Astral Hospice and Palliative Care, Inc.

“Upon patient record review, 1 of 14 (Patient #5) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable state law. Patient#5: The record indicates the POLST for DNR was signed by someone other than the patient. Above the signature they ask for the printed name of signer. The patients name is printed here but the signature does not belong to the patient. There is no evidence of the relationship of signed being listed on form. Corrected on site. This form was updated appropriately during survey.”

“Upon patient record review, 6 of 14 (Patient #1,#2,#3,#4,#6,#10) 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: During in home visit it was noted that metformin prescription bottle indicated to give 1000mg twice a day. The agency medication profile indicates to give one time a day. Corrected on site. Patient#2: The medication profile indicates patient has Voltaren gel 1% apply topically PRN and Triamcinolone Acetonide 0.1% Topical Cream PRN. There is no evidence of specified area of application on medication profile. The medication profile also shows Docusate Sodium 100mg Capsule 1 by mouth daily for constipation. There is no evidence of instructions to hold for loose bowel movements. Corrected on site. Patient#3,#10: The medication profile indicates patient using Thick-it as directed. There is no evidence of instructions for consistency or amount to use when preparing. Corrected on site. Patient#4: The medication profile indicates patient using lidocaine transdermal patch 5% for pain. There is no evidence of specified area for application. Corrected on site. Patient#6: The medication profile indicates patient taking Docusate Sodium 100mg Capsule 1 by mouth daily for constipation. There is no evidence of instructions to hold for loose bowel movements. The medication profile indicates patient using Diclofenac Sodium 1% Topical Gel PRN. There is no evidence of a specified area of application. Corrected on site.”

“Upon patient record review, 5 of 14 (Patient #2,#3,#4,#6,#7) 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 record indicates per nurse documentation that patient is at high risk for skin impairment and requires education on skin precautions. Chart also indicates patient is ordered ensure for nutritional needs and requires aspiration precautions. There is no evidence of goals or interventions related to these needs. Corrected on site. Patient#3: The record indicates patient requires Thick it for nutritional intake. There is no evidence of goals or interventions related to this need on the Plan of care. Corrected on site. Patient#4: The record indicates physician wrote an order on 12/18/24 for patient to use boost for nutritional supplement and for skin precautions. There is no evidence of goals or interventions for these needs on plan of care. Corrected on site. Patient#6: The record indicates the physician ordered aspiration and skin precautions for patient on day of admit. There is no evidence of goals or interventions related to these needs on the plan of care. Corrected on site. Patient#7: The record indicates the physician ordered bleeding precautions for patient on day of admit. There is no evidence of goals or interventions related to these needs on the plan of care. Corrected on site.”

“Upon patient record review, 6 of 14 (Patient ##1,#2,#3,#4,#6,#10) 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: During in home visit it was noted that metformin prescription bottle indicated to give 1000mg twice a day. The order in chart indicates to give one time a day. Family confirms patient takes twice per day. Corrected on site. Patient#2: The medication order indicates patient has Voltaren gel 1% apply topically PRN and Triamcinolone Acetonide 0.1% Topical Cream PRN. There is no evidence of specified area of application on order. Medication order shows Docusate Sodium 100mg Capsule 1 by mouth daily for constipation. There is no evidence of instructions to hold for loose bowel movements. Corrected on site. Patient#3,#10: The medication order indicates patient ordered Thick-it as directed. There is no evidence of instructions for consistency or amount to use when preparing. Corrected on site. Patient#4: The medication order indicates patient using lidocaine transdermal patch 5% for pain. There is no evidence of specified area for application. Corrected on site. Patient#6: The medication order indicates patient taking Docusate Sodium 100mg Capsule 1 by mouth daily for constipation. There is no evidence of instructions to hold for loose bowel movements. The medication order indicates patient using Diclofenac Sodium 1% Topical Gel PRN. There is no evidence of a specified area of application. Corrected on site.”

“Upon patient record review, 3 of 14 (Patient #1,#2,#3) 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: During the home visit, it was observed that the patient has a hospital bed, half rails, over the bed table, and mattress. This equipment is not listed on any of the POC’s. Corrected on site. Patient#2: During the home visit, it was observed that the patient has a hospital bed, half rails, shower chair, and mattress. This equipment is not listed on any of the POC’s. Corrected on site. Patient#3: During the home visit, it was observed that the patient has a hospital bed, half rails, and mattress. This equipment is not listed on any of the POC’s. Corrected on site.”

“Upon patient record review, 3 of 14 (Patient #3,#4,#5) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient#3: Plan of care indicates LVN frequency as twice a week. The frequency order states SN visit one time per week. Per documentation nurse visits are being made one time per week. No missed visit note or evidence of another order was found in chart. Plan of care corrected on site in order to bring into current compliance. Patient#4: Plan of care spiritual frequency ordered on 12/18/24 for initial assessment to be completed within 5 days and then a visit for each recertification. The record indicates spiritual visits are documented monthly on 12/22/24, 1/9/25, and 2/8/25. Plan of care corrected on site to bring into current compliance. Patient#5: Plan of care states spiritual care was declined. However, Spiritual care visits were documented in chart on 11/8/24, 12/4, 1/13/25, and 2/5. There is no evidence of an updated order or plan of care. Plan of care corrected on site to bring into current compliance.”

“Upon patient record review 1 of 14 (Patient #2) 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#2: The record indicates the aide visit frequency is ordered at 2 times per week. There is no evidence of aide visits between 1/30/25-2/19/25. There is no missed visits or an updated order found.”

“Upon patient record review, 2 of 14 (Patient #4,#14) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient#4: The nurses admit narrative states admitted to Regal hospice. However, this is agency is Astral Hospice. Correct on site with late entry documentation. Patient#14: The record indicates the patient was a full code at time of death. There is no evidence of documentation at death visit to support not doing CPR. After discussion with the nurse who attended death, it was discovered that caregiver had called 911 and the ambulance came and left prior to hospice nurse arrival. However, this was not documented in the chart.”