Vnacare

“Upon patient record review, 4 of 19 (Patient #1,4,7,8) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #1 - The medication profile showed patient was taking MiraLAX 17 gm daily for constipation. There was no evidence that a diluent was added to the instructions. Patient #4 - The medication profile showed patient was taking MiraLAX 17 gm daily for constipation. There was no evidence that a diluent was added to the instructions. The medication also contained nystatin 100,000 u/gm powder to add topically. There was no indication of the location to apply the powder. Patient #7 - The medication profile showed patient was taking MiraLAX 17 gm daily for constipation. There was no evidence that a diluent was added to the instructions. Patient #8 - The medication profile showed patient was taking MiraLAX 17 gm daily for constipation. There was no evidence that a diluent was added to the instructions.”

“Upon patient record review, 3 of 19 (Patient #2,13,14) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care Patient #2 - Patient was admitted on 10/07/25. The initial bereavement risk assessment is completed by the RN and documented on the nursing comprehensive assessment. The bereavement assessment on the nursing comprehensive was left blank. Patient #13 - Patient was admitted on 05/28/26. The initial bereavement risk assessment is completed by the RN and documented on the nursing comprehensive assessment. There were no risk factors identified and the primary bereaved was not indicated. Patient #14 - Patient was admitted on 03/23/26. The initial bereavement risk assessment is completed by the RN and documented on the nursing comprehensive assessment. The risk assessment was marked at a “moderate” risk level, with no documentation of the bereaved or the risk factors involved.”

“Upon patient record review, 5 of 19 (Patient #2,3,8,12,14) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #2 - The medical profile showed patient was taking Metformin along with Lantus for diabetes. Diabetes is also listed as related to the terminal diagnosis. There was no evidence of problems, goals, or interventions related to the endocrine system outlined. Patient #3 - The certification of terminal illness narrative included a related diagnosis of diabetes. There was no evidence of problems, goals, or interventions related to the endocrine system. Patient #8 - The initial plan of care included an order for a pureed diet. There was no evidence of problems, goals, or interventions related to dysphagia. Patient #12 - The medical record showed patient is choosing to remain at a full code status. There was no evidence of problems, goals, or interventions related to that full code status. Patient #14 - The medication profile showed patient was taking aspirin daily as a blood thinner. There was no evidence of problems, goals, or interventions related to bleeding risk noted on plan of care.”

“Upon patient record review, 4 of 19 (Patient #1,4,7,8) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #1 - The order dated 12/23/25 for MiraLAX 17 gm daily for constipation. There was no evidence that a diluent was added to the instructions. Patient #4 - The order dated 05/26/26 for MiraLAX 17 gm daily for constipation. There was no evidence that a diluent was added to the instructions. There was an additional order dated 05/26/26 which contained nystatin 100,000 u/gm powder to add topically. There was no indication of location to apply the powder. Patient #7 - The order dated 02/10/26 for MiraLAX 17 gm daily for constipation. There was no evidence that a diluent was added to the instructions. Patient #8 - The order dated 02/06/26 for MiraLAX 17 gm daily for constipation. There was no evidence that a diluent was added to the instructions.”

“Upon patient record review, 4 of 19 (Patient #2,3,4,5) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient #2 - The nursing comprehensive dated 10/07/25 and subsequent nursing assessments, listed patient as incontinent of bowel and bladder. The plan of care did not include incontinent supplies. These same assessments documented patient was utilizing a Hoyer lift. The Hoyer lift was not listed on the plan of care. Patient #3 - The recertification visit dated 05/12/26 documented patient is incontinent of bowel and bladder. The plan of care did not include incontinent supplies. Patient #4 - The medical record showed an order dated 05/26/26 for wound care to the stage 2 wound on the buttocks to included Medi honey and Mepilex dressings. The plan of care did not show those wound care supplies. Patient #5 - The nursing recertification visit and subsequent assessments noted patient to be incontinent of bowel and bladder. The plan of care did not include incontinent supplies.”

“Upon patient client record review, 1 of 19 (Patient #6) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #6 - Page 1 of 2 of the Election of Hospice Benefit form, the right to choose an attending physician, the patient elected to not choose an attending physician. The section “I acknowledge that my choice for an attending is” was also completed with the name of the Medical Director entered as the choice for attending physician.”