Caring Heart Hospice Inc.

“Upon patient record review, 7 of 14 (Patient #1, #2, #3, #4, #6, #8, #10) did not contain evidence 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: Diclofenac 1% gel did not indicate which knee(s) to be applied to. During home visit it was noted that patient had both Acetaminophen 650mg tabs 1 tab three times daily and 325mg 2 tabs two times daily. Acetaminophen 325mg tab was not listed on medication profile. During home visit it was noted that patient was using Senna 8.6mg tabs but both tablets and Senna 8.8mg/5mL syrup were listed on medication profile. Patient #2: Furosemide 20mg tab daily was listed on medication profile but was not found in the home during home visit. Senna 8.6mg tab and 8.8mg/5mL liquid on medication profile but only Senna liquid 8.8mg/5mL was in the home during home visit. Patient #3: Patient has order for oxygen 2L/NC PRN but this was not listed on medication profile. Patient #4: Patient has order for oxygen 2L/NC PRN but this was not listed on medication profile. Patient #6: 11/04/25 order date - Amoxicillin 500mg 1 tab three times daily for 10 days. There was no end date and medication was not discontinued. Patient #8: Diclofenac 1% gel did not indicate which knee(s) to be applied to. Patient #10: 10/08/25 order date - Bactrim DS 800/160mg 1 tab two times daily for 7 days. There was no end date and medication was not discontinued.”

“Upon patient record review, 8 of 14 (Patient #1, #2, #3, #4, #6, #7, #8, #10) did not contain 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: Initial POC and all updated POCs - Diclofenac 1% gel did not indicate which knee(s) to be applied to. During home visit it was noted that patient had both Acetaminophen 650mg tabs 1 tab three times daily and 325mg 2 tabs two times daily PRN. The 325mg tabs was not listed on POCs. During home visit it was noted that patient was using Senna 8.6mg tabs but both tablets and Senna 8.8mg/5mL syrup were listed on POC. Patient #2: Initial POC and all updated POCs - Furosemide 20mg tab daily was listed on POC but was not found in the home during home visit. Senna 8.6mg tab and 8.8mg/5mL liquid on POC but only Senna liquid 8.8mg/5mL in the home during home visit. Patient #3: Initial POC and all updated POCs - Patient has order for oxygen 2L/NC PRN but this is not listed on POC and was indicated on nurses comprehensive assessment. Patient #4: Initial POC and all updated POCs - Patient has order for oxygen 2L/NC PRN but this is not listed on POC and was indicated on nurses comprehensive assessment. Patient #6: 11/04/25 (order date) and following updated POCs - Amoxicillin 500mg 1 tab three times daily for 10 days. There was no end date and medication was not discontinued. Patient #7: Patient had 2 wounds indicated on POCs dated 07/18/25 and 11/05/25. Neither indicated who would perform wound care on days that hospice nurse was not present. Patient #8: Initial POC and all updated POCs - Diclofenac 1% gel did not indicate which knee(s) to be applied to. Patient #10: 10/08/25 (order date) and following updated POCs - Bactrim DS 800/160mg 1 tab two times daily for 7 days. There was no end date and medication was not discontinued.”

“Upon client record review, 7 of 14 (Patient #2, #4, #5, #7, #8, #10, #11) did not contain evidence that the IDG ensures that the care and services are provided in accordance with the plan of care: Patient #2: SN updated POC/IDG dated 09/05/25 reflected 1x/weekly visit. There were no visits made week of 10/26/25. Initial POC/IDG reflected MSW 1x/month visit and no visits were made during the month of September. Patient #4: Updated POC/IDG starting on 06/13/25 - 09/05/25 indicated SN visit frequency 2x/week. Week of 08/17/25 there was only 1 visit made. Updated POC/IDG starting on 09/06/25 - 11/14/25 indicated SN visit frequency 3x/week. Weeks of 10/19/25 and 10/26/25 there was only 2 visits made each week. MSW initial POC/IDG and all updated indicated 1x/month visit frequency. There were no visits made during September or October. Patient #5: MSW Initial POC/IDG and all updated indicated 1x/month visit frequency. There were no visits made during September. SN initial POC/IDG and all updated indicated 2x/weekly visit frequency. SN only made 1 visit week of 10/12/25. Patient #7: MSW Initial POC/IDG all updated indicated 1x/month visit frequency. There were no visit made during September. SN Initial POC/IDG and all updated indicated 2x/weekly visit frequency. There was only 1 visit made during weeks of 08/17/25 and 11/02/25. Patient #8: MSW Initial POC/IDG and all updated indicated 1x/month visit frequency. There were 2 visits made during July. There were no visits made during months of September and October. SC Initial POC/IDG and all updated indicated 1x/month visit frequency. During month of July and September there were 2 visits made. SN Initial POC/IDG and all updated indicated 2x/weekly visit frequency. Weeks of 04/27/25 and 07/20/25 there were 3 visits made. During week of 10/12/25 there was only 1 visit made. Patient #10: MSW Initial POC/IDG and all updated indicated 1x/month visit frequency. There were no visits made during September. SN IDG/POC beginning on 07/25/25 indicated visit frequency 1x/weekly. Week of 08/03/25 2 visits were made. Week of 08/17/25 there were no visits made. Week of 10/05/25 there were 3 visits made. Patient #11: MSW Initial POC/IDG and all updated indicated 1x/month visit frequency. There were no visits made following 08/26/25 visit.”

“Upon patient record review, 1 of 14 (Patient #1) did not contain evidence that the hospice aide POC/assignments and duties indicated 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: POC/assignments included changing patient linens but did not indicate the frequency for this to be completed. Bathing/hygiene indicated shampoo and shave but did not give frequency for either. Aide stated that she shampoos and shaves on M/W/F every week.”

“Upon patient record review 3 of 14 (Patient #1, #8, #10) did not contain evidence of documentation that a hospice aide provides services that were included in the plan of care: Patient #1: Plan of care indicated nails to be cleaned/filed at each visit and these were not completed during home visit. Deodorant to be applied at each visit and this was not done during home visit. At every visit patient’s trash/light housekeeping were to be performed and these were not done during home visit. Visit notes documented aide performed shampoo and shave although not frequency on POC, aide verbally stated these are performed every M/W/F. Patient #8: Aide Initial POC/IDG and all updated indicated visit frequency 2x/weekly. There were no visits made after 11/06/25. Patient #10: Aide IDG/POC beginning 07/10/25 indicated 2x/weekly visit frequency. Weeks of 07/20/25, 07/27/25, 08/03/25 and 08/10/25 there were 3 visits made. Week of 08/31/25 there were 4 visits made.”