Emerald Coast Hospice

“Upon patient record review, 1 of 27 (Patient #11) 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#11: The record indicates on 4/23/25 ketoconazole 2% apply 1 cm 2 times a day. However, there was no specified area of application indicated. The medication profile was update with location in order to correct on site.”

“Upon patient record review, 5 of 27 (Patient #1,#3,#11,#16,#17) 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#1: The record indicates the patient takes valproate 500mg/5ml 4 times a day for seizures. There is no evidence of seizure precautions on care plan. The record also indicates the patient has a PEG tube. There is no indication of goals and interventions regarding specific PEG tube care and flushes. The care plan was updated in order to correct on site. Patient#3: The record indicates seizure precautions are indicated on the aide plan of care. There is no evidence of seizure precautions on care plan. The Care plan was updated in order to correct on site. Patient#11: The record indicates seizure precautions, aspiration precautions, and oxygen safety/precautions are on the aide plan of care. There is no evidence of these precautions on care plan. This was updated in order to correct on site. Patient#16: The record indicates aspiration precaution are indicated on the aide plan of care. There is no evidence of this precaution on the care plan. This was updated in order to correct on site. Patient#17: The record indicates fall precaution are indicated on the aide plan of care. There is no evidence of this precaution on the care plan. This was updated in order to correct on site.”

“Upon patient record review, 2 of 27 (Patient #1,#11) 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: There was no evidence of an order for PEG tube care and flushes. An appropriate order was entered in order to correct on site. Patient#11: The record indicates on 4/23/25 ketoconazole 2% apply 1 cm 2 times a day. However, there was no specified area of application indicated. The order was update with location in order to correct on site.”

“Upon patient record review 1 of 27 (Patient #4) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient#4: The record indicates patient had an X-ray on 6/19/25 after a fall. The family called triage on 6/21 requesting results and was told the results had not yet been received. There was no evidence of results being received or any further follow up with X-ray company or patient. The agency obtained and uploaded the X-ray results and entered a coordination note.”

“Upon patient record review, 6 of 27 (Patient #1,#5,#7,#8,#9,#16,#19#20) 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: There is no evidence of fall precautions, aspiration precautions, or seizure precautions on aide plan of care. Also, there was no notification or mention that patient had PEG tube on aide plan of care. In order to correct on site, these needs were added to aide plan of care. Patient#5: The record indicates the aide frequency was ordered as 4 times per week. However, this order is unclear as documentation shows 2 aides going together 2 times per week. A new order was written with frequency of 2 aides to visit 2 times per week for a 2 person assist. Patient#7: The record indicates bleeding precautions are on the patient care plan. However, there is no evidence of this on the aide plan of care. This was added in order to correct on site. Patient#8: There is evidence that wheelchair, oral care, and nail care on the aide plan of care are assigned “every visit as needed”. In order to correct on site the aide plan of care was updated and as needed was removed. Patient#9: There is evidence that the shower task is assigned” every visit per patient request assist with getting into shower” on aide plan of care. This was corrected on site by updating to “ every visit stand by assist”. Patient#16: The record indicates bleeding precautions are indicated on the plan of care. There is no evidence of this on the aide plan of care. This was added to aide plan of care in order to correct on site. Patient#19: The record indicates fall precautions are indicated on the plan of care. There is no evidence of this on the aide plan of care. This was added to aide plan of care in order to correct on site. Patient#20: The record indicates the aide frequency was ordered as 4 times per week. However, this order is unclear as documentation shows 2 aides going together 2 times per week. A new order was written with frequency of 2 aides to visit 2 times per week for a 2 person assist.”

“Upon patient record review 2 of 27 (Patient #10,#17) 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#10: The record indicates the aide’s first visit to patient was on 6/19/25. There is no evidence of an aide supervisory visit being performed from 6/19 to present. The agency did completed an aide supervisory visit during survey on 7/9/25. Patient#17: There is no evidence of an aide supervisory visit completed between 5/22/25 and 6/23/25.”

“Upon patient client record review, 2 of 27 (Patient #5,#6) 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#5: The aide plan of care indicates patient has an amputation. There is no evidence in patient chart of an amputation. This was documented in error and removed from the aide plan of care in order to correct on site. Patient#6: Upon review of record evidence showed that RN narrative on 7/1/25 and 6/27/25 were the exact same. This was also found for RN narrative on 6/13 and 6/22.”