institution monitor the patient per policy for the most recent three months he or she was on 0 (cid:19)(cid:20) 0 0 t(cid:74)e (cid:79)e(cid:70)ication(cid:33) (cid:10)(cid:27)(cid:16)(cid:18)(cid:18)(cid:20)(cid:11) (cid:12) (cid:55)pon t(cid:74)e patient(cid:111)s a(cid:70)(cid:79)ission to speciali(cid:92)e(cid:70) (cid:79)e(cid:70)ical (cid:74)o(cid:87)sin(cid:73)(cid:28) (cid:57)ere all medications ordered, made available, and administered to the patient (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:89)it(cid:74)in re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:19)(cid:21)(cid:16)(cid:18)(cid:18)(cid:22)(cid:11) (cid:12) (cid:12) (cid:54)(cid:74)e OIG clinicians consi(cid:70)ere(cid:70) t(cid:74)ese co(cid:79)pliance tests alon(cid:73) (cid:89)it(cid:74) t(cid:74)eir case re(cid:88)ie(cid:89) fin(cid:70)in(cid:73)s (cid:89)(cid:74)en (cid:70)eter(cid:79)inin(cid:73) t(cid:74)e (cid:83)(cid:87)alit(cid:91) ratin(cid:73) for t(cid:74)is in(cid:70)icator(cid:16) So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:23)(cid:21) Preventive Services Overall Rating In this indicator, OIG compliance inspectors tested whether the institution offered or provided cancer screenings, tuberculosis (TB) Inadequate screenings, influenza vaccines, and other immunizations. The OIG rated this indicator solely based on the compliance score, using the same Case Review scoring thresholds as in the Cycle 4 and Cycle 5 medical inspections. Our Rating case review clinicians do not rate this indicator. (N/A) Compliance Results Overview Score Inadequate CCI staff had a mixed performance in preventive services. Staff (55.3%) performed well in administering TB medications to patients and offering colorectal cancer screening for all patients ages 50 through 75. However, they faltered in monitoring patients who were taking prescribed TB medication, screening patients annually for TB, offering influenza vaccines to patients, and offering required immunizations to chronic care patients. These findings are set forth in the table on the next page. We rated this indicator inadequate. Case Review and Compliance Testing Results Recommendations • Nursing leadership should consider developing and implementing measures to ensure that nursing staff timely screen patients for tuberculosis (TB) and thoroughly address signs and symptoms in their TB screening. • Medical leadership should determine the root cause(s) of untimely chronic care vaccinations. • Nursing leadership should consider developing and implementing measures to ensure that nursing staff document patient immunization refusals on the correct forms. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:23)(cid:22) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Table 16. Preventive Services Scored Answer Compliance Questions Yes No N/A Yes % Patients prescribed TB medication: Did the institution administer the (cid:19)(cid:20) 0 0 (cid:19)(cid:18)(cid:18)(cid:7) (cid:79)e(cid:70)ication to t(cid:74)e patient as prescri(cid:68)e(cid:70)(cid:33) (cid:10)(cid:27)(cid:16)(cid:18)(cid:18)(cid:19)(cid:11) Patients prescribed TB medication: Did the institution monitor the patient per policy for the most recent three months he or she was on 0 (cid:19)(cid:20) 0 0 t(cid:74)e (cid:79)e(cid:70)ication(cid:33) (cid:10)(cid:27)(cid:16)(cid:18)(cid:18)(cid:20)(cid:11) † (cid:35)nn(cid:87)al (cid:54)(cid:36) screenin(cid:73)(cid:28) (cid:57)as t(cid:74)e patient screene(cid:70) for (cid:54)(cid:36) (cid:89)it(cid:74)in t(cid:74)e last (cid:23) 20 0 (cid:20)(cid:18)(cid:16)(cid:18)(cid:7) (cid:91)ear(cid:33) (cid:10)(cid:27)(cid:16)(cid:18)(cid:18)(cid:21)(cid:11) (cid:57)ere all patients offere(cid:70) an in(cid:387)(cid:87)en(cid:92)a (cid:88)accination for t(cid:74)e (cid:79)ost recent (cid:19)(cid:24) (cid:27) 0 (cid:24)(cid:22)(cid:16)(cid:18)(cid:7) in(cid:387)(cid:87)en(cid:92)a season(cid:33) (cid:10)(cid:27)(cid:16)(cid:18)(cid:18)(cid:22)(cid:11) (cid:35)ll patients fro(cid:79) t(cid:74)e a(cid:73)e of (cid:23)(cid:18) t(cid:74)ro(cid:87)(cid:73)(cid:74) t(cid:74)e a(cid:73)e of (cid:25)(cid:23)(cid:28) (cid:57)as t(cid:74)e 23 2 0 (cid:27)(cid:20)(cid:16)(cid:18)(cid:7) patient offere(cid:70) colorectal cancer screenin(cid:73)(cid:33) (cid:10)(cid:27)(cid:16)(cid:18)(cid:18)(cid:23)(cid:11) (cid:40)e(cid:79)ale patients fro(cid:79) t(cid:74)e a(cid:73)e of (cid:23)(cid:18) t(cid:74)ro(cid:87)(cid:73)(cid:74) t(cid:74)e a(cid:73)e of (cid:25)(cid:22)(cid:28) (cid:57)as t(cid:74)e (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) patient offere(cid:70) a (cid:79)a(cid:79)(cid:79)o(cid:73)ra(cid:79) in co(cid:79)pliance (cid:89)it(cid:74) polic(cid:91)(cid:33) (cid:10)(cid:27)(cid:16)(cid:18)(cid:18)(cid:24)(cid:11) (cid:40)e(cid:79)ale patients fro(cid:79) t(cid:74)e a(cid:73)e of (cid:20)(cid:19) t(cid:74)ro(cid:87)(cid:73)(cid:74) t(cid:74)e a(cid:73)e of (cid:24)(cid:23)(cid:28) (cid:57)as (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) patient offere(cid:70) a pap s(cid:79)ear in co(cid:79)pliance (cid:89)it(cid:74) polic(cid:91)(cid:33) (cid:10)(cid:27)(cid:16)(cid:18)(cid:18)(cid:25)(cid:11) (cid:35)re re(cid:83)(cid:87)ire(cid:70) i(cid:79)(cid:79)(cid:87)ni(cid:92)ations (cid:68)ein(cid:73) offere(cid:70) for c(cid:74)ronic care patients(cid:33) (cid:23) 4 (cid:19)(cid:24) (cid:23)(cid:23)(cid:16)(cid:24)(cid:7) (cid:10)(cid:27)(cid:16)(cid:18)(cid:18)(cid:26)(cid:11) Are patients at the highest risk of coccidioidomycosis (valley fever) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) infection transferre(cid:70) o(cid:87)t of t(cid:74)e facilit(cid:91) in a ti(cid:79)el(cid:91) (cid:79)anner(cid:33) (cid:10)(cid:27)(cid:16)(cid:18)(cid:18)(cid:27)(cid:11) Overall percentage (MIT 9): 55.3% (cid:12) (cid:54)(cid:74)e OIG clinicians consi(cid:70)ere(cid:70) t(cid:74)ese co(cid:79)pliance tests alon(cid:73) (cid:89)it(cid:74) t(cid:74)eir case re(cid:88)ie(cid:89) fin(cid:70)in(cid:73)s (cid:89)(cid:74)en (cid:70)eter(cid:79)inin(cid:73) t(cid:74)e (cid:83)(cid:87)alit(cid:91) ratin(cid:73) for t(cid:74)is in(cid:70)icator(cid:16) † In April 2020, after our review but before this report was published, CCHCS reported adding the symptom of fatigue into t(cid:74)e electronic (cid:74)ealt(cid:74) recor(cid:70) s(cid:91)ste(cid:79) (cid:10)(cid:39)(cid:42)(cid:52)S(cid:11) po(cid:89)erfor(cid:79) for t(cid:87)(cid:68)erc(cid:87)losis (cid:10)(cid:54)(cid:36)(cid:11)(cid:15)s(cid:91)(cid:79)pto(cid:79) (cid:79)onitorin(cid:73)(cid:16) So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:23)(cid:23) Nursing Performance Overall In this indicator, the OIG clinicians evaluated the quality of care Rating delivered by the institution’s nurses, including registered nurses (RNs), Inadequate Nursing Performance licensed vocational nurses (LVNs), psychiatric technicians (PTs), and certified nursing assistants (CNAs). Our clinicians evaluated nurses’ Case Review ability to make timely and appropriate assessments and interventions. Rating In this indicator, the OIG clinicians evaluated the quality of care We also evaluated the institution’s nurses’ documentation for accuracy Inadequate delivered by the institution’s nurses, including registered nurses (RNs), licensed vocational nurses (LVNs), psychiatric technicians (PTs), and and thoroughness. Clinicians reviewed nursing performance in many clinical settings and processes, including sick call, outpatient care, care Compliance certified nursing assistants (CNAs). Our clinicians evaluated nurses’ Score ability to make timely and appropriate assessments and interventions. coordination and management, emergency services, specialized medical housing, hospitalizations, transfers, specialty services, and medication (N/A) We also evaluated the institution’s nurses’ documentation for accuracy and thoroughness. Clinicians reviewed nursing performance in many management. The OIG assessed nursing care through case review only clinical settings and processes, including sick call, outpatient care, care and performed no compliance testing for this indicator. coordination and management, emergency services, specialized medical When summarizing overall nursing performance, our clinicians housing, hospitalizations, transfers, specialty services, and medication understand that nurses perform numerous aspects of medical care. As management. The OIG assessed nursing care through case review only such, specific nursing quality issues are discussed in other indicators, and performed no compliance testing for this indicator. such as Emergency Services, Specialty Services, and Specialized When summarizing overall nursing performance, our clinicians Medical Housing. understand that nurses perform numerous aspects of medical care. As such, specific nursing quality issues are discussed in other indicators, Results Overview such as Emergency Services, Specialty Services, and Specialized Medical Housing. Nursing care was poor overall. It was apparent, despite the assistance of registry staff, that the pandemic put strain on CCI’s nursing operations. While nurses continued to evaluate patients, nursing leadership did not ensure nurses understood and followed the department’s COVID-19 guidelines.37 Consequently, abnormal clinical findings were not always recognized. Nurses’ assessments and interventions were often incomplete. Furthermore, nurses did not always contact providers regarding a patient’s worsening symptoms and arrange for an evaluation when warranted. In addition, nurses did not always communicate to patients when new medications were available for pick-up. After evaluating CCI’s nursing response during the pandemic, and taking all things into consideration, the OIG rated this indicator inadequate. Case Review Results We reviewed 250 nursing encounters in 44 cases. Of the nursing encounters we reviewed, 165 were in the outpatient setting. We identified 102 nursing performance deficiencies, 23 of which were significant.38 Nursing Assessments and Interventions Correctional nurses have a critical role in patient care. Often in correctional settings, nurses serve as the liaison between the patient, the 37. See CCHCS, COVID-19 and Seasonal Influenza: Interim Guidance for Health Care and Public Health Providers. 38. Deficiencies were identified in cases 2, 3, 4, 6, 7, 8, 9, 10, 11 ,12, 15, 16, 17, 18, 19, 20, 21, 22, 23, 25, 30, 32, 33, 35, 37, 39, 40, 41, 43, 44, and 45. Cases 2, 6, 7, 15, 18, 19, 20, 21, 23, 25, 30, 32, 33, 35, and 45 had significant deficiencies. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:23)(cid:24) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport primary care provider, and community health care services. Therefore, thorough assessments are critical to ensure patients receive necessary interventions and care. At CCI, we identified a pattern of deficiencies involving incomplete nursing assessments in multiple areas. However, most of these deficiencies occurred in the outpatient areas, including both clinics and housing units. Of the 44 cases our clinicians reviewed, 21 had deficiencies.39 Most significant deficiencies also occurred in the outpatient areas, often related to the management of COVID-19. The following are examples: • In cases 6, 19, and 22, on several days, COVID-19 quarantine rounds were not completed at least once. • In case 7, a patient was isolated for COVID-19 infection. For several days, the patient had symptoms of a fever and a low oxygen saturation level. Despite the abnormal findings, nurses did not listen to the patient’s lungs and notify a provider of the abnormal findings. In case 19, a nurse conducted COVID-19 quarantine rounds and documented that a patient had an elevated temperature. The nurse did not follow the CCHCS COVID-19 interim guidance related to abnormal temperatures; therefore, the patient was not isolated and tested for COVID-19.40 • In case 20, a patient complained of abdominal pain and vomiting of blood. However, a nurse did not examine the patient’s abdomen for distention. Later, the same patient was isolated for COVID-19 infection and complained of headaches. The nurse did not assess this complaint, provide an intervention, and educate the patient. • In case 21, a 72-year-old COVID-19-positive patient was isolated in a housing unit. An RN conducting rounds consulted the supervising registered nurse (SRN) about the patient’s decreased oxygen saturation level and worsening symptoms. The SRN noted the patient was evaluated by a provider two days prior and inappropriately advised the nurse that immediate interventions were not indicated. The patient’s lung sounds were not auscultated, oxygen was not administered, and education was not provided. Instead, the patient was inappropriately advised to submit a sick call request, which delayed his care. The next day, the patient required a transfer to a community hospital and was admitted for oxygen deprivation and COVID-19 pneumonia. 39. Deficiencies occurred in cases 2, 3, 4, 6, 7, 10, 11, 12, 15, 16, 17, 18, 19, 20, 21, 23, 25, 30, 32, 33, and 35. 40. See CCHCS, COVID-19 and Seasonal Influenza: Interim Guidance for Health Care and Public Health Providers.. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:23)(cid:25) Nursing Documentation Complete and accurate documentation is an essential component of patient care. Without proper documentation, health care staff may overlook changes in patients’ conditions and the ability to assess care quality becomes challenging. At CCI, nursing documentation deficiencies were identified in multiple areas. The following are examples: • In case 11, a first medical responder nurse did not document the amount of oxygen administered to a patient. • In case 15, during COVID-19 quarantine rounds, on multiple days, multiple nurses did not document assessing patients for all COVID-19 symptoms. • In case 19, a sick call nurse evaluated a patient but did not document the patient’s vital signs. • In case 41, a patient transferred to CCI and complained of arm pain. The R&R nurse did not document which of the patient’s arms had pain. Nursing Sick Call Our clinicians reviewed 63 sick call requests in 29 cases. The sick call triage process improved from our Cycle 5 report, as symptomatic patients were evaluated the next business day. However, during face- to-face evaluations, we found nurses did not always consult or refer patients to their primary care providers within an appropriate time frame when warranted.41 The following examples demonstrate opportunities for improvement: • In case 2, a patient was quarantined and submitted a sick call for shortness of breath. Despite, the correlation between the patient’s symptom and COVID-19, the sick call nurse did not assess for other symptoms of COVID-19, did not isolate the patient, and did not consult a provider. • In case 20, a sick call nurse evaluated a patient who had a persistent, red, swollen eye with tearing and irritation for two weeks. Instead of consulting with a provider, the nurse inappropriately initiated a two-week follow-up. • In case 35, a patient had fluid around the heart (pericardial effusion), a history of heart palpations, and a recent abnormal blood test. A sick call nurse performed an evaluation for complaints of lightheadedness. However, the nurse did not perform a sufficient assessment, consult the provider, or initiate an urgent appointment. 41. Cases 2, 20, 30, 32, 33, and 35. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:23)(cid:26) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Care Management/Coordinator At CCI, each primary care clinic RN served as the care manager and an LVN provided patients with chronic care education. We reviewed the LVN clinical care coordinator’s performance in providing chronic care education in six visits. We found these visits to be comprehensive, thorough, and well-documented. Emergency Services Nurses responded promptly to emergencies and provided urgent and emergency care. We identified 15 deficiencies, two of which were significant.42 In both of the cases with significant deficiencies, nurses did not contact a provider, plan for isolation, and conduct COVID-19 screenings for patients with shortness of breath. Opportunities for improvement are discussed in the Emergency Services indicator. Hospital Returns We reviewed 16 cases involving patients who returned from a community hospital or emergency room. CCI nurses evaluated patients, but we found incomplete documentation and incomplete assessments. The poor documentation made it difficult to determine which information the nurses communicated to providers. Furthermore, nurses did not always thoroughly review and document hospital discharge recommendations. Additional information can be found in the Transfers indicator. Transfers Overall, CCI nurses performed acceptably in managing patients transferring into the institution. However, for patients transferring out of the institution, nurses did not ensure transfer documentation was thorough and accurate. Similar findings were identified in our Cycle 5 report. Additional information is discussed in the Transfers indicator. Specialty Services CCI nurses provided good nursing care for patients returning from off-site specialty appointments. Most nurses performed appropriate nursing assessments, reviewed specialist recommendations properly, and communicated pertinent information to providers. The Specialty Services indicator provides further information. Medication Management OIG clinicians examined 110 events involving medication management and administration and identified 25 deficiencies. Of these 42. Cases 2, 3, 6, 7, 9, 10, 11, 15, 20, 21, and 22 had deficiencies. Significant deficiencies were identified in cases 2 and 15. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:23)(cid:27) deficiencies, 18 were related to nursing.43 Four of the five significant deficiencies were related to nurses not administering prescribed medications or reconciling essential medications.44 Examples are listed below. Additional information can be found in the Medication Management indicator. • In case 1, the pharmacy filled an order for a rescue inhaler for an asthmatic patient and delivered it to the medication administration area. However, the inhaler was never issued to the patient. • In case 7, nurses incorrectly documented administering medications to a patient admitted at a community hospital. • In case 8, a patient returned from a community hospital admission. An antibiotic was ordered, filled by the pharmacy, and delivered to the medication administration area. However, the medication was never issued to the patient. • In case 40, a patient transferred to CCI with prescribed medications. However, upon arrival to CCI, the R&R nurse did not administer one of the prescribed medications on the day of the transfer. Clinician On-Site Inspection During our CCI on-site visit, we met with medical executives, nursing supervisors, custody staff, and medical staff. In addition, we met with the COVID-19 incident management team, who explained CCI’s operations during the institution’s outbreak and the associated impacts. CCI’s COVID-19 surge began in late June 2020. In each of the institution’s five separate facilities, COVID-19 isolation and quarantine areas were established. However, many of these originally designated areas changed. OIG clinicians visited a quarantine and isolation area, located in Facility E. Both isolation and quarantine patients were housed in the same building. The upper-level cells were reserved for COVID-19-positive or symptomatic patients and the lower tier was reserved for quarantined patients; both tiers had cells with doors. At the time of our visit, three patients were quarantined on the bottom tier. These three patients walked together to the pill line to receive their medications. However, nurses stated medication administration for patients in isolation were conducted at cell-side. We met the acting chief nurse executive (CNE) to discuss general nursing operations and some of the OIG clinicians’ findings; we also spent a considerable amount of time discussing CCI’s COVID-19 operations. While the acting CNE had assumed this new role only two weeks prior to our visit, she was familiar with the institution due to her prior role as 43. Cases 1, 4, 6, 7, 18, 19, 21, 22, 40, and 41 had medication-related nursing deficiencies. 44. Significant medication-related nursing deficiencies were identified in cases 7, 18, 19, and 21. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 60 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport a supervising registered nurse III. The acting CNE reported that shortly after CCI’s COVID-19 outbreak began, sixty registry crisis staff arrived. These registry staff consisted of registered nurses, licensed vocational nurses and certified nursing assistants who were trained by the regional CCHCS nursing team. The four-hour training consisted of education on nursing COVID-19 charting and prison safety. Due to limited training, registry and licensed vocational nurses only performed COVID-19 related operations, such as isolation and quarantine rounds. However, the CNE explained that when patients required additional care, registry staff were instructed to contact the emergency response or TTA RN for further care. Nursing leadership reported that CCI followed a different temperature parameter than the department’s COVID-19 guidance.45 At CCI, nurses did not consider a patient’s temperature to be elevated unless it was above 100.4 degrees Fahrenheit to isolate for COVID-19. In contrast, the department’s guidance considered a person with a temperature greater than 100.0 degrees Fahrenheit or with symptoms of influenza-like illness as requiring further nursing actions, such as isolation and testing. The acting CNE stated a patient’s oxygen saturation results were not considered low until they decreased to 92 percent or less, regardless of the patient’s normal or baseline oxygen levels. The CNE also noted nurses were not expected to review patients’ recent oxygen levels to identify changes and they were not expected to auscultate lung sounds, subjectively assess for shortness of breath, and contact a provider until the patient’s oxygen saturation results were 92 percent or less. When an OIG clinician asked about the rationale for deviating from the department’s COVID-19 guidance, nursing leadership stated they were unaware of the differences in both peripheral oxygen saturation and body temperature parameters. OIG clinicians attended three virtual morning huddles, which were well- attended by medical, mental health, and dental staff. A nurse presented pertinent information and followed a scripted format. Clinic nurses’ appointments varied each day and staff reported no backlog. We also visited several of CCI’s medical clinics. In Facility B, the medical clinic was temporarily displaced due to the construction of a new clinic. The outpatient housing unit (OHU) was also closed due to construction and staff assigned to the OHU were reassigned to other nursing areas. CCI had also recently completed and opened a new medical clinic in Facility C. The OIG interviewed staff nurses. In the outpatient areas, the nurses stated COVID-19 information and education was disseminated by email and was overwhelming. The nurses also expressed frustration with the number of providers teleworking, as it led to an increased nursing workload. The nurses stated many providers began teleworking in March 2020 but had recently returned to their prior work schedule 45. See CCHCS, COVID-19 and Seasonal Influenza: Interim Guidance for Health Care and Public Health Providers. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:24)(cid:19) in February 2021. The absence of providers and the increased nursing demands appeared to have caused poor nursing morale. Recommendations • The CEO should consider directing nursing leadership to effectively communicate and provide clear expectations for the nursing staff. • Nursing leadership should work towards improving patient care coordination with medical providers. • Nursing leadership should ensure patients are aware when newly prescribed, PRN medications are available in the medication administration areas. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 62 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Provider Performance Provider Performance Overall In this indicator, OIG case review clinicians evaluated the quality of Rating In this indicator, OIG case review clinicians evaluated the quality of care the institution’s providers (physicians, physician assistants, and Inadequate care the institution’s providers (physicians, physician assistants, and nurse practitioners) delivered. Our clinicians assessed the institution’s nurse practitioners) delivered. Our clinicians assessed the institution’s providers’ ability to evaluate, diagnose, and manage their patients Case Review providers’ ability to evaluate, diagnose, and manage their patients properly. We examined provider performance across several clinical Rating properly. We examined provider performance across several clinical settings and programs, including sick call, emergency services, Inadequate settings and programs, including sick call, emergency services, outpatient care, chronic care, specialty services, intake, transfers, outpatient care, chronic care, specialty services, intake, transfers, hospitalizations, and specialized medical housing. The OIG assessed Compliance hospitalizations, and specialized medical housing. The OIG assessed Score provider care through case review only and performed no compliance provider care through case review only and performed no compliance testing for this indicator. (N/A) testing for this indicator. Results Overview CCI providers’ performance was poor. Although they generally delivered acceptable care in outpatient and emergency settings, they did not always document progress notes in the EHRS. When providers did not follow specialists’ recommendations, they did not document their rationale. In addition, providers did not always examine patients and order appropriate tests. Finally, providers’ diabetes care needed improvement. Therefore, the OIG rated this indicator inadequate. Case Review Results OIG clinicians reviewed 79 medical provider encounters and identified 57 deficiencies related to provider performance. Of these, 16 were significant.46 In addition, OIG clinicians examined care quality in 20 comprehensive case reviews. Of these 20 cases, 12 were rated adequate, and eight were rated inadequate.47 Assessment and Decision-Making CCI providers did not always examine patients, document findings, and order appropriate tests when delivering care. We identified five cases with inadequate assessments and decision-making.48 Two examples follow: • In case 16, a provider evaluated a patient for bowel incontinence but did not perform a thorough examination, consider a broader differential diagnosis, and order further diagnostic tests to determine the cause of the incontinence. • In case 23, a provider did not address a patient with a very high triglyceride cholesterol level. The provider did not perform a 46. Deficiencies occurred in cases 1, 2, 4, 5, 6, 7, 8, 12, 13, 14, 15, 16, 17, 18, 20, 21, 22, 23, and 33. Cases 1, 2, 6, 13, 14, 16, 18, and 23 had minor and significant deficiencies. 47. Inadequate care quality ratings in comprehensive case reviews occurred in cases 2, 6, 12, 13, 14, 16, 18, and 23. 48. Inadequate assessment and decision-making events occurred in cases 1, 13, 16, 20, and 23. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution 63 further evaluation with follow-up laboratory testing, did not prescribe medication, and did not order a follow-up appointment to reassess the high triglyceride cholesterol level. Review of Records CCI providers did not always review medical records carefully and did not document the rationale for not following specialists’ recommendations. OIG clinicians identified 10 deficiencies in the cases we reviewed.49 The review of records is a very important part of patient care; this was especially the case during the COVID-19 pandemic, when patient movement was limited to minimize the spread of COVID-19 and patients were seen less frequently based on their chart reviews. • In case 6, a patient was seen in the local hospital multiple times with an altered mental status and possible seizure activity. A provider did not thoroughly review the hospital discharge records and follow discharge recommendations. • In case 18, a provider did not thoroughly review a prostate biopsy pathology report to be aware that the biopsy result was suspicious for cancer. The provider also did not follow the pathologist’s recommendation. • In case 21, a provider did not thoroughly review a hospital discharge record and did not order the recommended discharge medications for COVID-19 pneumonia. Emergency Care CCI providers appropriately managed patients with urgent and emergent conditions in the TTA. Although providers did not always document consult notes, they were available for consultation with TTA nursing staff either in person or by telephone. When patients in the TTA required higher levels of care, CCI providers appropriately referred them to the community hospital. Chronic Care Generally, CCI providers appropriately managed patients’ chronic health conditions such as hypertension, asthma, hepatitis C infection, and cardiovascular disease, including chronic atrial fibrillation and valvular heart disease with anticoagulation therapy.50 However, OIG clinicians identified that providers did not thoroughly follow CCHCS guidelines and strategies when managing diabetes.51 49. Deficiencies occurred in cases 2, 6, 7, 18, 21, and 23. 50. Atrial fibrillation is an abnormal heart rhythm that often requires a blood thinner medication to prevent stroke. Anticoagulation therapy is treatment with a blood thinner medication. 51. See CCHCS Care Guide: Type 2 Diabetes. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 64 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport • In case 12, a patient had persistently high blood sugar levels and providers ordered multiple regular insulin doses; however, they did not document high sugar levels and treatment plans and did not order urgent provider follow-up appointments. • In case 13, a provider reviewed a laboratory finding of elevated hemoglobin A1c, indicating that the patient’s diabetes was not well-controlled; however, the provider did not follow up on the patient timely.52 Although the provider saw the patient three months later, the provider did not consider additional interventions for the elevated hemoglobin A1c level. • In case 14, a provider reviewed a laboratory finding of elevated hemoglobin A1c, indicating the patient’s diabetes was not well- controlled; however, the provider did not manage the diabetes care with a timely follow-up and instead saw the patient five months later. Specialty Services Generally, CCI providers appropriately referred patients for specialty consultations when needed. However, when specialists made recommendations, providers did not always follow those recommendations and did not document the rationale. • In case 23, a provider assessed a patient for follow-up after a consultation with a cardiology specialist. The cardiologist recommended further imaging studies. However, the provider did not document why the specialist’s recommendation was not followed. Also in this case, the patient was seen by a general surgeon who recommended sitz baths.53 However, the provider did not follow this recommendation for the patient. Documentation Quality CCI providers did not always document notes when consulted by nursing staff during outpatient visits, TTA encounters, COVID-19 roundings and on-call coverage. Documentation is vital for care coordination, quality management, and safe and effective treatment, especially during the COVID-19 pandemic. OIG clinicians identified 27 events in which providers did not document notes in the EHRS when nursing staff consulted them.54 • In case 2, a TTA RN assessed a patient for leg pain with swelling and consulted a provider. However, the provider did not document a treatment plan. Later that day, the patient presented 52. The hemoglobin A1C laboratory test is a blood test that measures the patient’s average blood sugar level for three months. 53. A sitz bath is a bath in which a person sits in water to the hips to relieve discomfort and pain. 54. There was lack of documentation for consult encounters in cases 1, 2, 4, 6, 7, 8, 12, 18, 20, 21, 22, 23, and 33. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:24)(cid:23) with an overdose of hypertensive medications; the TTA RN notified the provider, who ordered the patient to be transferred for higher level of care. The provider did not document a consultation note. • In case 8, a TTA RN assessed a patient who was not breathing. Staff initiated CPR with supplemental oxygen and administered multiple doses of Narcan, an opioid overdose reversal medication. The RN consulted the provider on-call and transferred the patient to the local hospital. However, the provider-on-call did not document a progress note. • In case 20, a TTA RN consulted the provider-on-call after assessing a patient who presented twice to the TTA with acute abdominal pain. During the second TTA evaluation, the provider recommended the patient be transferred to a local community hospital. However, the provider did not document progress notes for both encounters. Provider Continuity Generally, CCI offered good provider continuity. Providers were assigned to specified clinics to ensure continuity of patient care. When there was a shortage of clinic providers during the COVID-19 pandemic, the providers continued to deliver medical care via telemedicine and consulted with other clinic providers when an in-person examination was required. Patients received care from a designated primary care team during the pandemic. Clinician On-Site Inspection During the COVID-19 pandemic, CCI providers conducted provider meetings and daily morning huddles via teleconference. OIG clinicians attended three clinic huddles where medical staff discussed events that occurred overnight, such as TTA events and patient returns from the hospital or specialty appointments. The daily huddles were well-attended by the chief physician and surgeon (CP&S), providers, nurses, and ancillary staff. During the pandemic, only one provider was available on-site at each clinic. Two providers withdrew their services, one due to retirement and the other due to illness. At Yard B, only one telemedicine provider was available four days a week, and the other days were covered by providers from other clinics. Providers stated that due to the shortage of providers and the increased workload, documentation was not completed at all times. Along with the nursing staff, mid-level providers participated in mass COVID-19 testing. The CP&S affirmed the importance of documentation in patient care, including complete progress notes and consultation notes. He also affirmed that all canceled appointments would be rescheduled as soon as safely possible and that health care staff would continue to see and treat patients through the sick call process during the COVID-19 pandemic. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents 66 C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Recommendations • Medical leadership should ensure providers document patient related calls and management plans in the electronic medical health record for clear communication and collaboration with the patient care team and for the continuity of patient care. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:24)(cid:25) Specialized Medical Housing Overall CCI’s outpatient housing unit (OHU) was temporarily closed due to Rating Specialized Medical Housing construction; therefore, we were not able to review specialized medical N/A housing this cycle. During the on-site visit, we learned that patients in In this indicator, OIG inspectors evaluated the quality of care in the the specialized medical housing unit who needed care were transferred Case Review specialized medical housing units. We evaluated the performance of the to other institutions. Rating medical staff in assessing, monitoring, and intervening for medically complex patients requiring close medical supervision. Our inspectors N/A also evaluated the timeliness and quality of provider and nursing intake assessments and care plans. We considered staff members’ performance Compliance in responding promptly when patients’ conditions deteriorated and Score looked for good communication when staff consulted with one another N/A while providing continuity of care. At the time of our inspection, tthhee CCMMFF ssppeecciiaalliizzeedd mmeeddiiccaall hhoouussiinngg iinncclluuddeedd aann oouuttppaattiieenntt hhoouussiinngg uunniitt ((OOHHUU)),, aa ccoorrrreeccttiioonnaall ttrreeaattmmeenntt cceenntteerr ((CCTTCC)),, aanndd hhoossppiiccee.. [[bbaasseedd oonn aabboovvee,, llaanngguuaaggee mmaayy vvaarryy..]] Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:24)(cid:26) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Specialty Services Overall Specialty Services Rating In this indicator, OIG inspectors evaluated the quality of specialty Inadequate services. The OIG clinicians focused on the institution’s ability In this indicator, OIG inspectors evaluated the quality of specialty to provide needed specialty care. Our clinicians also examined services. The OIG clinicians focused on the institution’s ability Case Review specialty appointment scheduling, providers’ specialty referrals, to provide needed specialty care. Our clinicians also examined Rating and medical staff’s retrieval, review, and implementation of any specialty appointment scheduling, providers’ specialty referrals, Adequate specialty recommendations. and medical staff’s retrieval, review, and implementation of any specialty recommendations. Compliance Results Overview Score Inadequate CCI’s performance in this indicator was mixed. Although CCI provided (61.4%) good access to high-priority specialty requests, they faltered in providing access to medium and routine-priority specialty requests. In addition, CCI did not always provide timely follow-up appointments with providers and specialists. Many reports were not retrieved and scanned timely and providers did not review them timely. Due to the COVID-19 pandemic, there were movement restrictions and some delays in face- to-face consultations. However, factoring compliance testing and case reviews, we rated this indicator inadequate. Case Review and Compliance Testing Results We reviewed 38 events related to specialty services; twenty-three were specialty consultations and procedures. OIG clinicians found nine deficiencies in this category, one of which was significant.55 Access to Specialty Services Compliance testing showed that CCI completed high-priority, medium-priority, and routine-priority specialty appointments at a rate of 86.7, 66.7, and 53.3 percent, respectively (MIT 14.001, MIT 14.004, and MIT 14.007). However, there was poor continuity of specialty services due to poor performance in timely scheduling specialty services appointments for patients transferring from other institutions (MIT 14.010, 22.2%). Provider Performance CCI providers generally referred patients appropriately, reviewed specialty reports within the recommended time frames, and addressed specialists’ recommendations. We identified three deficiencies in which providers did not follow specialists’ recommendations, of which one was significant.56 • In case 23, a provider assessed a patient after a cardiology specialist consultation; however, the provider did not thoroughly 55. Deficiencies occurred in cases 1, 2, 20, and 23. Case 23 had a significant deficiency. 56. Deficiencies occurred in cases 2 and 23. Case 23 had significant deficiencies. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:24)(cid:27) follow the specialist’s recommendation to order further testing for peripheral vascular disease.57 This deficiency is discussed in the Provider Performance indicator. Compliance testing showed the follow-up visit with the provider after a specialty consultation occurred within the required time frames 65.8 percent of the time (MIT 1.008). Nursing Performance CCI nurses’ performance in providing specialty services was adequate. Nurses generally evaluated patients properly upon their return from off-site appointments. OIG clinicians reviewed 15 nursing encounters related to specialty services and identified four minor deficiencies related to the documentation of patient assessments, but none were significant.58 • In case 23, when a patient returned from off-site specialist visits, nursing staff did not document physical assessments in the EHRS on three occasions. Health Information Management Although health information management staff scanned specialty notes into the EHRS within the required time frame most of the time (MIT 4.002, 80.0%), CCI providers did not always review specialty reports timely. Compliance testing found that providers reviewed the consultant reports within the required time frame at a rate of 66.7 percent for high-priority referrals, 46.2 percent for medium-priority referrals, and 41.7 percent for routine-priority referrals (MIT 14.002, MIT 14.005, and MIT 14.008). Clinician On-Site Inspection OIG clinicians discussed specialty referral management with managers, supervisors, providers, and utilization nursing staff. Providers reviewed the charts to determine the urgency and necessity of specialty consultations, weighing the risk of possible exposure and COVID-19 infection. Providers indicated some of the specialists’ recommendations were not followed after COVID-19 risk assessment. Movement restrictions imposed due to COVID-19 affected access to specialist care for some patients. We were informed that some off-site specialists required a telemedicine appointment before a face-to-face consultation. Recommendations • Medical leadership should consider expanding the telemedicine provision in each medical clinic to include specialty services. 57. Peripheral vascular disease is a disease or disorder of the circulatory system, often affecting blood vessels. 58. Deficiencies occurred in cases 20 and 23. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:25)(cid:18) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport • Medical leadership should review the causes of the untimely provider review of specialty reports; medical leadership should implement remedial measures as appropriate. Compliance Testing Results Table 17. Specialty Services Scored Answer Compliance Questions Yes No N/A Yes % Did the patient receive the high-priority specialty service within (cid:19)(cid:22)(cid:124)calen(cid:70)ar (cid:70)a(cid:91)s of t(cid:74)e pri(cid:79)ar(cid:91) care pro(cid:88)i(cid:70)er or(cid:70)er or t(cid:74)e (cid:50)(cid:74)(cid:91)sician (cid:19)(cid:21) 2 0 (cid:26)(cid:24)(cid:16)(cid:25)(cid:7) (cid:52)e(cid:83)(cid:87)est for Ser(cid:88)ice(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:19)(cid:11) (cid:12) Did the institution receive and did the primary care provider review the high-priority specialty service consultant report within the (cid:19)(cid:18) (cid:23) 0 (cid:24)(cid:24)(cid:16)(cid:25)(cid:7) re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)e(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:20)(cid:11) (cid:12) (cid:38)i(cid:70) t(cid:74)e patient recei(cid:88)e t(cid:74)e s(cid:87)(cid:68)se(cid:83)(cid:87)ent follo(cid:89)(cid:15)(cid:87)p to t(cid:74)e (cid:74)i(cid:73)(cid:74)(cid:15)priorit(cid:91) specialty service appointment as ordered by the primary care (cid:25) (cid:19) (cid:25) (cid:26)(cid:25)(cid:16)(cid:23)(cid:7) pro(cid:88)i(cid:70)er(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:21)(cid:11) (cid:12) Did the patient receive the medium-priority specialty service within (cid:19)(cid:23)(cid:15)(cid:22)(cid:23) calen(cid:70)ar (cid:70)a(cid:91)s of t(cid:74)e pri(cid:79)ar(cid:91) care pro(cid:88)i(cid:70)er or(cid:70)er or (cid:50)(cid:74)(cid:91)sician (cid:19)(cid:18) (cid:23) 0 (cid:24)(cid:24)(cid:16)(cid:25)(cid:7) (cid:52)e(cid:83)(cid:87)est for Ser(cid:88)ice(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:22)(cid:11) (cid:12) Did the institution receive and did the primary care provider review the medium-priority specialty service consultant report within the 6 (cid:25) 2 (cid:22)(cid:24)(cid:16)(cid:20)(cid:7) re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)e(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:23)(cid:11) (cid:12) (cid:38)i(cid:70) t(cid:74)e patient recei(cid:88)e t(cid:74)e s(cid:87)(cid:68)se(cid:83)(cid:87)ent follo(cid:89)(cid:15)(cid:87)p to t(cid:74)e (cid:79)e(cid:70)i(cid:87)(cid:79)(cid:15) priority specialty service appointment as ordered by the primary care (cid:23) 4 6 (cid:23)(cid:23)(cid:16)(cid:24)(cid:7) pro(cid:88)i(cid:70)er(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:24)(cid:11) (cid:12) Did the patient receive the routine-priority specialty service within (cid:27)(cid:18) calen(cid:70)ar (cid:70)a(cid:91)s of t(cid:74)e pri(cid:79)ar(cid:91) care pro(cid:88)i(cid:70)er or(cid:70)er or (cid:50)(cid:74)(cid:91)sician (cid:26) (cid:25) 0 (cid:23)(cid:21)(cid:16)(cid:21)(cid:7) (cid:52)e(cid:83)(cid:87)est for Ser(cid:88)ice(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:25)(cid:11) (cid:12) Did the institution receive and did the primary care provider review the routine-priority specialty service consultant report within the (cid:23) (cid:25) 3 (cid:22)(cid:19)(cid:16)(cid:25)(cid:7) re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)e(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:26)(cid:11) (cid:12) (cid:38)i(cid:70) t(cid:74)e patient recei(cid:88)e t(cid:74)e s(cid:87)(cid:68)se(cid:83)(cid:87)ent follo(cid:89)(cid:15)(cid:87)p to t(cid:74)e ro(cid:87)tine(cid:15) priority specialty service appointment as ordered by the primary care 3 2 (cid:19)(cid:18) (cid:24)(cid:18)(cid:16)(cid:18)(cid:7) pro(cid:88)i(cid:70)er(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:27)(cid:11) (cid:12) (cid:40)or en(cid:70)orse(cid:70) patients recei(cid:88)e(cid:70) fro(cid:79) anot(cid:74)er C(cid:38)C(cid:52) instit(cid:87)tion(cid:28) If the patient was approved for a specialty services appointment at the 2 (cid:25) (cid:19) (cid:20)(cid:20)(cid:16)(cid:20)(cid:7) sending institution, was the appointment scheduled at the receiving instit(cid:87)tion (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:19)(cid:18)(cid:11) (cid:12) (cid:38)i(cid:70) t(cid:74)e instit(cid:87)tion (cid:70)en(cid:91) t(cid:74)e pri(cid:79)ar(cid:91) care pro(cid:88)i(cid:70)er(cid:111)s re(cid:83)(cid:87)est for (cid:19)(cid:18) 2 0 (cid:26)(cid:21)(cid:16)(cid:21)(cid:7) specialt(cid:91) ser(cid:88)ices (cid:89)it(cid:74)in re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:19)(cid:19)(cid:11) (cid:40)ollo(cid:89)in(cid:73) t(cid:74)e (cid:70)enial of a re(cid:83)(cid:87)est for specialt(cid:91) ser(cid:88)ices, (cid:89)as t(cid:74)e patient infor(cid:79)e(cid:70) of t(cid:74)e (cid:70)enial (cid:89)it(cid:74)in t(cid:74)e re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)e(cid:33) (cid:26) 4 0 (cid:24)(cid:24)(cid:16)(cid:25)(cid:7) (cid:10)(cid:19)(cid:22)(cid:16)(cid:18)(cid:19)(cid:20)(cid:11) Overall percentage (MIT 14): 61.4% (cid:12) (cid:54)(cid:74)e OIG clinicians consi(cid:70)ere(cid:70) t(cid:74)ese co(cid:79)pliance tests alon(cid:73) (cid:89)it(cid:74) t(cid:74)eir case re(cid:88)ie(cid:89) fin(cid:70)in(cid:73)s (cid:89)(cid:74)en (cid:70)eter(cid:79)inin(cid:73) t(cid:74)e (cid:83)(cid:87)alit(cid:91) ratin(cid:73) for t(cid:74)is in(cid:70)icator(cid:16) So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:25)(cid:19) Table 18. Other Tests Related to Specialty Services Scored Answer Compliance Questions Yes No N/A Yes % Specialty service follow-up appointments: Did the clinician follow-up (cid:20)(cid:23) (cid:19)(cid:21) (cid:25) (cid:24)(cid:23)(cid:16)(cid:26)(cid:7) (cid:88)isits occ(cid:87)r (cid:89)it(cid:74)in re(cid:83)(cid:87)ire(cid:70) ti(cid:79)e fra(cid:79)es(cid:33) (cid:10)(cid:19)(cid:16)(cid:18)(cid:18)(cid:26)(cid:11) *, † Are specialty documents scanned into the patient’s electronic health 24 6 (cid:19)(cid:23) (cid:26)(cid:18)(cid:16)(cid:18)(cid:7) recor(cid:70) (cid:89)it(cid:74)in fi(cid:88)e calen(cid:70)ar (cid:70)a(cid:91)s of t(cid:74)e enco(cid:87)nter (cid:70)ate(cid:33) (cid:10)(cid:22)(cid:16)(cid:18)(cid:18)(cid:20)(cid:11) (cid:12) (cid:12) (cid:54)(cid:74)e OIG clinicians consi(cid:70)ere(cid:70) t(cid:74)ese co(cid:79)pliance tests alon(cid:73) (cid:89)it(cid:74) t(cid:74)eir o(cid:89)n case re(cid:88)ie(cid:89) fin(cid:70)in(cid:73)s (cid:89)(cid:74)en (cid:70)eter(cid:79)inin(cid:73) t(cid:74)e (cid:83)(cid:87)alit(cid:91) ratin(cid:73) for t(cid:74)is in(cid:70)icator(cid:16) † CC(cid:42)CS c(cid:74)an(cid:73)e(cid:70) its specialt(cid:91) policies in (cid:35)pril (cid:20)(cid:18)(cid:19)(cid:27), re(cid:79)o(cid:88)in(cid:73) t(cid:74)e re(cid:83)(cid:87)ire(cid:79)ent for pri(cid:79)ar(cid:91) care p(cid:74)(cid:91)sician follo(cid:89)(cid:15)(cid:87)p (cid:88)isits follo(cid:89)in(cid:73) (cid:79)ost specialt(cid:91) ser(cid:88)ices(cid:16) (cid:35)s a res(cid:87)lt, (cid:89)e test (cid:19)(cid:16)(cid:18)(cid:18)(cid:26) onl(cid:91) for (cid:74)i(cid:73)(cid:74)(cid:15)priorit(cid:91) specialt(cid:91) ser(cid:88)ices or (cid:89)(cid:74)en t(cid:74)e staff or(cid:70)ers (cid:50)C(cid:50) or (cid:50)C (cid:52)(cid:48) follo(cid:89)(cid:15)(cid:87)ps(cid:16) (cid:54)(cid:74)e OIG contin(cid:87)es to test t(cid:74)e clinical appropriateness of specialty follow-ups through its case review testing. So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:25)(cid:20) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Administrative Operations In this indicator, OIG compliance inspectors evaluated health care administrative processes. Our inspectors examined the timeliness of Administrative Operations the medical grievance process and checked whether the institution Overall followed reporting requirements for adverse or sentinel events and Rating In this indicator, OIG compliance inspectors evaluated health care patient deaths. Inspectors checked whether the Emergency Medical Inadequate administrative processes. Our inspectors examined the timeliness of Response Review Committee (EMRRC) met and reviewed incident the medical grievance process and checked whether the institution packages. We investigated and determined if the institution conducted Case Review followed reporting requirements for adverse or sentinel events and the required emergency response drills. Inspectors also assessed whether Rating patient deaths. Inspectors checked whether the Emergency Medical the Quality Management Committee (QMC) met regularly and addressed (N/A) Response Review Committee (EMRRC) met and reviewed incident program performance adequately. In addition, the inspectors examined packages. We investigated and determined if the institution conducted if the institution provided training and job performance reviews for Compliance the required emergency response drills. Inspectors also assessed whether its employees. They checked whether staff possessed current, valid Score the Quality Management Committee (QMC) met regularly and addressed professional licenses, certifications, and credentials. The OIG rated this Inadequate program performance adequately. In addition, the inspectors examined indicator solely based on the compliance score, using the same scoring (74.0%) if the institution provided training and job performance reviews for thresholds as in the Cycle 4 and Cycle 5 medical inspections. Our case its employees. They checked whether staff possessed current, valid review clinicians do not rate this indicator. professional licenses, certifications, and credentials. The OIG rated this Because none of the tests in this indicator affected clinical patient indicator solely based on the compliance score, using the same scoring care directly (it is a secondary indicator), the OIG did not consider thresholds as in the Cycle 4 and Cycle 5 medical inspections. Our case this indicator’s rating when determining the institution’s overall review clinicians do not rate this indicator. quality rating. Because none of the tests in this indicator affected clinical patient care directly (it is a secondary indicator), the OIG did not consider this indicator’s rating when determining the institution’s overall quality rating. Results Overview CCI’s performance worsened compared with Cycle 5. Although CCI scored 100 percent in some applicable testing areas, it struggled with others. Emergency drill packages did not include the required documents. Staff did not utilize the correct forms for the initial death reports. The physician managers only sometimes completed the annual performance appraisals in a timely manner. These findings are set forth in the table on the following page. We rated this indicator inadequate. Nonscored Results At CCI, the OIG did not have any applicable adverse sentinel events requiring root-cause analysis during the inspection period (MIT 15.001). We obtained CCHCS Death Review Committee (DRC) reporting data. Five unexpected (Level 1) deaths occurred during our review period. The DRC must complete its death review summary report within 60 calendar days of a death. When the DRC completes the death review summary report, it must submit the report to the institution’s CEO within seven calendar days of completion. In our inspection, we found the DRC did not complete any death review reports promptly; the DRC finished five reports between 16 and 112 days late, and submitted them to the institution’s CEO between nine and 105 days after that (MIT 15.998). Recommendations The OIG offers no specific recommendations for this indicator. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:25)(cid:21) Table 19. Administrative Operations Scored Answer Compliance Questions Yes No N/A Yes % (cid:40)or (cid:74)ealt(cid:74) care inci(cid:70)ents re(cid:83)(cid:87)irin(cid:73) root ca(cid:87)se anal(cid:91)sis (cid:10)(cid:52)C(cid:35)(cid:11)(cid:28) (cid:38)i(cid:70) t(cid:74)e (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) instit(cid:87)tion (cid:79)eet (cid:52)C(cid:35) reportin(cid:73) re(cid:83)(cid:87)ire(cid:79)ents(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:18)(cid:18)(cid:19)(cid:11) (cid:12) (cid:38)i(cid:70) t(cid:74)e instit(cid:87)tion(cid:111)s (cid:51)(cid:87)alit(cid:91) (cid:47)ana(cid:73)e(cid:79)ent Co(cid:79)(cid:79)ittee (cid:10)(cid:51)(cid:47)C(cid:11) (cid:79)eet (cid:23) (cid:19) 0 (cid:26)(cid:21)(cid:16)(cid:21)(cid:7) (cid:79)ont(cid:74)l(cid:91)(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:18)(cid:18)(cid:20)(cid:11) (cid:40)or (cid:39)(cid:79)er(cid:73)enc(cid:91) (cid:47)e(cid:70)ical (cid:52)esponse (cid:52)e(cid:88)ie(cid:89) Co(cid:79)(cid:79)ittee (cid:10)(cid:39)(cid:47)(cid:52)(cid:52)C(cid:11) re(cid:88)ie(cid:89)e(cid:70) cases(cid:28) (cid:38)i(cid:70) t(cid:74)e (cid:39)(cid:47)(cid:52)(cid:52)C re(cid:88)ie(cid:89) t(cid:74)e cases ti(cid:79)el(cid:91), an(cid:70) (cid:70)i(cid:70) (cid:27) 3 0 (cid:25)(cid:23)(cid:16)(cid:18)(cid:7) t(cid:74)e inci(cid:70)ent pac(cid:77)a(cid:73)es t(cid:74)e co(cid:79)(cid:79)ittee re(cid:88)ie(cid:89)e(cid:70) incl(cid:87)(cid:70)e t(cid:74)e re(cid:83)(cid:87)ire(cid:70) (cid:70)oc(cid:87)(cid:79)ents(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:18)(cid:18)(cid:21)(cid:11) (cid:40)or instit(cid:87)tions (cid:89)it(cid:74) license(cid:70) care facilities(cid:28) (cid:38)i(cid:70) t(cid:74)e (cid:46)ocal Go(cid:88)ernin(cid:73) (cid:36)o(cid:70)(cid:91) (cid:10)(cid:46)G(cid:36)(cid:11) or its e(cid:83)(cid:87)i(cid:88)alent (cid:79)eet (cid:83)(cid:87)arterl(cid:91) an(cid:70) (cid:70)isc(cid:87)ss local (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) (cid:48)(cid:17)(cid:35) operatin(cid:73) proce(cid:70)(cid:87)res an(cid:70) an(cid:91) applica(cid:68)le policies(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:18)(cid:18)(cid:22)(cid:11) Did the institution conduct medical emergency response drills during eac(cid:74) (cid:89)atc(cid:74) of t(cid:74)e (cid:79)ost recent (cid:83)(cid:87)arter, an(cid:70) (cid:70)i(cid:70) (cid:74)ealt(cid:74) care an(cid:70) 0 3 0 0 c(cid:87)sto(cid:70)(cid:91) staff participate in t(cid:74)ose (cid:70)rills(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:19)(cid:11) Did the responses to medical grievances address all of the inmates’ (cid:19)(cid:18) 0 0 (cid:19)(cid:18)(cid:18)(cid:7) appeale(cid:70) iss(cid:87)es(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:20)(cid:11) Did the medical staff review and submit initial inmate death reports (cid:23) 0 0 (cid:19)(cid:18)(cid:18)(cid:7) to t(cid:74)e CC(cid:42)CS (cid:38)eat(cid:74) (cid:52)e(cid:88)ie(cid:89) (cid:55)nit on ti(cid:79)e(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:21)(cid:11) Did nurse managers ensure the clinical competency of nurses who (cid:19)(cid:18) 0 0 (cid:19)(cid:18)(cid:18)(cid:7) a(cid:70)(cid:79)inister (cid:79)e(cid:70)ications(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:22)(cid:11) Did physician managers complete provider clinical performance 3 (cid:25) 0 (cid:21)(cid:18)(cid:16)(cid:18)(cid:7) appraisals ti(cid:79)el(cid:91)(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:23)(cid:11) (cid:38)i(cid:70) t(cid:74)e pro(cid:88)i(cid:70)ers (cid:79)aintain (cid:88)ali(cid:70) state (cid:79)e(cid:70)ical licenses(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:24)(cid:11) (cid:19)(cid:23) 0 0 (cid:19)(cid:18)(cid:18)(cid:7) (cid:38)i(cid:70) t(cid:74)e staff (cid:79)aintain (cid:88)ali(cid:70) Car(cid:70)iop(cid:87)l(cid:79)onar(cid:91) (cid:52)es(cid:87)scitation (cid:10)C(cid:50)(cid:52)(cid:11), Basic Life Support (BLS), and Advanced Cardiac Life Support (ACLS) 2 0 (cid:19) (cid:19)(cid:18)(cid:18)(cid:7) certifications(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:25)(cid:11) Did the nurses and the pharmacist-in-charge (PIC) maintain valid professional licenses an(cid:70) certifications, an(cid:70) (cid:70)i(cid:70) t(cid:74)e p(cid:74)ar(cid:79)ac(cid:91) 6 0 (cid:19) (cid:19)(cid:18)(cid:18)(cid:7) (cid:79)aintain a (cid:88)ali(cid:70) correctional p(cid:74)ar(cid:79)ac(cid:91) license(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:26)(cid:11) Did the pharmacy and the providers maintain valid Drug Enforcement (cid:19) 0 0 (cid:19)(cid:18)(cid:18)(cid:7) (cid:35)(cid:73)enc(cid:91) (cid:10)(cid:38)(cid:39)(cid:35)(cid:11) re(cid:73)istration certificates(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:27)(cid:11) Did nurse managers ensure their newly hired nurses received the 0 (cid:19) 0 0 re(cid:83)(cid:87)ire(cid:70) on(cid:68)oar(cid:70)in(cid:73) an(cid:70) clinical co(cid:79)petenc(cid:91) trainin(cid:73)(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:19)(cid:19)(cid:18)(cid:11) This is a nonscored test. Please (cid:38)i(cid:70) t(cid:74)e CC(cid:42)CS (cid:38)eat(cid:74) (cid:52)e(cid:88)ie(cid:89) Co(cid:79)(cid:79)ittee process (cid:70)eat(cid:74) re(cid:88)ie(cid:89) refer to the discussion in this reports ti(cid:79)el(cid:91)(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:27)(cid:27)(cid:26)(cid:11) indicator. This is a nonscored test. Please (cid:57)(cid:74)at (cid:89)as t(cid:74)e instit(cid:87)tion(cid:111)s (cid:74)ealt(cid:74) care staffin(cid:73) at t(cid:74)e ti(cid:79)e of t(cid:74)e OIG refer to Table 4 for CCHCS- (cid:79)e(cid:70)ical inspection(cid:33) (cid:10)(cid:19)(cid:23)(cid:16)(cid:27)(cid:27)(cid:27)(cid:11) pro(cid:88)i(cid:70)e(cid:70) staffin(cid:73) infor(cid:79)ation(cid:16) Overall percentage (MIT 15): 74.0% (cid:12) (cid:39)ffecti(cid:88)e (cid:47)arc(cid:74) (cid:20)(cid:18)(cid:20)(cid:19), t(cid:74)is test (cid:89)as for infor(cid:79)ational p(cid:87)rposes onl(cid:91)(cid:16) So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection res(cid:87)lts(cid:16) Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:25)(cid:22) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport (This page left blank for reproduction purposes.) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents California Correctional Institution (cid:25)(cid:23) Appendix A: Methodology In designing the medical inspection program, the OIG met with stakeholders to review CCHCS policies and procedures, relevant court orders, and guidance developed by the American Correctional Association. We also reviewed professional literature on correctional medical care; reviewed standardized performance measures used by the health care industry; consulted with clinical experts; and met with stakeholders from the court, the receiver’s office, the department, the Office of the Attorney General, and the Prison Law Office to discuss the nature and scope of our inspection program. With input from these stakeholders, the OIG developed a medical inspection program that evaluates the delivery of medical care by combining clinical case reviews of patient files, objective tests of compliance with policies and procedures, and an analysis of outcomes for certain population-based metrics. We rate each of the quality indicators applicable to the institution under inspection based on case reviews conducted by our clinicians or compliance tests conducted by our registered nurses. Figure A–1 below depicts the intersection of case review and compliance. Figure A–1. Inspection Indicator Review Distribution for CCI Access to Care Emergency Health Care W Services Diagnostic Services Environment C O E I M V Health Information Management P E Nursing Preventive L R Performance Services I Transfers A E N S C A C Provider Medication Management Administrative E Performance Operations Specialty Services SSoo(cid:87)(cid:87)rrccee(cid:28)(cid:28) (cid:54)(cid:54)(cid:74)(cid:74)ee OOfffificcee ooff tt(cid:74)(cid:74)ee IInnssppeeccttoorr GGeenneerraall (cid:79)(cid:79)ee(cid:70)(cid:70)iiccaall iinnssppeeccttiioonn rreess(cid:87)(cid:87)llttss(cid:16)(cid:16) Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:25)(cid:24) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Case Reviews The OIG added case reviews to the Cycle 4 medical inspections at the recommendation of its stakeholders, which continues in the Cycle 6 medical inspections. Below, Table A–1 provides important definitions that describe this process. Table A–1. Case Review Definitions The medical care provided to one patient over a Case, Sample, specific(cid:124)perio(cid:70), (cid:89)(cid:74)ic(cid:74) can co(cid:79)prise (cid:70)etaile(cid:70) or foc(cid:87)se(cid:70) or Patient case reviews. A review that includes all aspects of one patient’s medical care assesse(cid:70) o(cid:88)er a si(cid:90)(cid:15)(cid:79)ont(cid:74) perio(cid:70)(cid:16) (cid:54)(cid:74)is re(cid:88)ie(cid:89) allo(cid:89)s Comprehensive t(cid:74)e OIG clinicians to e(cid:90)a(cid:79)ine (cid:79)an(cid:91) areas of (cid:74)ealt(cid:74) care Case Review delivery, such as access to care, diagnostic services, health infor(cid:79)ation (cid:79)ana(cid:73)e(cid:79)ent, an(cid:70) specialt(cid:91)(cid:124)ser(cid:88)ices(cid:16) (cid:35) re(cid:88)ie(cid:89) t(cid:74)at foc(cid:87)ses on one specific aspect of (cid:79)e(cid:70)ical Focused care. This review tends to concentrate on a singular Case Review facet of patient care, such as the sick call process or the institution’s emergency medical response. A direct or indirect interaction between the patient and t(cid:74)e (cid:74)ealt(cid:74) care s(cid:91)ste(cid:79)(cid:16) (cid:39)(cid:90)a(cid:79)ples of (cid:70)irect interactions Event include provider encounters and nurse encounters. An e(cid:90)a(cid:79)ple of an in(cid:70)irect interaction incl(cid:87)(cid:70)es a pro(cid:88)i(cid:70)er reviewing a diagnostic test and placing additional orders. A medical error in procedure or in clinical judgment. Both Case Review procedural and clinical judgment errors can result in policy Deficiency noncompliance, elevated risk of patient harm, or both. Adverse Event An event that caused harm to the patient. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:25)(cid:25) The OIG eliminates case review selection bias by sampling using a rigid methodology. No case reviewer selects the samples he or she reviews. Because the case reviewers are excluded from sample selection, there is no possibility of selection bias. Instead, nonclinician analysts use a standardized sampling methodology to select most of the case review samples. A randomizer is used when applicable. For most basic institutions, the OIG samples 20 comprehensive physician review cases. For institutions with larger high-risk populations, 25 cases are sampled. For the California Health Care Facility, 30 cases are sampled. Case Review Sampling Methodology We obtain a substantial amount of health care data from the inspected institution and from CCHCS. Our analysts then apply filters to identify clinically complex patients with the highest need for medical services. These filters include patients classified by CCHCS with high medical risk, patients requiring hospitalization or emergency medical services, patients arriving from a county jail, patients transferring to and from other departmental institutions, patients with uncontrolled diabetes or uncontrolled anticoagulation levels, patients requiring specialty services or who died or experienced a sentinel event (unexpected occurrences resulting in high risk of, or actual, death or serious injury), patients requiring specialized medical housing placement, patients requesting medical care through the sick call process, and patients requiring prenatal or postpartum care. After applying filters, analysts follow a standardized protocol and select samples for clinicians to review. Samples are obtained per the case review methodology shared with stakeholders in prior cycles. Our physician and nurse reviewers test the samples by performing comprehensive or focused case reviews. Case Review Testing Methodology An OIG physician, a nurse consultant, or both review each case. As the clinicians review medical records, they record pertinent interactions between the patient and the health care system. We refer to these interactions as case review events. Our clinicians also record medical errors, which we refer to as case review deficiencies. Deficiencies can be minor or significant, depending on the severity of the deficiency. If a deficiency caused serious patient harm, we classify the error as an adverse event. On the next page, Figure A–2 depicts the scenarios that can lead to these different events. After the clinician inspectors review all the cases, they analyze the deficiencies, then summarize their findings in one or more of the health care indicators in this report. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:25)(cid:26) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Figure A–2. Case Review Testing (cid:54)(cid:74)e OIG clinicians e(cid:90)a(cid:79)ine t(cid:74)e c(cid:74)osen sa(cid:79)ples, perfor(cid:79)in(cid:73) eit(cid:74)er a comprehensive case review or a focused case review, to determine the events that occurred. Sample = Patient = Case No Deficiency or Minor Deficiency Sample Events Significant Deficiency * A sample leading to events Deficiencies (cid:48)ot all e(cid:88)ents lea(cid:70) to (cid:70)eficiencies (cid:10)(cid:79)e(cid:70)ical errors(cid:11)(cid:29) (cid:74)o(cid:89)e(cid:88)er, if errors (cid:70)i(cid:70) occur, then the OIG clinicians determine whether any were adverse. Significant Sample Events Deficiency * A sample leading to events that could cause harm Did the event cause harm to the patient? * If an event (in this case, a si(cid:73)nificant (cid:70)eficienc(cid:91)(cid:11) ca(cid:87)se(cid:70) (cid:74)ar(cid:79), t(cid:74)e(cid:124)OIG clinician la(cid:68)els it adverse. Yes No AAddvveerrssee Significant EEvveenntt Deficiency So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection anal(cid:91)sis(cid:16) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:25)(cid:27) Compliance Testing Compliance Sampling Methodology Our analysts identify samples for both our case review inspectors and compliance inspectors. Analysts follow a detailed selection methodology. For most compliance questions, we use sample sizes of approximately 25 to 30. Figure A–3 below depicts the relationships and activities of this process. Figure A–3. Compliance Sampling Methodology Total Patient Population Filters Subpopulation Randomize Sample Flagging So(cid:87)rce(cid:28) (cid:54)(cid:74)e Office of t(cid:74)e Inspector General (cid:79)e(cid:70)ical inspection anal(cid:91)sis(cid:16) Compliance Testing Methodology Our inspectors answer a set of predefined medical inspection tool (MIT) questions to determine the institution’s compliance with CCHCS policies and procedures. Our nurse inspectors assign a Yes or a No answer to each scored question. Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:26)(cid:18) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport OIG headquarters nurse inspectors review medical records to obtain information, allowing them to answer most of the MIT questions. Our regional nurses visit and inspect each institution. They interview health care staff, observe medical processes, test the facilities and clinics, review employee records, logs, medical grievances, death reports, and other documents, and also obtain information regarding plant infrastructure and local operating procedures. Scoring Methodology Our compliance team calculates the percentage of all Yes answers for each of the questions applicable to a particular indicator, then averages the scores. The OIG continues to rate these indicators based on the average compliance score using the following descriptors: proficient (85.0 percent or greater), adequate (between 84.9 percent and 75.0 percent), or inadequate (less than 75.0 percent). Indicator Ratings and the Overall Medical Quality Rating To reach an overall quality rating, our inspectors collaborate and examine all the inspection findings. We consider the case review and the compliance testing results for each indicator. After considering all the findings, our inspectors reach consensus on an overall rating for the institution. Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:26)(cid:19) Appendix B: Case Review Data Table B–1. CCI Case Review Sample Sets Sample Set Total Anticoagulation 3 CTC (cid:17) OHU 0 (cid:38)eat(cid:74) (cid:52)e(cid:88)ie(cid:89) (cid:17) Sentinel Events 2 Diabetes 3 (cid:39)(cid:79)er(cid:73)enc(cid:91) Ser(cid:88)ices (cid:115) C(cid:50)(cid:52) 4 (cid:39)(cid:79)er(cid:73)enc(cid:91) Ser(cid:88)ices (cid:115) (cid:48)on(cid:15)C(cid:50)(cid:52) 2 (cid:42)i(cid:73)(cid:74) (cid:52)is(cid:77) 4 Hospitalization 4 Intrasystem Transfers In 3 Intrasystem Transfers Out 3 (cid:52)(cid:48) Sic(cid:77) Call (cid:19)(cid:23) Specialty Services 2 45 Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:26)(cid:20) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Table B–2. CCI Case Review Chronic Care Diagnoses Diagnosis Total Anticoagulation 4 (cid:35)rt(cid:74)ritis(cid:17)(cid:38)e(cid:73)enerati(cid:88)e (cid:44)oint (cid:38)isease 3 Asthma 4 CO(cid:56)I(cid:38)(cid:15)(cid:19)(cid:27) (cid:23) Cardiovascular Disease 3 Chronic Kidney Disease (cid:19) Chronic Pain (cid:19)(cid:20) Cirr(cid:74)osis(cid:17)(cid:39)n(cid:70)(cid:15)Sta(cid:73)e (cid:46)i(cid:88)er (cid:38)isease 3 Coccidioidomycosis (cid:19) (cid:38)eep (cid:56)eno(cid:87)s (cid:54)(cid:74)ro(cid:79)(cid:68)osis(cid:17)(cid:50)(cid:87)l(cid:79)onar(cid:91) (cid:39)(cid:79)(cid:68)olis(cid:79) (cid:19) Diabetes 6 Gastroesop(cid:74)a(cid:73)eal (cid:52)e(cid:387)(cid:87)(cid:90) (cid:38)isease (cid:23) Hepatitis C (cid:19)(cid:23) Hyperlipidemia (cid:19)(cid:22) Hypertension (cid:19)(cid:26) Mental Health (cid:20)(cid:19) Migraine Headaches (cid:19) Seizure Disorder (cid:19) Sleep Apnea (cid:19) Substance Abuse (cid:19)(cid:24) 135 Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:26)(cid:21) Table B–3. CCI Case Review Events by Program Diagnosis Total Diagnostic Services (cid:19)(cid:25)(cid:27) Emergency Care (cid:23)(cid:19) Hospitalization (cid:21)(cid:25) Intrasystem Transfers In (cid:19)(cid:25) Intrasystem Transfers Out 6 (cid:48)ot Specifie(cid:70) 2 Outpatient Care (cid:22)(cid:19)(cid:27) Specialized Medical Housing 0 Specialty Services (cid:23)(cid:18) 761 Table B–4. CCI Case Review Sample Summary (cid:47)(cid:38) (cid:52)e(cid:88)ie(cid:89)s (cid:38)etaile(cid:70) (cid:20)(cid:19) (cid:47)(cid:38) (cid:52)e(cid:88)ie(cid:89)s (cid:40)oc(cid:87)se(cid:70) 0 (cid:52)(cid:48) (cid:52)e(cid:88)ie(cid:89)s (cid:38)etaile(cid:70) (cid:26) (cid:52)(cid:48) (cid:52)e(cid:88)ie(cid:89)s (cid:40)oc(cid:87)se(cid:70) (cid:20)(cid:23) (cid:54)otal (cid:52)e(cid:88)ie(cid:89)s (cid:23)(cid:22) (cid:54)otal (cid:55)ni(cid:83)(cid:87)e Cases (cid:22)(cid:23) O(cid:88)erlappin(cid:73) (cid:52)e(cid:88)ie(cid:89)s (cid:10)(cid:47)(cid:38) (cid:8) (cid:52)(cid:48)(cid:11) (cid:27) Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:26)(cid:22) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Appendix C: Compliance Sampling Methodology California Correctional Institution Quality No. of Indicator Sample Category Samples Data Source Filters Access to Care (cid:47)I(cid:54)(cid:124)(cid:19)(cid:16)(cid:18)(cid:18)(cid:19) Chronic Care (cid:20)(cid:23) (cid:47)aster (cid:52)e(cid:73)istr(cid:91) • Chronic care conditions (at least Patients one condition per patient — any risk level) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:47)I(cid:54)(cid:124)(cid:19)(cid:16)(cid:18)(cid:18)(cid:20) (cid:48)(cid:87)rsin(cid:73) (cid:52)eferrals (cid:20)(cid:23) OIG (cid:51)(cid:28) (cid:24)(cid:16)(cid:18)(cid:18)(cid:19) • See Transfers (cid:47)I(cid:54)s(cid:124)(cid:19)(cid:16)(cid:18)(cid:18)(cid:21) (cid:115) (cid:18)(cid:18)(cid:24) Nursing Sick Call 30 Clinic • Clinic (each clinic tested) (6 per clinic) Appointment List • (cid:35)ppoint(cid:79)ent (cid:70)ate (cid:10)(cid:20) (cid:115) (cid:27) (cid:79)ont(cid:74)s(cid:11) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:47)I(cid:54)(cid:124)(cid:19)(cid:16)(cid:18)(cid:18)(cid:25) (cid:52)et(cid:87)rns (cid:40)ro(cid:79) (cid:20)(cid:23) OIG (cid:51)(cid:28) (cid:22)(cid:16)(cid:18)(cid:18)(cid:23) • See Health Information Community Management (cid:10)(cid:47)e(cid:70)ical (cid:52)ecor(cid:70)s(cid:11) Hospital (returns from community hospital) (cid:47)I(cid:54)(cid:124)(cid:19)(cid:16)(cid:18)(cid:18)(cid:26) Specialty Services (cid:22)(cid:23) OIG (cid:51)(cid:28) (cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:19), • See Specialty Services (cid:40)ollo(cid:89)(cid:15)(cid:55)p (cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:22) (cid:8) (cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:25) (cid:47)I(cid:54)(cid:124)(cid:19)(cid:16)(cid:19)(cid:18)(cid:19) Availability of 6 OIG on-site review • (cid:52)an(cid:70)o(cid:79)l(cid:91) select one (cid:74)o(cid:87)sin(cid:73) (cid:87)nit Health Care from each yard Ser(cid:88)ices (cid:52)e(cid:83)(cid:87)est (cid:40)or(cid:79)s Diagnostic Services (cid:47)I(cid:54)s (cid:20)(cid:16)(cid:18)(cid:18)(cid:19) (cid:115) (cid:18)(cid:18)(cid:21) (cid:52)a(cid:70)iolo(cid:73)(cid:91) (cid:19)(cid:18) (cid:52)a(cid:70)iolo(cid:73)(cid:91) (cid:46)o(cid:73)s • Appointment date (cid:10)(cid:27)(cid:18) (cid:70)a(cid:91)s (cid:115) (cid:27) (cid:79)ont(cid:74)s(cid:11) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e • Abnormal MITs 2.004 – 006 Laboratory (cid:19)(cid:18) (cid:51)(cid:87)est • (cid:35)ppt(cid:16) (cid:70)ate (cid:10)(cid:27)(cid:18) (cid:70)a(cid:91)s (cid:115) (cid:27) (cid:79)ont(cid:74)s(cid:11) • Order name (CBC or CMPs only) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e • Abnormal (cid:47)I(cid:54)s (cid:20)(cid:16)(cid:18)(cid:18)(cid:25) (cid:115) (cid:18)(cid:18)(cid:27) Laboratory STAT (cid:51)(cid:87)est • (cid:35)ppt(cid:16) (cid:70)ate (cid:10)(cid:27)(cid:18) (cid:70)a(cid:91)s (cid:115) (cid:27) (cid:79)ont(cid:74)s(cid:11) • Order name (CBC or CMPs only) 0 • (cid:52)an(cid:70)o(cid:79)i(cid:92)e • Abnormal (cid:47)I(cid:54)s (cid:20)(cid:16)(cid:18)(cid:19)(cid:18) (cid:115) (cid:18)(cid:19)(cid:20) Pathology (cid:19)(cid:18) Inter(cid:51)(cid:87)al • (cid:35)ppt(cid:16) (cid:70)ate (cid:10)(cid:27)(cid:18) (cid:70)a(cid:91)s (cid:115) (cid:27) (cid:79)ont(cid:74)s(cid:11) • Service (pathology related) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:26)(cid:23) Quality No. of Indicator Sample Category Samples Data Source Filters Health Information Management (Medical Records) (cid:47)I(cid:54)(cid:124)(cid:22)(cid:16)(cid:18)(cid:18)(cid:19) Health Care Services 30 OIG (cid:51)s(cid:28) (cid:19)(cid:16)(cid:18)(cid:18)(cid:22) • Nondictated documents (cid:52)e(cid:83)(cid:87)est (cid:40)or(cid:79)s • (cid:40)irst (cid:20)(cid:18) I(cid:50)s for (cid:47)I(cid:54)(cid:124)(cid:19)(cid:16)(cid:18)(cid:18)(cid:22) (cid:47)I(cid:54)(cid:124)(cid:22)(cid:16)(cid:18)(cid:18)(cid:20) Specialty Documents (cid:22)(cid:23) OIG (cid:51)s(cid:28) (cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:20), • Specialty documents (cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:23) (cid:8) (cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:26) • (cid:40)irst (cid:19)(cid:18) I(cid:50)s for eac(cid:74) (cid:83)(cid:87)estion (cid:47)I(cid:54)(cid:124)(cid:22)(cid:16)(cid:18)(cid:18)(cid:21) Hospital Discharge (cid:20)(cid:23) OIG (cid:51)(cid:28) (cid:22)(cid:16)(cid:18)(cid:18)(cid:23) • Community hospital discharge Documents documents • (cid:40)irst (cid:20)(cid:18) I(cid:50)s selecte(cid:70) (cid:47)I(cid:54)(cid:124)(cid:22)(cid:16)(cid:18)(cid:18)(cid:22) Scanning Accuracy 24 Documents for any • (cid:35)n(cid:91) (cid:79)isfile(cid:70) or (cid:79)isla(cid:68)ele(cid:70) tested inmate (cid:70)oc(cid:87)(cid:79)ent i(cid:70)entifie(cid:70) (cid:70)(cid:87)rin(cid:73) OIG compliance review (24 or (cid:79)ore(cid:124)(cid:31)(cid:124)(cid:48)o(cid:11) (cid:47)I(cid:54)(cid:124)(cid:22)(cid:16)(cid:18)(cid:18)(cid:23) (cid:52)et(cid:87)rns (cid:40)ro(cid:79) (cid:20)(cid:23) CADDIS off-site • (cid:38)ate (cid:10)(cid:20) (cid:115) (cid:26) (cid:79)ont(cid:74)s(cid:11) Community Hospital Admissions • Most recent 6 months provided (within date range) • (cid:52)(cid:90) co(cid:87)nt • Discharge date • (cid:52)an(cid:70)o(cid:79)i(cid:92)e Health Care Environment (cid:47)I(cid:54)s(cid:124)(cid:23)(cid:16)(cid:19)(cid:18)(cid:19) (cid:115) (cid:19)(cid:18)(cid:23) Clinical Areas (cid:19)(cid:21) OIG inspector • Identify and inspect all on-site (cid:47)I(cid:54)s(cid:124)(cid:23)(cid:16)(cid:19)(cid:18)(cid:25) (cid:115) (cid:19)(cid:19)(cid:19) on-site review clinical areas. Transfers (cid:47)I(cid:54)s(cid:124)(cid:24)(cid:16)(cid:18)(cid:18)(cid:19) (cid:115) (cid:18)(cid:18)(cid:21) Intrasystem Transfers (cid:20)(cid:23) SOMS • (cid:35)rri(cid:88)al (cid:70)ate (cid:10)(cid:21) (cid:115) (cid:27) (cid:79)ont(cid:74)s(cid:11) • Arrived from (another departmental facility) • (cid:52)(cid:90) co(cid:87)nt • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:47)I(cid:54)(cid:124)(cid:24)(cid:16)(cid:19)(cid:18)(cid:19) Transfers Out 0 OIG inspector • (cid:52)(cid:8)(cid:52) I(cid:50) transfers (cid:89)it(cid:74) (cid:79)e(cid:70)ication on-site review Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:26)(cid:24) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Quality No. of Indicator Sample Category Samples Data Source Filters Pharmacy and Medication Management (cid:47)I(cid:54)(cid:124)(cid:25)(cid:16)(cid:18)(cid:18)(cid:19) Chronic Care (cid:20)(cid:23) OIG (cid:51)(cid:28) (cid:19)(cid:16)(cid:18)(cid:18)(cid:19) See Access to Care Medication • At least one condition per patient — any risk level • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:47)I(cid:54)(cid:124)(cid:25)(cid:16)(cid:18)(cid:18)(cid:20) New Medication (cid:20)(cid:23) (cid:47)aster (cid:52)e(cid:73)istr(cid:91) • (cid:52)(cid:90) co(cid:87)nt Orders • (cid:52)an(cid:70)o(cid:79)i(cid:92)e • Ensure no duplication of IPs teste(cid:70) in (cid:47)I(cid:54)(cid:124)(cid:25)(cid:16)(cid:18)(cid:18)(cid:19) (cid:47)I(cid:54)(cid:124)(cid:25)(cid:16)(cid:18)(cid:18)(cid:21) (cid:52)et(cid:87)rns (cid:40)ro(cid:79) (cid:20)(cid:23) OIG (cid:51)(cid:28) (cid:22)(cid:16)(cid:18)(cid:18)(cid:23) • See Health Information Community Hospital Management (cid:10)(cid:47)e(cid:70)ical (cid:52)ecor(cid:70)s(cid:11) (returns from community hospital) (cid:47)I(cid:54)(cid:124)(cid:25)(cid:16)(cid:18)(cid:18)(cid:22) (cid:52)C (cid:35)rri(cid:88)als (cid:116) (cid:48)(cid:17)(cid:35) at this OIG (cid:51)(cid:28) (cid:19)(cid:20)(cid:16)(cid:18)(cid:18)(cid:19) • See Reception Center Medication Orders institution (cid:47)I(cid:54)(cid:124)(cid:25)(cid:16)(cid:18)(cid:18)(cid:23) Intrafacility Moves (cid:20)(cid:23) MAPIP transfer • (cid:38)ate of transfer (cid:10)(cid:20) (cid:115) (cid:26) (cid:79)ont(cid:74)s(cid:11) data • (cid:54)o location(cid:17)fro(cid:79) location (cid:10)(cid:91)ar(cid:70) to (cid:91)ar(cid:70) an(cid:70) to(cid:17)fro(cid:79) (cid:35)S(cid:55)(cid:11) • (cid:52)e(cid:79)o(cid:88)e an(cid:91) to(cid:17)fro(cid:79) (cid:47)(cid:42)C(cid:36) • (cid:48)(cid:35)(cid:17)(cid:38)O(cid:54) (cid:79)e(cid:70)s (cid:10)an(cid:70) ris(cid:77) le(cid:88)el(cid:11) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:47)I(cid:54)(cid:124)(cid:25)(cid:16)(cid:18)(cid:18)(cid:24) (cid:39)n (cid:52)o(cid:87)te 0 SOMS • (cid:38)ate of transfer (cid:10)(cid:20)(cid:115) (cid:26) (cid:79)ont(cid:74)s(cid:11) • Sending institution (another departmental facility) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e • (cid:48)(cid:35)(cid:17)(cid:38)O(cid:54) (cid:79)e(cid:70)s (cid:47)I(cid:54)s (cid:25)(cid:16)(cid:19)(cid:18)(cid:19) (cid:115) (cid:19)(cid:18)(cid:21) Medication Storage (cid:56)aries OIG inspector • Identify and inspect clinical Areas by test on-site review (cid:8) (cid:79)e(cid:70) line areas t(cid:74)at store medications (cid:47)I(cid:54)s (cid:25)(cid:16)(cid:19)(cid:18)(cid:22) (cid:115) (cid:19)(cid:18)(cid:25) Medication (cid:56)aries OIG inspector • Identify and inspect on-site Preparation and by test on-site review clinical areas that prepare and Administration Areas administer medications (cid:47)I(cid:54)s (cid:25)(cid:16)(cid:19)(cid:18)(cid:26) (cid:115) (cid:19)(cid:19)(cid:19) Pharmacy (cid:19) OIG inspector • I(cid:70)entif(cid:91) (cid:8) inspect all on(cid:15)site on-site review pharmacies (cid:47)I(cid:54)(cid:124)(cid:25)(cid:16)(cid:19)(cid:19)(cid:20) Medication Error (cid:20)(cid:23) Medication error • All medication error reports with (cid:52)eportin(cid:73) reports (cid:46)e(cid:88)el(cid:124)(cid:22) or (cid:74)i(cid:73)(cid:74)er • Select total of (cid:20)(cid:23) (cid:79)e(cid:70)ication error reports (cid:10)recent (cid:19)(cid:20) (cid:79)ont(cid:74)s(cid:11) (cid:47)I(cid:54)(cid:124)(cid:25)(cid:16)(cid:27)(cid:27)(cid:27) (cid:52)estricte(cid:70) (cid:55)nit (cid:45)O(cid:50) (cid:19)(cid:18) On-site active • (cid:45)O(cid:50) resc(cid:87)e in(cid:74)alers (cid:8) Medications medication listing nitroglycerin medications for IPs housed in restricted units Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:26)(cid:25) Quality No. of Indicator Sample Category Samples Data Source Filters Prenatal and Postpartum Care (cid:47)I(cid:54)s(cid:124)(cid:26)(cid:16)(cid:18)(cid:18)(cid:19) (cid:115) (cid:18)(cid:18)(cid:25) (cid:52)ecent (cid:38)eli(cid:88)eries (cid:48)(cid:17)(cid:35) at this O(cid:36) (cid:52)oster • (cid:38)eli(cid:88)er(cid:91) (cid:70)ate (cid:10)(cid:20) (cid:115) (cid:19)(cid:20) (cid:79)ont(cid:74)s(cid:11) institution • Most recent deliveries (within date range) Pregnant Arrivals (cid:48)(cid:17)(cid:35) at this O(cid:36) (cid:52)oster • (cid:35)rri(cid:88)al (cid:70)ate (cid:10)(cid:20) (cid:115) (cid:19)(cid:20) (cid:79)ont(cid:74)s(cid:11) institution • Earliest arrivals (within date range) Preventive Services (cid:47)I(cid:54)s (cid:27)(cid:16)(cid:18)(cid:18)(cid:19) (cid:115) (cid:18)(cid:18)(cid:20) TB Medications (cid:19)(cid:20) (cid:47)a(cid:90)or • (cid:38)ispense (cid:70)ate (cid:10)past (cid:27) (cid:79)ont(cid:74)s(cid:11) • Time period on TB meds (cid:10)(cid:21)(cid:124)(cid:79)ont(cid:74)s or (cid:19)(cid:20) (cid:89)ee(cid:77)s(cid:11) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:47)I(cid:54)(cid:124)(cid:27)(cid:16)(cid:18)(cid:18)(cid:21) TB Evaluation, (cid:20)(cid:23) SOMS • (cid:35)rri(cid:88)al (cid:70)ate (cid:10)at least (cid:19) (cid:91)ear prior Annual Screening to inspection) • Birth month • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:47)I(cid:54)(cid:124)(cid:27)(cid:16)(cid:18)(cid:18)(cid:22) In(cid:387)(cid:87)en(cid:92)a (cid:20)(cid:23) SOMS • (cid:35)rri(cid:88)al (cid:70)ate (cid:10)at least (cid:19) (cid:91)ear prior (cid:56)accinations to inspection) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e • (cid:40)ilter o(cid:87)t I(cid:50)s teste(cid:70) in (cid:47)I(cid:54)(cid:124)(cid:27)(cid:16)(cid:18)(cid:18)(cid:26) (cid:47)I(cid:54)(cid:124)(cid:27)(cid:16)(cid:18)(cid:18)(cid:23) Colorectal Cancer (cid:20)(cid:23) SOMS • (cid:35)rri(cid:88)al (cid:70)ate (cid:10)at least (cid:19) (cid:91)ear prior Screening to inspection) • (cid:38)ate of (cid:68)irt(cid:74) (cid:10)(cid:23)(cid:19) or ol(cid:70)er(cid:11) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:47)I(cid:54)(cid:124)(cid:27)(cid:16)(cid:18)(cid:18)(cid:24) Mammogram (cid:48)(cid:17)(cid:35) at this SOMS • Arrival date (at least 2 yrs. prior institution to inspection) • (cid:38)ate of (cid:68)irt(cid:74) (cid:10)a(cid:73)e (cid:23)(cid:20) (cid:115) (cid:25)(cid:22)(cid:11) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:47)I(cid:54)(cid:124)(cid:27)(cid:16)(cid:18)(cid:18)(cid:25) Pap Smear (cid:48)(cid:17)(cid:35) at this SOMS • Arrival date (at least three yrs. institution prior to inspection) • (cid:38)ate of (cid:68)irt(cid:74) (cid:10)a(cid:73)e (cid:20)(cid:22) (cid:115) (cid:23)(cid:21)(cid:11) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:47)I(cid:54)(cid:124)(cid:27)(cid:16)(cid:18)(cid:18)(cid:26) Chronic Care (cid:20)(cid:23) OIG (cid:51)(cid:28) (cid:19)(cid:16)(cid:18)(cid:18)(cid:19) • Chronic care conditions (at least (cid:56)accinations (cid:19)(cid:124)con(cid:70)ition per I(cid:50) (cid:116) an(cid:91) ris(cid:77) le(cid:88)el(cid:11) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e • Con(cid:70)ition (cid:79)(cid:87)st re(cid:83)(cid:87)ire vaccination(s) (cid:47)I(cid:54)(cid:124)(cid:27)(cid:16)(cid:18)(cid:18)(cid:27) (cid:56)alle(cid:91) (cid:40)e(cid:88)er 0 Cocci transfer • (cid:52)eports fro(cid:79) past (cid:20) (cid:115) (cid:26) (cid:79)ont(cid:74)s (number will vary) status report • Institution • Ineligibility date (60 days prior to inspection date) • All Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:26)(cid:26) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Quality No. of Indicator Sample Category Samples Data Source Filters Reception Center (cid:47)I(cid:54)s (cid:19)(cid:20)(cid:16)(cid:18)(cid:18)(cid:19) (cid:115) (cid:18)(cid:18)(cid:26) (cid:52)C (cid:48)(cid:17)(cid:35) at this SOMS • (cid:35)rri(cid:88)al (cid:70)ate (cid:10)(cid:20) (cid:115) (cid:26) (cid:79)ont(cid:74)s(cid:11) institution • Arrived from (county jail, return from parole, etc.) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e Specialized Medical Housing (cid:47)I(cid:54)s (cid:19)(cid:21)(cid:16)(cid:18)(cid:18)(cid:19) (cid:115) (cid:18)(cid:18)(cid:22) Specialized Health (cid:48)(cid:17)(cid:35) at this CADDIS • (cid:35)(cid:70)(cid:79)it (cid:70)ate (cid:10)(cid:20) (cid:115) (cid:26) (cid:79)ont(cid:74)s(cid:11) Care Housing Unit institution • Type of stay (no MH beds) • Length of stay (minimum of (cid:23)(cid:124)(cid:70)a(cid:91)s(cid:11) • (cid:52)(cid:90) co(cid:87)nt • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:47)I(cid:54)(cid:124)(cid:19)(cid:21)(cid:16)(cid:19)(cid:18)(cid:19) (cid:115) (cid:19)(cid:18)(cid:20) Call Buttons (cid:48)(cid:17)(cid:35) at this OIG inspector • Specialized Health Care Housing institution on-site review • (cid:52)e(cid:88)ie(cid:89) (cid:68)(cid:91) location Specialty Services (cid:47)I(cid:54)s (cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:19) (cid:115) (cid:18)(cid:18)(cid:21) High-Priority (cid:19)(cid:23) Specialty Service • (cid:35)ppro(cid:88)al (cid:70)ate (cid:10)(cid:21) (cid:115) (cid:27) (cid:79)ont(cid:74)s(cid:11) Initial an(cid:70) (cid:40)ollo(cid:89)(cid:15)(cid:55)p Appointments • (cid:114) (cid:52)e(cid:79)o(cid:88)e cons(cid:87)lt to a(cid:87)(cid:70)iolo(cid:73)(cid:91), (cid:52)(cid:40)S chemotherapy, dietary, Hep C, (cid:42)I(cid:56), ort(cid:74)otics, (cid:73)(cid:91)necolo(cid:73)(cid:91), cons(cid:87)lt to p(cid:87)(cid:68)lic (cid:74)ealt(cid:74)(cid:17)Specialt(cid:91) (cid:52)(cid:48), (cid:70)ial(cid:91)sis, (cid:39)CG (cid:19)(cid:20)(cid:15)(cid:46)ea(cid:70) (cid:10)(cid:39)(cid:45)G(cid:11), mammogram, occupational therapy, ophthalmology, optometry, oral surgery, physical therapy, physiatry, podiatry, and radiology services • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:47)I(cid:54)s (cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:22) (cid:115) (cid:18)(cid:18)(cid:24) Medium-Priority (cid:19)(cid:23) Specialty Service • (cid:35)ppro(cid:88)al (cid:70)ate (cid:10)(cid:21) (cid:115) (cid:27) (cid:79)ont(cid:74)s(cid:11) Initial an(cid:70) (cid:40)ollo(cid:89)(cid:15)(cid:55)p Appointments • (cid:114) (cid:52)e(cid:79)o(cid:88)e cons(cid:87)lt to a(cid:87)(cid:70)iolo(cid:73)(cid:91), (cid:52)(cid:40)S chemotherapy, dietary, Hep C, (cid:42)I(cid:56), ort(cid:74)otics, (cid:73)(cid:91)necolo(cid:73)(cid:91), cons(cid:87)lt to p(cid:87)(cid:68)lic (cid:74)ealt(cid:74)(cid:17)Specialt(cid:91) (cid:52)(cid:48), (cid:70)ial(cid:91)sis, (cid:39)CG (cid:19)(cid:20)(cid:15)(cid:46)ea(cid:70) (cid:10)(cid:39)(cid:45)G(cid:11), mammogram, occupational therapy, ophthalmology, optometry, oral surgery, physical therapy, physiatry, podiatry, and radiology services • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:47)I(cid:54)s (cid:19)(cid:22)(cid:16)(cid:18)(cid:18)(cid:25) (cid:115) (cid:18)(cid:18)(cid:27) (cid:52)o(cid:87)tine(cid:15)(cid:50)riorit(cid:91) (cid:19)(cid:23) Specialty Service • (cid:35)ppro(cid:88)al (cid:70)ate (cid:10)(cid:21) (cid:115) (cid:27) (cid:79)ont(cid:74)s(cid:11) Initial an(cid:70) (cid:40)ollo(cid:89)(cid:15)(cid:55)p Appointments • (cid:114) (cid:52)e(cid:79)o(cid:88)e cons(cid:87)lt to a(cid:87)(cid:70)iolo(cid:73)(cid:91), (cid:52)(cid:40)S chemotherapy, dietary, Hep C, (cid:42)I(cid:56), ort(cid:74)otics, (cid:73)(cid:91)necolo(cid:73)(cid:91), cons(cid:87)lt to p(cid:87)(cid:68)lic (cid:74)ealt(cid:74)(cid:17)Specialt(cid:91) (cid:52)(cid:48), (cid:70)ial(cid:91)sis, (cid:39)CG (cid:19)(cid:20)(cid:15)(cid:46)ea(cid:70) (cid:10)(cid:39)(cid:45)G(cid:11), mammogram, occupational therapy, ophthalmology, optometry, oral surgery, physical therapy, physiatry, podiatry, and radiology services • (cid:52)an(cid:70)o(cid:79)i(cid:92)e Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:26)(cid:27) Quality No. of Indicator Sample Category Samples Data Source Filters (cid:47)I(cid:54)(cid:124)(cid:19)(cid:22)(cid:16)(cid:18)(cid:19)(cid:18) Specialty Services (cid:19)(cid:18) Specialty Services • Arrived from (other departmental Arrivals Arrivals institution) • (cid:38)ate of transfer (cid:10)(cid:21) (cid:115) (cid:27) (cid:79)ont(cid:74)s(cid:11) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:47)I(cid:54)s(cid:124)(cid:19)(cid:22)(cid:16)(cid:18)(cid:19)(cid:19) (cid:115) (cid:18)(cid:19)(cid:20) Denials (cid:19)(cid:20) Inter(cid:51)(cid:87)al • (cid:52)e(cid:88)ie(cid:89) (cid:70)ate (cid:10)(cid:21) (cid:115) (cid:27) (cid:79)ont(cid:74)s(cid:11) • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:48)(cid:17)(cid:35) I(cid:55)(cid:47)C(cid:17)(cid:47)(cid:35)(cid:52) • (cid:47)eetin(cid:73) (cid:70)ate (cid:10)(cid:27) (cid:79)ont(cid:74)s(cid:11) Meeting Minutes • Denial upheld • (cid:52)an(cid:70)o(cid:79)i(cid:92)e Administrative Operations (cid:47)I(cid:54)(cid:124)(cid:19)(cid:23)(cid:16)(cid:18)(cid:18)(cid:19) (cid:35)(cid:70)(cid:88)erse(cid:17)sentinel 0 (cid:35)(cid:70)(cid:88)erse(cid:17)sentinel • (cid:35)(cid:70)(cid:88)erse(cid:17)Sentinel e(cid:88)ents events (ASE) events report (cid:10)(cid:20) (cid:115) (cid:26) (cid:79)ont(cid:74)s(cid:11) (cid:47)I(cid:54)(cid:124)(cid:19)(cid:23)(cid:16)(cid:18)(cid:18)(cid:20) (cid:51)(cid:47)C (cid:47)eetin(cid:73)s 6 (cid:51)(cid:87)alit(cid:91) • (cid:47)eetin(cid:73) (cid:79)in(cid:87)tes (cid:10)(cid:19)(cid:20) (cid:79)ont(cid:74)s(cid:11) Management Committee meeting minutes MIT (cid:19)(cid:23)(cid:16)(cid:18)(cid:18)(cid:21) (cid:39)(cid:47)(cid:52)(cid:52)C (cid:19)(cid:20) (cid:39)(cid:47)(cid:52)(cid:52)C (cid:79)eetin(cid:73) • Monthly meeting minutes minutes (6 months) (cid:47)I(cid:54)(cid:124)(cid:19)(cid:23)(cid:16)(cid:18)(cid:18)(cid:22) LGB 0 LGB meeting • (cid:51)(cid:87)arterl(cid:91) (cid:79)eetin(cid:73) (cid:79)in(cid:87)tes minutes (cid:10)(cid:19)(cid:20)(cid:124)(cid:79)ont(cid:74)s(cid:11) (cid:47)I(cid:54)(cid:124)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:19) Medical Emergency 3 On-site summary • (cid:47)ost recent f(cid:87)ll (cid:83)(cid:87)arter (cid:52)esponse (cid:38)rills reports (cid:8) • Each watch documentation for (cid:39)(cid:52) (cid:70)rills (cid:47)I(cid:54)(cid:124)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:20) Institutional Level (cid:19)(cid:18) On-site list of • Medical grievances closed Medical Grievances (cid:73)rie(cid:88)ances(cid:17)close(cid:70) (6 months) (cid:73)rie(cid:88)ance files (cid:47)I(cid:54)(cid:124)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:21) (cid:38)eat(cid:74) (cid:52)eports (cid:23) Institution-list of • (cid:47)ost recent (cid:19)(cid:18) (cid:70)eat(cid:74)s deaths in prior • Initial death reports (cid:19)(cid:20)(cid:124)(cid:79)ont(cid:74)s (cid:47)I(cid:54)(cid:124)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:22) Nursing Staff (cid:19)(cid:18) On-site nursing • On duty one or more years (cid:56)ali(cid:70)ations e(cid:70)(cid:87)cation files • Nurse administers medications • (cid:52)an(cid:70)o(cid:79)i(cid:92)e (cid:47)I(cid:54)(cid:124)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:23) Provider Annual (cid:19)(cid:18) On-site • (cid:35)ll re(cid:83)(cid:87)ire(cid:70) perfor(cid:79)ance Evaluation Packets provider evaluation documents e(cid:88)al(cid:87)ation files (cid:47)I(cid:54)(cid:124)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:24) Provider Licenses (cid:19)(cid:23) Current provider • (cid:52)e(cid:88)ie(cid:89) all listing (at start of inspection) (cid:47)I(cid:54)(cid:124)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:25) Medical Emergency All On-site • All staff (cid:52)esponse certification ◦ Providers (ACLS) Certifications tracking logs ◦ (cid:48)(cid:87)rsin(cid:73) (cid:10)(cid:36)(cid:46)S(cid:17)C(cid:50)(cid:52)(cid:11) • C(cid:87)sto(cid:70)(cid:91) (cid:10)C(cid:50)(cid:52)(cid:17)(cid:36)(cid:46)S(cid:11) (cid:47)I(cid:54)(cid:124)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:26) Nursing Staff and All On-site tracking • (cid:35)ll re(cid:83)(cid:87)ire(cid:70) licenses an(cid:70) Pharmacist in Charge system, logs, or certifications Professional Licenses e(cid:79)plo(cid:91)ee files an(cid:70) Certifications Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:27)(cid:18) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport Quality No. of Indicator Sample Category Samples Data Source Filters Administrative Operations (cid:47)I(cid:54)(cid:124)(cid:19)(cid:23)(cid:16)(cid:19)(cid:18)(cid:27) Pharmacy and All On-site listing • All DEA registrations Providers’ Drug of provider DEA Enforcement Agency registration #s (cid:10)(cid:38)(cid:39)(cid:35)(cid:11) (cid:52)e(cid:73)istrations (cid:8) p(cid:74)ar(cid:79)ac(cid:91) registration document (cid:47)I(cid:54)(cid:124)(cid:19)(cid:23)(cid:16)(cid:19)(cid:19)(cid:18) Nursing Staff All Nursing staff • New employees (hired within last New Employee training logs (cid:19)(cid:20)(cid:124)(cid:79)ont(cid:74)s(cid:11) Orientations (cid:47)I(cid:54)(cid:124)(cid:19)(cid:23)(cid:16)(cid:27)(cid:27)(cid:26) (cid:38)eat(cid:74) (cid:52)e(cid:88)ie(cid:89) (cid:23) OIG summary log: • (cid:36)et(cid:89)een (cid:21)(cid:23) (cid:68)(cid:87)siness (cid:70)a(cid:91)s (cid:8) Committee deaths (cid:19)(cid:20)(cid:124)(cid:79)ont(cid:74)s prior • California Correctional Health Care Services death reviews Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents California Correctional Institution (cid:27)(cid:19) California Correctional Health Care Services’ Response September 29, 2021 Roy Wesley, Inspector General Office of the Inspector General 10111 Old Placerville Road, Suite 110 Sacramento, CA 95827 Dear Mr. Wesley: The Office of the Receiver has reviewed the draft report of the Office of the Inspector General (OIG) Medical Inspection Results for California Correctional Institution (CCI) conducted from May to October 2020. California Correctional Health Care Services (CCHCS) acknowledges the OIG findings. Thank you for preparing the report. Your efforts have advanced our mutual objective of ensuring transparency and accountability in CCHCS operations. If you have any questions or concerns, please contact me at (916) 691-3557. Sincerely, Digitally signed by Erin Erin HoppinHoppin Date: 2021.09.29 14:31:23 -07'00' Erin Hoppin Associate Director Risk Management Branch California Correctional Health Care Services cc: Diana Toche, D.D.S., Undersecretary, Health Care Services, CDCR Clark Kelso, Receiver Richard Kirkland, Chief Deputy Receiver Directors, CCHCS Roscoe Barrow, Chief Counsel, CCHCS Office of Legal Affairs Jackie Clark, Deputy Director (A), Institution Operations, CCHCS DeAnna Gouldy, Deputy Director, Policy and Risk Management Services, CCHCS Renee Kanan, M.D., Deputy Director, Medical Services, CCHCS Barbara Barney-Knox, R.N., Deputy Director, Nursing Services, CCHCS Annette Lambert, Deputy Director, Quality Management, CCHCS Regional Health Care Executive, Region III, CCHCS Regional Deputy Medical Executive, Region III, CCHCS Regional Nursing Executive, Region III, CCHCS Chief Executive Officer, CCI Katherine Tebrock, Chief Assistant Inspector General, OIG Doreen Pagaran, R.N., Nurse Consultant Program Review, OIG Misty Polasik, Staff Services Manager I, OIG P.O. Box 588500 Elk Grove, CA 95758 Report Issued: November 2021 Office of the Inspector General, State of California Return to Contents Return to Contents (cid:27)(cid:20) C(cid:91)cle (cid:24) (cid:47)e(cid:70)ical Inspection (cid:52)eport (This page left blank for reproduction purposes.) Office of the Inspector General, State of California Inspection Period: May 2020 – October 2020 Return to Contents Return to Contents Cycle 6 Medical Inspection Report for California Correctional Institution OFFICE of the INSPECTOR GENERAL Roy W. Wesley Inspector General Bryan B. Beyer Chief Deputy Inspector General STATE of CALIFORNIA November 2021 OIG