Eden Hospice, Inc.

“Upon patient record review, 1 of 14 (Patient #3) 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 # 3) Upon home visit, the hospice medication profile/plan of care contained a) Senna 8.6 mg 1 tab, oral, daily. b) Morphine Sulfate 20 mg/1ml solution, 0.25 ml, sublingual, every two hours as needed for pain. b) Ondansetron 4 mg, oral, take 1 tab by mouth every four hours as need for nausea and vomiting. c) Acetaminophen 650 mg suppository every four hours as needed for mild pain or fever greater than 100.4 degrees. d) Bisacodyl 10 mg, suppository, once a day as needed for constipation. Daughter stated they did not have the medication in the home. The nurse looked for the medications and they were not at this location.”

“Upon patient record review, 6 of 14 (Patients # 1, 2, 5, 9, 11, 14) 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. Patient # 1) Patient’s plan of care dated 7/17/25, the MSW was ordered PRN without a frequency for the PRN visits. Patient # 2) Patient’s plan of care dated 4/18/25, the MSW and SC were ordered PRN without a frequency for the PRN visits. Patient # 5) Patient’s plan of care dated 7/17/25, the MSW was ordered PRN without a frequency for the PRN visits. Patient # 9) Patient’s plan of care dated 7/17/25, the MSW and SC were ordered PRN without a frequency for the PRN visits. Patient # 11) Patient’s plan of care dated 6/19/25, the MSW was ordered PRN without a frequency for the PRN visits. Patient # 14) Patient’s plan of care dated 9/26/24, the MSW and SC were ordered PRN without a frequency for the PRN visits.”

“Upon personnel record review, 1 of 14 (Personnel # 9) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel #9) There was no evidence of a competency to include communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff.”

“Upon patient record review, 8 of 14 (Patients # 1, 2, 4, 6, 10, 11, 13, 14) 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 # 1) The aide plan of care dated 6/29/25 did not contain frequencies for the tasks of empty urine collection bag, record bowel movement, feeding assistance, and change linens. Patient # 2) The aide plan of care dated 4/18/25 did not contain frequencies for the tasks of record bowel movement and change linens. Patient # 4) The aide plan of care dated 7/13/25 did not contain frequencies for the tasks of turn and reposition, record bowel movement, feeding assistance, and change linens. Patient # 6) The aide plan of care dated 6/1/25 did not contain frequencies for the tasks of record bowel movements and change linens. Patient # 10) The aide plan of care dated 2/2/25 did not contain frequencies for the tasks of turn and reposition, empty urine collection bag, record bowel movements, and change linens. Patient # 11) The aide plan of care dated 5/29/25 did not contain frequencies for the tasks of turn and reposition, record bowel movement, encourage fluids if tolerated and not contradicted, and change linens. Patient # 13) The aide plan of care dated 9/9/24 did not contain frequencies for the tasks of turn and reposition, and change linens. Patient # 14) The aide plan of care dated 6/29/25 did not contain frequencies for the tasks of change linens.”