Ace Home Health Care & Hospice, Inc.

“Upon patient record review, 5 of 19 (Patients #3, 5, 6, 10, 11) 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 #3: Patient is prescribed Acetaminophen 650mg suppositories 1 every 6 hours prn fever and 650mg po every 6 hours prn pain. Neither order states maximum dose in 24 hours. Patient is prescribed Miralax. The order does not include instructions for reconstitution. Patient #5: Patient is prescribed Acetaminophen 650mg suppositories 1 every 6 hours prn fever and 650mg po every 6 hours prn pain. Neither order states maximum dose in 24 hours. Patient #6: Patient is prescribed Acetaminophen 650mg suppositories 1 every 6 hours prn fever; Norco 10/325mg 1 every 6 hours prn pain; Norco 10/325mg 1 tablet twice daily; Norco 10/325mg prn prior to wound care. The orders do not contain 24 hour max dose. Patient #10: Patient is prescribed Acetaminophen 650mg suppositories 1 every 6 hours prn fever and 650mg po every 6 hours prn pain, as well as Norco 5/325mg 1 every 8 hours prn. The orders do not include the 24 hour max dose. Patient #11: Patient is prescribed Acetaminophen 650mg suppositories 1 every 6 hours prn fever and 650mg po every 6 hours prn pain. Neither order states maximum dose in 24 hours. Patient is prescribed Miralax. The order does not include instructions for reconstitution.”

“Upon patient record review, 5 of 19 (Patients #1, 7, 8, 11, 12) 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 #1: The patient is on anti seizure medications for history of epilepsy. There are no goals or interventions for seizure on the POC. Patient #7: The patient is on anti seizure medications for history of seizures. There are no goals or interventions for seizures on the POC. Patient #8: The patient is on Pradaxa, an anti coagulant. There are no interventions or goals for anticoagulation and bleeding precautions on the POC. The patient is on hospice with a primary diagnosis of Colon Cancer. There are no interventions or goals for Cancer on the POC. Patient #11: The patient is on Plavix, an anticoagulant. There are no interventions or goals for anti coagulant use or bleeding precautions on the POC. Patient #12: The patient is on Aspirin, an anti coagulant. There are no interventions or goals for anti coagulant use or bleeding precautions on the POC.”

“Upon personnel record review, 1 of 14 (Personnel #12) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel #12: There is not evidence on competency evaluations that all required tasks were done with a pseudo or actual patient, including Temperature, Pulse, Respirations, Positioning and Range of motion”

“Upon patient record review, 5 of 19 (Patients #1, 7, 8, 11, 12) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #1: The patient has history of Epilepsy, Seizure precautions are not included in the Aide POC. Patient #7: The patient has history of seizures. Seizure precautions are not included in the Aide POC. Patient #8: The patient is on anticoagulants. Bleeding precautions are not included in the Aide POC. Patient #11: The patient is on anticoagulants. Bleeding precautions are not included in the Aide POC. Patient #12: The patient is on anticoagulants. Bleeding precautions are not included in the Aide POC.”