Gentiva

“Upon patient record review, 5 of 14 (Patient #1,#2,#6,#7,#9) 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: The medication profile contained Clotrimazole-betamethasone 1% - 0.05% twice a day for 7 days started on 02/06/25. There is no evidence of a specified area of application. This medication is also still active on medication profile. Corrected on Site. Patient#2: The medication profile contained doxycycline 100mg twice a day for 7 days starting 2/20/25. This medication is still active on medication profile. Additionally, the medication profile contained lidocaine 4% patch one daily to affected area. There is no evidence of a specified area of application. Corrected on site. Patient#6: The medication profile contained Zithromax Z-pak 250mg starting on 3/2/25. This medication is still showing as active. Corrected on site. Patient#7: The medication profile contained Diclofenac 1% topical four times daily prn pain to affected area. There is no evidence of a specified area of application. Corrected on site. Patient#9: During observation of home visit and medication reconciliation, the medication profile contained Levetiracetam 500mg 1 twice a day. The medication bottle in the home was for Levetiracetam 750mg 1 at bedtime. This dose was confirmed with confirmed with caregiver. Corrected on site.”

“Upon patient record review, 8 of 14 (Patient #1,#2,#3,#4,#5,#6,#8,#9) 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 has Dysphagia as documented on 2/12/25 IDG. The aide plan of care indicates bleeding precautions are to be taken. Patient is taking Plavix (ordered 2/5/25) and has increased bruising per IDG note on 03/12/25. There is no evidence of problems with goals or interventions related to dysphagia or bleeding precautions on the plan of care. Corrected on site Patient#2: The record indicates patient is taking Eliquis daily. There is no evidence of problems containing goals and interventions for bleeding precautions. Corrected on site Patient#3: The record indicates patient is taking Warfarin 4mg daily. There is no evidence of problems containing goals and interventions for bleeding precautions. Corrected on site. Patient#4: The record indicates patient has diagnosis of heart failure and issues with pitting edema since admission. The NP F2F on 7/11/24 documents a recommendation of monitoring fluid volume. Nurse documentation indicates +2 edema on 2/19/25 visit and +3 edema on following nurse visit. There is no evidence of problems with goals and interventions related to edema. Corrected on site. Patient#5: The record indicates patient is taking Keppra for seizures and has seizure precautions listed on the aide plan of care. There is no evidence of problems, goals, or interventions related to seizure precautions on the plan of care. Documentation indicates patient previously had indwelling catheter which has been discontinued. However, goals and interventions related to this are still active on plan of care. Corrected on site. Patient#6: The patient is taking Eliquis daily. There is no evidence of bleeding precautions on plan of care. Corrected on site Patient#8: The record indicates on the 2/12/25 IDG and on the aide care plan that patient requires aspiration precautions. There is no evidence of goals or interventions related to aspiration precautions on the plan of care. Corrected on site Patient#9: The record indicates in initial bereavement assessment that family is at high risk. There is no evidence the plan of care addresses this need.”

“Upon patient record review, 4 of 14 (Patient #1,#2,#7,#9) 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: The record indicates an order for Clotrimazole-betamethasone 1% - 0.05% twice a day for 7 days started on 02/06/25. There is no evidence of a specified area of application. Corrected on site Patient#2: The record indicates an order for lidocaine 4% patch one daily to affected area. There is no evidence of a specified area of application. Corrected on site Patient#7: The record indicates an order for Diclofenac 1% topical four times daily prn pain to affected area. There is no evidence of a specified area of application. COS Patient#9: The record indicates an order for Levetiracetam 500mg 1 twice a day. The medication bottle in the home was for Levetiracetam 750mg 1 at bedtime. This dose was confirmed with confirmed with caregiver. Corrected on site.”

“Upon patient record review, 4 of 14 (Patient #1,#3,#6,#9) 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 care plan (2/06/24) includes task of bathing every visit “per patient request”, hair care “per patient request”, and dressing “as needed”. There is no evidence of bleeding precautions on the aide plan of care. Corrected on site. Patient#3: The record indicates patient is taking Warfarin 4mg daily. There is no evidence of bleeding precaution on the aide plan of care. Corrected on site. Patient#6: The record indicates patient is taking Eliquis daily. There is no evidence of bleeding precautions on aide plan of care. Corrected on site. Patient#9: The record indicates the plan of care includes seizure precautions. There is no evidence of seizure precautions on the aide plan of care. Corrected on site.”

“Upon patient client record review, 10 of 14 (Patient#1,#2,#3,#4,#5,#6,#7,#8,#9#10) 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,#3,#4,#5,#6,#7,#8,#9#10: The record indicates all social worker visits were signed electronically in medical records. However, the credentials on social worker signature indicate Licensed Practical Nurse. There is no evidence of social worker credentials on visit signatures. Patient#1: The record indicates a documentation for a missed visit for aide on 01/14/25. However, patient was not admitted to services until 02/05/25. Patient#2: The record indicates DNR signed by patient representative on 02/21/25 and by medical director on 02/26/25. However, the social worker note on IDG 03/12/25 states patient is a full code. Patient#7: The record indicates in social worker initial evaluation that the patient was admitted with end stage renal disease. However, the CTI and RN initial assessment state admitting diagnosis is osteoarthritis of the hip. Patient#10: The record indicates the last LVN visit was made on 1/09/25 with the RN completing an supervisory visit on 2/4/25. Additionally, the RN completed LVN supervisory visits on 2/13/25, 2/20, and 3/6. There is no evidence of an LVN visit after 1/9/25.”