Angel’s Best Hospice Care Inc.

“Upon patient record review, 2 of 5 (Patient #1,3) 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 #1 Medication Profile listed Metoprolol 50mg ER, po BID -Xarelto 25mg po daily - Isosorbide 30mg po daily. These medications were not found in the home and the caregiver confirmed patient no longer taking those medications. Medications found in the home that were not on Medication profile: Metformin 850mg BID, po- Lisinopril 10mg po daily-Atorvastatin 20mg po daily-Vitamin D2 50,000 Units Po weekly-Omega 3 1GM , take 2 soft gels BID. These medications were confirmed by caregiver as current medications. Patient #3 Medication Profile listed Metoprolol 50mg ER, po BID, Losartan 50mg po daily, Gabapentin 600mg po daily, Nexium 40mg daily, Lasix 40mg daily, Amlodipine 10mg po daily. (Nexium and Lasix only on med profile)--these medications were not found in the home- Additionally, medications found in home and verified as current by patient as follows, were not on Medication profile: Entresto 97mg-103mg, BID-Aldactone 25mg daily-Jardiance 10mg daily-Toprol XL 200mg daily- Rybelsus 14mg po daily-Metformin 500mg BID-Amitriptyline 100mg PRN for sleep.”

“Upon patient record review, 2 of 5 (Patient #1,3) 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 medications and treatments. Patient #1 Plan of Care orders listed Metoprolol 50mg ER, po BID -Xarelto 25mg po daily - Isosorbide 30mg po daily. These medications were not found in the home and the caregiver confirmed patient no longer taking those medications. Medications found in the home that were not on Plan of Care: Metformin 850mg BID, po- Lisinopril 10mg po daily-Atorvastatin 20mg po daily-Vitamin D2 50,000 Units Po weekly-Omega 3 1GM , take 2 soft gels BID. These medications were confirmed by caregiver as current medications. Patient #3 Plan of Care orders listed Metoprolol 50mg ER, po BID, Losartan 50mg po daily, Gabapentin 600mg po daily, Nexium 40mg daily, Lasix 40mg daily, Amlodipine 10mg po daily. (Nexium and Lasix not on the Plan of Care)--these medications were not found in the home- Additionally, medications found in home and verified as current by patient as follows, were not on Plan of Care: Entresto 97mg-103mg, BID-Aldactone 25mg daily-Jardiance 10mg daily-Toprol XL 200mg daily- Rybelsus 14mg po daily-Metformin 500mg BID-Amitriptyline 100mg PRN for sleep.”

“Upon personnel record review, 1 of 14 (Personnel #7) 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.) ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed 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 #7 did not include direct observation of a “Sponge bath”. Additionally, the competency for “shower/ Tub bath” was marked as “V” for verbalized as the evaluation method.”

“Upon patient record review, 5 of 5 (Patient #1,2,3,4,5) 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 #1, 2 have overlapping Initial Comprehensive Assessment times by same nurse. Patient #1 on 1/31/25 IN 1600 Out 1800. Patient #2 on 1/31/25 IN 1715 Out 1845. Patient #2 first name misspelled on all agency- generated clinical records. This was verified during home visit when completing medication reconciliation. Proper spelling on medication bottles, “Aghavni”. Clinical record per agency “Agavni”. Patient #3 Election form is dated/timed “1/31/25 @ 1300”- The comprehensive SN and psychosocial assessment is dated/timed “1/31/25, IN 1230, OUT 1300”. Patients #4, 5 both have Election forms dated/ timed “10/11/24 @ 0900” by the same RN as Hospice Representative.”

“Upon patient record review, 5 of 5 (Patient #1,2,3,4,5) did not have evidence in the patient record that the interdisciplinary group, as part of the review of the plan of care, determines the ability of the patient and/or family to safely self-administer drugs and biologicals to the patient in his or her home. If the patient and/or family are not capable of safely administering drugs and biologicals in the home, the hospice must address this issue in the patient’s plan of care. Patients #1,2,3,4,5 resided at home with family/caregiver. Med Profile indicated medications administered either by patient or family/patient caregiver. There is no evidence in the IDG notes or on the plan of care that states the IDG “determines the ability of the patient and/or family to safely self-administer drugs and biologicals to the patient in his or her home.””