Continuum Care Hospice LLC

“Upon patient record review, 3 of 19 (Patient #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 4:The medical record contains nursing documentation on 5/11/24 that patient was using oxygen at 2 liters per minute for dyspnea. There is no evidence that the medication profile includes an entry for oxygen. Patient 7:The medical record includes nursing documentation of fungal rash with subsequent treatment using Nystatin powder. There is no evidence of an entry on the medication profile for Nystatin. Patient 8:The medication profile includes entries of Lotrimin antifungal cream 1% cream daily, Lidocaine 4% Patch q 12 hours and calmoseptine external ointment 0.44-20.6% every shift. There is no evidence that the entries include the location for administration of the medications.”

“Upon patient record review, 3 of 19 (Patient #6,#9,#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 6:The medical record contains nursing documentation that the patient may use oxygen 2 liters per minute as needed for shortness of breath and requires the use of a Hoyer lift for transfers. There is no evidence that the plan of care includes problems, goals and interventions for the management and safety of oxygen or the use and safety for mechanical lift. Patient 9 and 12:The medical record contains nursing documentation that the patient requires anticoagulation therapy using Eliquis. There is no evidence that the plan of care includes problems, goals and interventions for the management of anticoagulation therapy and the risk of bleeding.”

“Upon patient record review, 4 of 19 (Patient #3,#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 3:The plan of care includes provision of wound care to include cleanse with normal saline, pat dry and cover with dry dressing. There is no evidence that the order includes the location of the wound, the frequency for treatment and who is to perform care. Patient 4:The medical record contains nursing documentation on 5/11/24 that patient was using oxygen at 2 liters per minute for dyspnea. There is no evidence that the plan of care includes an order for oxygen therapy. Patient 7:The medical record includes nursing documentation of fungal rash with subsequent treatment using Nystatin powder. There is no evidence that the plan of care includes an order for Nystatin. Patient 8: The plan of care includes orders for Lotrimin antifungal cream 1% cream daily, Lidocaine 4% Patch q 12 hours and calmoseptine external ointment 0.44-20.6% every shift. There is no evidence that the orders include the location for administration of the medications.”

“Upon patient record review, 2 of 19 (Patient #2,#9) 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 medical record includes nursing documentation that the patient requires use of a hospital bed, walker and shower chair. There is no evidence that these items are included on the plan of care. Patient 9:The medical record includes nursing documentation that the patient requires use of a hospital bed, walker, oxygen equipment and supplies. There is no evidence that these items are included on the plan of care.”

“Upon patient record review, 2 of 10 (Patient #5,#7) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient 5:The medical record contains nursing documentation of a diet change to pureed with thickened liquids, increasing dysphagia and a risk of aspiration as well as a new onset fungal rash. There is no evidence of updates to the plan of care to include altered nutrition/risk of aspiration or altered skin integrity with rash. Patient 7:The medical record contains nursing documentation on 6/11/24 that patient has increased itching in the perineal area with a subsequent treatment using antifungal cream. There is no evidence of an update to the plan of care with problems, goals and interventions for the management of altered skin.”

“Upon patient record review, 4 of 19 (Patient #2,#8,#12,#13) 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 2:The aide plan of care includes the task of change linens. The frequency assigned to delivery of service is noted as weekly, when soiled and PRN. Patient 8:The aide plan of care includes the tasks of assist with ambulation, change linens, shower and shampoo. There is no frequency for the provision of these tasks. Patient 12:The medical record includes nursing documentation that patient is a fall risk and is on anticoagulation therapy. The aide plan of care does not include fall or bleeding precautions Patient 13:The aide plan of care included complete bed bath. There was no assigned task to undress and dress the patient.”

“Upon patient record review 2 of 19 (Patient #7,#9) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 7:The aide plan of care included the task of shampoo hair assigned 1 time weekly with a frequency of 2 visits per week. There is evidence that the task was completed on 5/27/24, 5/29/24, 6/3/24,6/10/24,6/12/24,6/17/24 and 6/19/24. Patient 9:The aide plan of care included a frequency of 2 visits per week. There is evidence that only 1 visit week of 6/2/24.”