Zenith Healthcare Inc.

“Upon patient record review, 4 of 14 (Patient #1,3,8,9) 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: The RN documentation indicated that patient has oxygen at 2LNC PRN available within the home for shortness of breath. No evidence that the oxygen was placed on the current medication profile. Corrected on site. During home visit and medication reconciliation, the active medication profile contained two entries for Lorazepam, one scheduled and one prn, that were not on the active SNF medication profile. Patient 3: The current medication list includes several schedule acetaminophen products and PRN products that contain acetaminophen. No evidence that a max amount of acetaminophen was listed with any of those medication. Current plan of care contains Senna 8.6 and Bisacodyl 10mg supp both listed as PRN daily for constipation. No evidence that instructions were given on when to use which medication for constipation. Corrected on site. Patient 8: Miralax on the active medication profile does not have instructions on how to dilute. Corrected on site Patient 9: Current medication list includes 2 entries for Senna, both instructed to be given orally, one was scheduled and one was prn. The medical record indicated that the patient has a PEG tube, dysphagia, and was taking nothing by mouth.”

“Upon patient record review, 6 of 14 (Patient #6,7,8,9,13,14) 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 6: No evidence that the bereavement risk assessment was completed within 5 days of the election of hospice. Patient admitted on 03/7/2025, assessment completed on 03/14/2025. Patient 7: No evidence that the bereavement risk assessment was completed within 5 days of the election of hospice. Patient admitted on 12/6/2024, assessment completed on 12/13/2024. Patient 8: No evidence that the bereavement risk assessment was completed within 5 days of the election of hospice. Patient admitted on 08/26/2024, assessment completed on 12/31/2024. Patient 9: No evidence that the bereavement risk assessment was completed within 5 days of the election of hospice. Patient admitted on 06/26/2024, assessment completed on 07/31/2024. Patient 13: No evidence that a bereavement risk assessment was completed. Patient 14: No evidence that the bereavement risk assessment was completed within 5 days of the election of hospice. Patient admitted on 05/17/2024, assessment completed on 05/27/2024.”

“Upon patient record review, 3 of 14 (Patient #2,6,9) 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: Patient currently takes Eliquis 2.5mg as a blood thinner. There was no evidence of problems, goals, and interventions related to risk for bleeding included in the plan of care. Corrected on site. Patient 6: Patient currently takes Keppra for epilepsy, has a related dx of epilepsy on the POC. No evidence that problems, goals, and interventions related to safety for seizure activity included in the plan of care. Corrected on site Patient 9: Patient has a PEG and has history of difficulty swallowing/dysphagia related to Parkinsonism. No evidence of problems, goals, and interventions related to risk for aspiration includes in the plan of care. Corrected on site.”

“Upon patient record review, 2 of 14 (Patient #6,7) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient’s plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patients 6: SW and SC only have PRN orders on POC. No evidence of routine visits on plan of care. No evidence of a frequency for PRN visits. Patients 7: SW only has PRN orders on POC. No evidence of routine visits on plan of care. No evidence of a frequency for PRN visits.”

“Upon patient record review, 3 of 14 (Patient #1,3,8) 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 1: The RN documentation indicated that has oxygen at 2LNC PRN available within the home for shortness of breath. No evidence that an order was received for oxygen. Corrected on site Patient 3: The RN documentation indicated that the patient had a foley catheter in place that had been replace several times (11/02/24 & 03/29/2025) by the hospice RN. No evidence that an order was received to include foley catheter size, change frequency, or care standards. Also the current medication list includes several scheduled acetaminophen products and PRN products that contain acetaminophen. No evidence that a max amount of acetaminophen was listed with any of those medication. Current plan of care contains Senna 8.6 and Bisacodyl 10mg supp both listed as PRN daily for constipation. No evidence that instructions were given on when to use which medication for constipation. Corrected on site. Patient 8: The POC has an active order for Miralax powder that does not include instructions on how to dilute the powder. Corrected on site.”

“Upon client record review, 3 of 14 (Patient #4,6,9) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 4: Plan of care has an order for the volunteer to visit the patient 2 times a week was placed on 05/06/2025. No evidence that the patient received a visit from the volunteer at the time of survey. Patient 6: Plan of care indicated the SN frequency was ordered as once a week. No evidence that the patient received a visit for the week of 05/11/25-05/17/25. No evidence that this visit was missed at the request of the patient or that an order was received to stopped visits for that month. Patient 9: Plan of care indicated the SW frequency was ordered as monthly. No evidence that the patient received a visit for the month of November 2024. The SW entered a note on 11/30/2024 stating that the MSW was out of town for the holiday. No evidence that this visit was missed at the request of the patient or that an order was received to stopped visits for that month.”

“Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient’s life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination: • The primary terminal condition • Related diagnosis • Current subjective and objective medical findings • Current medication and treatment orders • Information about the medical management of any of the patient’s conditions unrelated to the terminal illness Patient 1: CTI narrative written by the medical director was an exact copy of the RN admission assessment narrative, only adding that the pt is appropriate for hospice.”