Medvista Healthcare, Inc.

“Upon patient record review 4 of 14 (Patient #3,#4,#8,#10) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual’s attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #3: Admission date 12-3-25. Spiritual care coordinator comprehensive assessment was completed on 12-10-26 which is greater than the 5 day requirement. Patient #4: Admission date 1-14-26. Spiritual care coordinator comprehensive assessment was completed on 1-20-26 which is greater than the 5 day requirement. Patient #8: Admission date 9-25-25. Spiritual comprehensive assessment was completed on 10-1-25 which is greater than the 5 day requirement. Patient #10: Admission date 4-2-26. Psychosocial comprehensive assessment was completed on 4-11-26 which is greater than the 5 day requirement.”

“Upon patient record review, 5 of 14 (Patient #2, #3, #5, #6, #7) 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 #2: The medication profile states artificial tears ophthalmic eye drops as needed for dry eye but is lacking which eye or eyes both to administer the medication. Patient #3: The medication profile states to apply Lidocaine 4% topical patch for pain. Does not provide instructions where to apply the medication patch. The medication profile indicates MiraLAX to be administered daily for constipation. Lacking the quantity of fluid required to reconstitute prior to administration. Patient #5: The medication profile indicates patient to receive Vyzulta eye drops. Instructions are to administer 1 drop daily for glaucoma. No evidence on the medication profile which eye or both to administer the medication. Patient #6: The medication profile indicates to apply 1 Lidoderm patch every day on for 12 hours for pain. No indication of where to apply the medicated patch for pain management. Patient #7: The medication profile contains duplicate therapies for scheduled MiraLAX stool softener. Both orders were entered on 3-1-26. First order indicates MiraLAX to be given twice a day. The second order indicates MiraLAX to be given once daily.”

“Upon patient record review, 4 of 14 (Patient #4, #5, #8, #10) 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 #4, #10: No evidence the initial bereavement risk assessment was completed. Patient #5: Start of care 8-21-25. The initial bereavement risk assessment was completed on 5-13-26 which is outside of the 5 day requirement. Patient #8: Start of care 9-25-25. The initial bereavement risk assessment was completed on 1-21-26 which is outside of the 5 day requirement.”

“Upon patient record review, 2 of 14 (Patient #2,#9) 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: Documentation in the medical record indicates patient is on an anticoagulant. Unable to identify individual goals and interventions were initiated for monitoring bleeding precaution interventions. Patient #9: Documentation in the medical record indicates patient has impaired skin integrity. Unable to identify individualized goals and interventions were in place for monitoring effectiveness of current interventions.”

“Upon patient record review, 6 of 14 (Patient #2, #3, #4, #5, #6, #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 medications and treatments. Patient #2: Medication order for artificial tears ophthalmic eye drops present. The medication did not specify which eye or both to administer the medicated drops. Patient #3: Medication order for Lidocaine 4% topical patch - lacking where to apply the medication patch. Order written on 5-4-26 for wound care to right dorsal foot. Order does not indicate who is responsible for completing the daily dressing changes. Order on 4-4-26 for MiraLAX laxative. Lacking reconstitution instructions. Patient #4: Medication order instructed skilled nurse to obtain oxygen saturations at every visit. The order did not identify parameters or when to notify the physician. Patient #5: Medication order for Vyzulta eye drops. The medication order did not specify which or both eyes to administer the medication. Patient #6: Medication order for Lidoderm pain patch. The medication order did not include where to apply the medicated patch. Patient #9: Medication order to check oxygen saturation daily. The order did not identify parameters or when to notify the physician.”

“Upon patient record review, 6 of 14 (Patient #1,#2,#3, #6, #7, #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 #1:Documentation in the medical record indicated the patient had bedrails, nebulizer, and lamb wool to be placed between toes. The hospice plan of care DME / Supplies list did not include these items. Patient #2: Documentation in the medical record indicated the patient utilized a walker and required incontinence supplies. The hospice plan of care did not include the equipment. Patient #3: Documentation in the medial records indicated the patient utilized oxygen as needed for shortness of breath. The hospice plan of care did not include the equipment. Patient #6: Documentation in the medical record indicated the patient utilizes a wheelchair for mobility and a Hoyer lift with all transfers. The hospice plan of care did not include the equipment. Patient #7:Documentation noted in the medical record that patient utilizes a Hoyer lift with all transfers. The hospice plan of care did not include the equipment. Patient #9: Documentation noted in the medical record that patient has a wheel chair for mobility. The hospice plan of care did not include the equipment.”

“Upon patient record review, 6 of 14 (Patient #2,4,5,7,8,10) 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: Documentation in the medical record indicates patient utilizes a shower chair and walker and wheelchair for mobility. No evidence the aide plan of care was updated to reflect this equipment. The medical record indicates this patient is currently on a scheduled blood thinner. No evidence the aide plan of care was updated to include bleeding precautions. The medical record indicates this patient has oxygen available as needed for shortness of breath. No evidence the aide plan of care was updated to reflect oxygen safety. The medical record indicates patient with an active history of seizures. No evidence the aide plan of care was updated to reflect seizure precautions. The medical record indicates patient has aspiration precautions in place. No evidence the aide care plan was updated to reflect aspiration precautions. Patient #4: Documentation in the medical record indicates patient is to utilize bed rails while in bed. No evidence the hospice aide plan of care was updated to reflect this task. Patient utilizes incontinence supplies and there is no evidence these items are reflected on the hospice plan of care. Patient #5: Documentation in the medical record indicated the patient utilized a walker for ambulation and utilized oxygen 2Liters as needed for shortness of breath. No evidence the aide care plan was individualized to include a walker or oxygen. Patient #7: Documentation found in the medical record states the patient is utilizing a prescribed blood thinner. No evidence of bleeding precautions listed on the aide care plan. Documentation in the medical records by the nurse indicated the patient had a active wound to the right lower leg. No evidence the aide plan of care was updated to reflect the location and instructions on how to preserve the adhesive dressing during bathing. Documentation in the medical record states patient has fall mats to be used when the patient is in bed. No evidence the aide care plan was updated to include this task. Patient #8: Order written 4-29-26 for compression stocking for bilateral lower leg edema. No evidence in the aide plan of care instructing the aide to removing and applying the stockings during a visit. Patient #10: Documentation by the nurse indicated the patient utilized a walker for ambulation. No evidence the hospice aide plan of care was updated to include this form of mobility.”