Gentiva

“Upon patient record review, 6 of 27 (Patient #3,#4,#5,#8,#13,#17) 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: The medication profile indicates acetaminophen 325mg take 2 every 6 hours is a routine scheduled medication. However, the instructions state take as needed for pain. Patient#4: Medication profile indicates patient using pharmacy compounded ABH gel to apply to wrist every 6 hours as needed. However, there is no evidence of an amount to apply. Patient#5: Medication profile indicates patient using oxygen per instruction by provider at bedtime with CPAP. However, there is no evidence of an amount or LPM. Patient#8: There is no evidence of flush for PEG tube before or after gravity feeds on medication profile. Patient#13: The medication profile indicates Bisacodyl is a scheduled routine medication for constipation to be given every 72 hours. However, the instructions states to take if senna is ineffective and is a PRN medication. Patient#17: The medication profile indicates Tussin DM 100mg/5ml give twice a day for cough for 10 days. However, this medication was ordered on 09/23/25 and is still active. There is no evidence of an updated order.”

“Upon patient record review, 7 of 27 (Patient #1,#2,#4,#5,#9,#14,#20) 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: Face-to-face in chart states patient chokes and coughs during feeds and now requires the use of thickener. Nurse documents in visit 9/1/26 that nurse observed patient choking while being fed. Nurse educated on aspiration precautions and had caregiver do return demonstration. However, there is no evidence of problems, goals, or interventions on the plan of care related to aspiration precautions. The plan of care indicates there is an active intervention for the MSW is to assist patient and family with volunteer services. However, the record indicates patient declined these services. Patient#2: The record indicates that patient has 2 pinpoint chronic abscesses. The nurse monitors drainage of these at visit and patient cleans them. However, there is no evidence of problems, goals, or interventions related to this on the plan of care. Patient#4: The record indicates patient most recent wound was inactivated and healed on 7/6/26. However, this wound is still active on the plan of care. Since admit patient has had multiple wounds. However, there is no evidence of problems, goals, and interventions related to skin precautions on the plan of care. Patient#5: On multiple visits the nurse documents assessing and educating on edema to bilateral lower extremities. There is no evidence of goals or interventions related to management of edema. Patient#9: The plan of care indicates PEG tube feeding are 3 times a day. However, the order in the chart states twice a day. Patient#14: Documentation indicates that the patient requires nectar thick liquids. However, there is no evidence of this on the plan of care. Patient#20: The record indicates patient takes Eliquis daily. There is no evidence of bleeding precautions on the plan of care.”

“Upon patient record review, 3 of 27 (Patient #2.#5,#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#2: The record indicates that patient has 2 pinpoint chronic abscesses that have drainage. There is no evidence of an order for care and management of the abscesses. Patient#5: The medication order states oxygen as directed by provider at bedtime with CPAP. There is no evidence of an amount or LPM on the order. Patient#8: There is no evidence of order for 30ml flushes before and after the bolus gravity feeds via PEG tube.”

“Upon patient record review, 8 of 27 (Patient #1,#5,#9,#10,#13,#15,#18,#19) 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 equipment and supply needs. Patient#1: The record indicates patient requires use of thickener for liquids. There is no evidence of thickener being on supply order for nutritional/feeding supplies. Patient#5: The record indicates patient is diabetic and taking daily medication to manage diabetes. However, there is no evidence of diabetic supplies on the supply order to monitor and manage these needs. Patient#9: The record indicates a nebulizer is listed on the supply/DME order for pan of care. However, There is no evidence patient is ordered a medication requiring the use of a nebulizer. The record also indicates that wound care supplies are active on the supply order for the plan of care. However, the patient wound was inactivated and healed 8/14/26. Patient#10: The record indicates patient is non ambulatory per the face-to-face on 7/2/26. The aide plan of care indicates aide to give patient a shower. However, there is no evidence of shower DME or safety equipment on the supply/DME order for plan of care. Patient#13,#15,#19: The record indicates a nebulizer is listed on the supply/DME order for pan of care. However, There is no evidence patient is ordered a medication requiring the use of a nebulizer. Patient#18: The record indicates wound care supplies are active on supply order for plan of care. However, there is no evidence that patient has a wound at this time.”

“Upon client record review, 4 of 27 (Patient #1,#6,#13,#18) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient#1: Skilled nurse frequency is ordered at 3 times for one week then 2 times a week for 8 weeks. The record indicates only one visit documented for week of 8/9, 8/16, and week 8/30. There is no evidence of a missed visit documented. Patient#6: The record indicates on 8/19/26 patient was ordered PT for evaluation and treatment x 4 for weakness causing falls. There is no evidence evaluation or visits being completed. Patient#13: The nurse frequency is ordered at 1 time per week. However, there are 2 nurse visits completed the week of 8/30/26. Patient#18: The nurse frequency is ordered at 1 time per week. However, there are 2 nurse visits completed the week of 8/30/26.”

“Upon patient record review, 2 of 27 (Patient #5,#18) did not have evidence that the IDG shares information on a on-going basis with non-hospice healthcare providers furnishing services unrelated to the terminal illness and related conditions. Patient#5: Documentation on 8/24/26 nurse visit indicates patient having dental procedure tomorrow and has stopped Eliquis for a few days. Also states he recently had a procedure to change battery for pacemaker and has plug in his groin. Patient has follow up with cardiology coming up. There is no evidence of follow-up of coordination/collaboration with these physicians. Patient#18: During home visit it was noted that home health agency was coming into the patient home to provide insulin and diabetic services. There is no evidence of coordination or collaboration with the home health in the record.”

“Upon patient record review, 2 of 27 (Patient #3,#19) 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: There is no evidence of aspiration precautions on the aide plan of care. However, aspiration precautions are on the nursing plan of care. Patient#19: There is no evidence of the aide being notified of PEG tube in place on aide plan of care.”

“Upon patient client record review, 5 of 27 (Patient #2,#3,#6,#10,#15) 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#2: The CTI for benefit period starting 6/17/26 states the patient is on supplemental oxygen. However, per the record patient does not use oxygen. Patient#3,#10,#15: The State of Florida DNR order is not filled out below the authorized signature to indicate if the signer is surrogate, proxy, POA, or a guardian. Patient#6: Nurse visit on 8/26/26 documentation states “SOBOE” and “ABD SNT HYPO BS”. Per agency policy these are not approved abbreviations.”