Gentiva

“Upon personnel record review, 3 of 19 (Personnel #1, #2, #5 ) did not have evidence Emergency Preparedness training including: • Initial training in emergency preparedness policies and procedures to all new and existing hospice employees, and individuals providing services under arrangement, consistent with their expected roles • Demonstrate staff knowledge of emergency procedures • Provide emergency preparedness training at least annually • Periodically review and rehearse its emergency preparedness plan with hospice employees (including nonemployee staff), with special emphasis placed on carrying out the procedures necessary to protect patients and others • Maintain documentation of all emergency preparedness training Personnel #1, #2, #5- There was no evidence of Emergency Preparedness Training.”

“Upon patient record review, 8 of 19 (Patient #1,#3,#4,#5,#8,#9,#11,#12) 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 indicated 2L oxygen. There was no evidence of a route. Corrected onsite. Also, the record indicated order for oxygen 2L. RN visit notes for 10/31/23, 11/8/23, and 12/14 stated patient was on 2.5L-3L oxygen. There was not evidence of an order to change the liter flow. Corrected onsite. Patient#3: The medication profile indicated patient on 3L oxygen, without evidence of a route. Corrected onsite. In addition, Miralax 17 GM daily for constipation. There was not evidence of a diluent. Corrected onsite. Also, Lidocaine Patch 5% topical patch for pain, without evidence of specific location to apply patch. Corrected onsite. Also, Nystop 100,000units/gm topical powder. No evidence of specific location to apply powder. Corrected onsite. Also, Voltaren Arthritis Pain 1% topical gel for arthritis pain. No evidence of specific location to apply gel. Corrected onsite. Patient#4: The certification of terminal illness and nurse documentation indicated that the patient is on 2L oxygen as needed. There was not evidence that oxygen was on the medication profile. Corrected onsite. Also, Biscodyl 10mg rectal suppository, 1 suppository daily PRN constipation, Miralax 17gm oral powder 1 packet daily PRN constipation, and Simethicone 125mg 2 caplets twice daily PRN constipation. There was not evidence of which laxative to use first and under what conditions to use the second laxative. Corrected on site. Patient#5: The medication profile indicated patient on 2L oxygen, without evidence of a route. Corrected onsite. Patient #8: The medication profile indicated for Miralax 17 GM daily for constipation. There was not evidence of a diluent. Corrected onsite. In addition, oxygen 3L/min continuously without evidence of a route. Corrected onsite. Patient #9: The medication profile indicated for Acetaminophen 160mg/5ml., 30ml q6h prn pain or fever, There was not evidence of parameters for the fever. Corrected onsite. Patient#11: The medication profile indicated patient on 1-6L oxygen continuous, without evidence of a route. In addition, medication profile indicated duplicated orders of Lorazepam 0.5mg 2 tablet PO every 4 hours PRN and Lorazepam 0.5mg 1 tablet PO every 4 hours PRN. Patient#12: The medication profile indicated Latanoprost 0.005% eye drops 1 drop at bedtime. There was no evidence of which eye to place drop in.”

“Upon patient record review, 6 of 19 (Patient #1,#2,#3,#4,#5,#6) 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#1: The patient was admitted on 10/23/23. The record indicated that the bereavement assessment was completed on 11/24/23. Patient#2: The patient was admitted on 10/20/23. The record indicated that the bereavement assessment was completed on 10/30/23. Patient#3: The patient was admitted on 10/17/23. The record indicated that the bereavement assessment was completed on 10/30/23. Patient#4: The patient was admitted on 8/4/23. The record indicated that the bereavement assessment was completed on 10/30/23. Patient#5: The patient was admitted on 1/14/23. The record indicated that the bereavement assessment was completed on 1/22//23. Record #6: The patient was admitted on 11/10/23. The record indicated that the bereavement assessment was completed on 12/1/23.”

“Upon patient record review, 4 of 19 (Patient #4,#5,#6,#14) 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#4: The record indicated patient has Atherosclerotic Heart Disease diagnosis and a 19% ejection fraction rate. There was no evidence of a cardiovascular care plan. Corrected onsite. Patient#5: The initial certification of terminal illness indicated multiple falls despite the use of a walker. The certification of terminal illness for the benefit period beginning 11/10/23 indicated that the patient suffered falls several weeks ago.. There was not evidence of falls/safety in the plan of care. Corrected onsite. Patient #6: The certification of terminal illness indicated that the patient has frequent falls. Social work documentation dated 12/4/23 indicated that the grandson stated that the patient falls 1-2x/day. There was not evidence that the hospice has developed an individualized written plan of care that reflects patient/family goals and interventions based on safety, especially in regards to falls. Corrected onsite. Patient#14: Record indicated Stage 2 sacrum pressure ulcer. There was no evidence of a skin integrity/wound care plan.”

“Upon patient record review, 7 of 19 (Patient #3, #6,#7,#10,#11,#13,#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#3: The initial visit frequencies for the spiritual care counselor and the social worker were both 1 prn Patient #6: The initial visit frequencies for the spiritual care counselor and the social worker were both 1 prn. Patient #7: The initial visit frequency for the social worker was 6 prn. Patient#10: The initial visit frequency for the spiritual care counselor was 1 prn. Patient#11: The initial visit frequencies for the spiritual care counselor and the social worker were both 1 prn. Patient#13: The initial visit frequencies for the spiritual care counselor and the social worker were both 1 prn. Patient#14: The initial visit frequencies for the spiritual care counselor and the social worker were both 1 prn.”

“Upon patient record review, 8 of 19 (Patient #1, #3,#4,#5,#8,#9,#11,#12) 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: Record indicated order for oxygen 2L. RN visit notes for 10/31/23, 11/8/23, and 12/14 stated patient was on 2.5L-3L oxygen. There was no evidence of an order to adjust the liter flow. Corrected onsite. In addition, record indicated 2L oxygen. There was no evidence of a route. Corrected onsite. Patient#3: The record indicated patient on 3L oxygen, without evidence of a route. Corrected onsite.. Also, Miralax 17 GM daily for constipation. There was not evidence of a diluent. Corrected onsite. Also, Lidocaine Patch 5% topical patch for pain, without evidence of specific location to apply patch. Corrected onsite. Also, Nystop 100,000units/gm topical powder. No evidence of specific location to apply powder. Corrected onsite. Also, Voltaren Arthritis Pain 1% topical gel for arthritis pain. No evidence of specific location to apply gel. Corrected onsite. Patient#4: The certification of terminal illness and nurse documentation indicated that the patient is on 2L oxygen as needed. There was not evidence of an order for oxygen. Corrected onsite. Also, Biscodyl 10mg rectal suppository, 1 suppository daily PRN constipation, Miralax 17gm oral powder 1 packet daily PRN constipation, and Simethicone 125mg 2 caplets twice daily PRN constipation. There was not evidence of which laxative to use first and under what conditions to use the second laxative. Corrected on site. Patient#5: The record indicated patient on 2L oxygen, without evidence of a route. Corrected onsite. Patient #8: The record indicated for Miralax 17 GM daily for constipation. There was not evidence of a diluent. Corrected onsite. In addition, oxygen 3L/min continuously without evidence of a route. Corrected onsite. Patient #9: The record indicated that the patient had a Foley catheter. There was not evidence of an order for the foley, including the catheter size, balloon size, or under what conditions to change or flush the catheter. Corrected onsite. In addition, the record indicated for Acetaminophen 160mg/5ml., 30ml q6h prn pain or fever, There was not evidence of parameters for the fever. Corrected onsite. Patient#11: The record indicated patient on 1-6L oxygen continuous, without evidence of a route. Patient#12: The record indicated Latanoprost 0.005% eye drops 1 drop at bedtime. There was no evidence of which eye to place drop in.”

“Upon patient record review, 3 of 19 (Patient #1, #4,#5) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient#1: Record indicated that patient had Advance Care Directives (signed 11/29/23). All IDG meeting reports/updated plan of care, including 12/6/23 stated, “No Advance Care Directives.” Patient#4: The social worker documentation in the plan of care indicated a goal of facilitating discussion to patient regarding advance directives. The patient had an advance directive and this was a part of the record. There was not evidence that the plan of care was revised and this goal remained on the plan of care. Corrected onsite. Patient#5: The record indicated patient had a left wrist skin tear with wound care orders. There was no evidence of a skin or wound care plan.”

“Upon client record review, 8 of 19 (Patient #2,#4,#5,#7,#10,#11,#12,#13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient#2: The record indicated chaplain visit frequency for an evaluation then 3M2, 2M1, 1M1. Evaluation was conducted on 10/25/23. A missed visit document was in the record dated 11/1/23, and a routine visit on 11/27/23. Patient#4: For the benefit period beginning on 11/2/23, the skilled nurse visit frequency was 1W6. The record indicated visits on 11/9/23, 11/22/23, and 12/6/23. Patient#5: The visit frequency for the skilled nurse in the benefit period beginning 11/10/23 was 1 every 2W2, 1W7. The record indicated visits on 11/14/23, 11/20/23, 12/1/23, and 12/7/23 Patient #7: The skilled nurse visit for the benefit period beginning on 9/19/23 was 2x/week. For the week of 11/12/23-11/18/23, the record indicated only 1 visit. And, for the benefit period beginning 11/18/23, the skilled nurse visit frequency was 1 every 2W2, 2W1, 1W6. The record indicated that visits were conducted on 11/20/23, 11/27/23, 12/1/23, 12/7/23, and 12/14/23. Patient#10: The skilled nurse visit frequency was 6W1, 2W12. The record indicated visits on 10/2/23, 10/3/23, and 10/5/23. Also, chaplain visit frequency 1 visit every 2M2, 2M1, 4PRN. The record indicated an evaluation on 10/6/23, with 2 routine visits on 11/3/23 and 12/1/23. Patient#11: The record indicated the chaplain visit frequency 2 visits every 2M2, 3M1. The record indicated 2 visits on 11/20/23 and 12/5/23 Patient#12: The record indicated the skilled nurse frequency of 1W1, 4W1, 2W12. The record indicated visits on 12/9/23 for week 1, followed by visits on 12/10/23, 12/12/23, and 12/14/23. Patient #13: The skilled nurse visit frequency was 2x/week. For the week of 11/26/23 -12/2/23, the record indicated only 1 visit on 12/1/23.”

“Upon patient record review, 3 of 19 (Patient #3,#6,#8) 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 #3: The aide care plan indicated to provide a bed bath and a shower at every visit. Corrected onsite. Patient #6: The certification of terminal illness indicated that the patient has frequent falls. Social work documentation dated 12/4/23 indicated that the grandson stated that the patient falls 1-2x/day. There was not evidence of fall precautions on the aide plan of care. Corrected onsite. Patient #8: The aide plan of care indicated to provide a bed bath weekly and to shower at every visit. (Aide visit frequency was 2x/week). Corrected onsite.”

“Upon patient record review 5 of 19 (Patient #1,#3,#6,#10,#13) 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#1: The record indicated no aide visits made from SOC 10/23/23-10/29/23. Aide visit frequency was 2x/week. Patient#3: The record indicated aide visit frequency was 2x/week. From 12/3/23-12/9/23, there was evidence of only 1 visit during this week. Also, the aide plan of care indicated to provide the task of nail care and shampoo weekly. From 10/24/23 to current, the record indicated that the aide performed a shampoo at all visits and nail care at most visits. Patient #6: The aide plan of care indicated to provide the task of nail care weekly. The record indicated that the aide performed this task at all visits. In addition, the aide visit frequency was 2x/week. For the weeks of 11/19/23-11/25/23 and 11/26/23-12/2/23, the record indicated only 1 visit each of these weeks. Patient#10: The aide plan of care indicated to provide the tasks of bath or shower and nail care weekly. The record indicated that the aide performed these tasks at all visits. In addition, aide visit frequency was 2x/week. From 11/19/23-11/25/23, there was evidence of only 1 visit on 11/22/23. Patient#13: The aide visit frequency was 2x/week. There was evidence that only 1 visit was made from 11/19/23-11/25/23.”

“Upon patient record review 1 of 19 (Patient #3) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient’s needs. Patient#3: The record indicated an aide supervisory visit on 11/6/23. There was not evidence of another aide supervisory visit until 11/28/23 which is greater than the 14 day requirement.”