Gentiva

“Upon observation, there was no evidence that all alleged violations involving mistreatment, neglect, or verbal, mental, sexual and physical abuse, including injuries of unknown source, and misappropriation of patient property by anyone furnishing services on behalf of the hospice, are reported immediately to the Administrator or appropriate designee. Patient#4: Documentation for 6/22/26 visit by MSW states that spouse has bandages to arms. Spouse states it was injuries due to incident with their granddaughter. Spouse also reported to MSW that the pushing or similar incidents also happens to the patient. Granddaughter has an APS worker. There is no evidence of investigation or collaboration with the APS case worker following the incident, the MSW stated she did follow-up up with worker and collaborate for patient; however, there was no documentation in chart.”

“Upon patient record review, 6 of 19 (Patient #2,#5,#7,#8,#9,#14) 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#2:The medication profile indicates the following medications are active: loperamide 2mg scheduled to give one twice a day for diarrhea, Colace two times a day for constipation, and MiraLAX 17 grams scheduled for constipation. Patient#5:The medication profile indicates the patient is taking lactase 9000 units 1 tab four times a day orally and Glucerna four times a day orally. However, this patient has a PEG tube for all meds and intake. The medication profile also indicates lactase is marked as no for not having reviewed directions for use, not having reviewed medication purpose, and not having reviewed side effects/interactions. Patient#7:The medication profile indicates patient is using fentanyl patches. However, there is no evidence of specific instructions for application. Patient#8:It is noted during home visit that Lotrimin AF and Neosporin are active on the medication profile. However, per the caregiver the patient is no longer using these. It was also noted that the patient is currently using artificial tears 1% PRN to both eyes. However, there is no evidence of artificial tears on the medication profile. Patient#9: The medication profile indicates patient actively taking Nitrofurantoin for UTI that was ordered on 01/19/26. However, the instructions state to take for 7 days. Patient#14:The medication profile indicates that nitroglycerin sublingual is scheduled daily. However, the instructions state to take as needed for chest pain.”

“Upon patient record review, 2 of 19 (Patient #4,#14) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family’s needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient#4: There is no evidence of wound #1 to distal right calf being measured the week of 6/21/26. This is not in compliance with agency policy. Patient#14: The record indicates on 5/29/26 the MSW made a PRN visit and documented that patient cried out in pain and also had a fall. MSW documents she contacted RN who stated she would assess the patient. However, there is no evidence of any follow-up or assessment by the RN.”

“Upon patient record review, 6 of 19 (Patient #1,#2,#4,#5,#10,#12) 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 plan of care contains interventions for education regarding smoking while using oxygen. However, the the RN documents on visits 6/9/26 and 6/30/26 that the patient is not a smoker. There is no evidence of goals and interventions related to oxygen safety and education. Patient#2:There is documentation on 6/23/26 nurse visit that patient is legally blind and also experiences blurred vision. There is no evidence of problems, goals, or interventions on the nursing plan of care. Patient#4:The record indicates that contact precautions due to bed bugs are listed on the aide plan of care. There is no evidence of problems, goals, or interventions related to this on the main plan of care. Patient#5:The record indicates patient uses PEG tube for medications and intake. However, there is no evidence of aspiration precautions problems, goals, and interventions on plan of care. The plan of care also has interventions for abdominal drain. However, the patient does not have an abdominal drain. Patient#10: The record indicates patient is on oxygen. However, there is no evidence of problems, goals, or interventions on the plan of care for oxygen precautions. Patient#12:The record indicates aspiration precautions are listed on the aide plan of care. However, there is no evidence of aspiration precautions problems, goals, or interventions on the main plan of care.”

“Upon patient record review, 4 of 19 (Patient #2,#5,#7,#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 there is an active order for loperamide 2mg schedule for 1 twice a day for diarrhea. However, there is also active orders for Colace scheduled for twice a day for constipation, and for MiraLAX 17 grams scheduled daily for constipation. Patient#5:The record indicates lactase 9000 unit take 1 orally 4 times a day. However, this patient is taking all meds via PEG tube. Patient#7: The record indicates fentanyl is ordered for the patient. However, there is no evidence of specific instructions for application. Patient#8:It is noted during home visit that the patient is currently using artificial tears 1% PRN to both eyes. However, there is no evidence of an order for this.”

“Upon patient record review, 1 of 19 (Patient #1) did not have evidence that the IDG documents the sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement. Patient#1:During home visit the patient and family explained patient was going to a specialist every 3 months in Savannah to get the trach prosthetic changed and the physician also does a deep suction if needed. There is no evidence of these visits, collaboration, or coordination with the physician or the care he is providing in the patient chart.”

“Upon patient record review, 4 of 19 (Patient #4,#5,#8,#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#4:There is no evidence on aide plan of care that aide was notified of wound or dressing on on patient. Patient#5:There is no evidence on the aide plan of care of skin precautions or aspirations precautions. These precautions are noted on nursing plan of care. patient #8: There is no evidence on aide plan of care for skin precautions. Skin precautions are noted on the nursing plan of care. patient#9:There is no evidence of the aide plan of care of skin precautions. This is noted to be on the nursing plan of care.”