Gentiva

“Upon patient record review, 6 of 19 (Patient #2,#3,#4,#6,#13,#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: During home visit it was noted that assisted living has medication profile indicated patient receiving alprazolam 0.5mg 1 by mouth BID as needed for agitation or anxiety. However, the agency medication profile indicates to take every 6 hours. The assisted living medication profile indicates patient taking Haloperidol 1mg every 6 hours as needed for agitation. However, the agency medication profile indicates dose is 0.5mg every 6 hours. It was also noted that assisted living medication list indicates patient taking the following: Anti-diarrhea 2mg, AZO D-mannose 500mg, Bisacodyl 10mg suppository, Cranberry 450mg, Diphenhydramine 25mg, escitalopram oxalate 10mg, Antacid anti-gas 20ml, Geri-Tussin 100/5ml, ibuprofen 200mg, methimazole 5mg, milk of magnesia , ondansetron 4mg, risperidone 1 mg, senna+docusate, trazodone 50mg. There is no evidence of these on the agency medication profile. Patient#3: During home visit it was noted there was no senna in home. However, the medication profile indicates this is a scheduled daily medication. Patient#4: During home visit caregiver indicates giving Humalog insulin on a sliding scale and uses a math calculation to determine dose, and giving glargine insulin as needed. However, medication profile states insulin glargine 26 unit daily and Humalog 26 units 3 times a day. Patient#6: Medication order 5/4/26 states all medications to be given via PEG except Zofran. However, for ASA 81mg, Celexa 10mg, oxycodone 5mg senna 8.6, and cetirizine 10mg the medication profile indicates route is oral with alternate route PEG. Patient#13: Medication profile indicates Tylenol extra strength 500mg take 2 every 8 hours as scheduled routine medication. However, the instruction states as needed every 8 hours. Patient#14: The medication profile indicates fentanyl patch 1 every 72 hours. However, there is no evidence of instructions for where to apply or if rotation of sites is needed.”

“Upon patient record review, 3 of 19 (Patient #2,#6,#13) 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#2: The plan of care indicates interventions are active for bleeding precautions. However, this patient is no longer on anticoagulant and bleeding precautions were removed from aide plan of care but not nursing plan of care. Patient#6: Oxygen safety problems, goals, and interventions are noted on the plan of care. However, there is no evidence in record that the patient is ordered or uses oxygen. Patient#13: The aide plan of care states patient is on skin precautions. There is no evidence of skin precautions on the main plan of care. The record indicates patient is bedbound, incontinent, and has foot drop.”

“Upon patient record review, 3 of 19 (Patient #2,#3,#6) 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: During home visit it was noted that assisted living has medication order indicated patient receiving alprazolam 0.5mg 1 by mouth BID as needed for agitation or anxiety. However, the agency medication order indicates to take every 6 hours. The assisted living medication order indicates patient taking Haloperidol 1mg every 6 hours as needed for agitation. However, the agency medication order indicates dose is 0.5mg every 6 hours. It was also noted that assisted living medication orders include patient taking the following: Anti-diarrhea 2mg, AZO D-mannose 500mg, Bisacodyl 10mg suppository, Cranberry 450mg, Diphenhydramine 25mg, escitalopram oxalate 10mg , Antacid anti gas 20ml, Geri-Tussin 100/5ml, ibuprofen 200mg, methimazole 5mg, milk of magnesia , ondansetron 4mg, risperidone 1 mg, senna+docusate, trazodone 50mg. There is no evidence of medication order for these in hospice record. Patient#3: Metronidazole is noted as active on the medication order for foot wound. However, updated wound care order did not include this medication. Patient#6: Nurse documentation 7/28/26 indicates patient has a PEG tube. Review of record revealed physician order 08/04/26 ordered Isosource 1.5 for nutrition and indicated all meds to be given via PEG tube except Zofran which may be administered sublingual. This order was not intended for this patient as this patient does not have a peg tube.”

“Upon patient record review, 3 of 19 (Patient #1,#3,#5) 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 per aide plan of care that patient is given a shower. There is no evidence of shower safety equipment on supply order for plan of care. The patient has a diagnosis of Parkinson and has had multiple falls including a recent fall with femur fracture. Patient#3: The record indicates patient has a foley. There is no evidence of foley supplies noted on supply order for plan of care. Patient#5: The record indicates per aide plan of care that patient is given a shower. There is no evidence of shower safety equipment on supply order for plan of care. Patient has foley, is a fall risk , uses wheelchair or rollator at all times.”

“Upon patient record review, 4 of 19 (Patient #4,#7,#8,#10) 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#4: Nurse documentation on 8/4/26 indicates patient spouse tells nurse that 1/2 cough syrup is water. She thinks their son did it as he has a drug problem. There is no evidence of updated plan of care problems, goals, or interventions regarding medication safety and education caregiver. Patient#7: The record indicates on 8/2/26 patient went to ER for seizure like activity. Medication order in chart indicates hospice MD ordered lorazepam for signs and symptom of seizures. No evidence of update to plan of care for problems, goals, or interventions related to seizure precautions and education. Patient#8: IDG note on 7/23/26 nurse documentation indicates patient having multiple episodes of chest pain. There is no evidence plan of care updated to address this. Patient#10: Nurse documentation on PRN visit 8/1/26 indicates patient fell down the stairs in home. She was found by daughter with blood on her head due to skin tear. Patient had bruising to right knee and left shoulder. Patient now residing upstairs in the home with bathroom available to her. There is no evidence of home safety problem, goals, or interventions updated on plan of care. There is no evidence of safety measure put in place to prevent patient from accessing stairs as she resides upstairs or for continuous supervision of patient as patient previous left alone.”

“Upon patient record review, 1 of 19 (Patient #7) 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#7: Nurse documents that patient was sent to ER 8/2/26 for possible seizure like activity. There is no evidence of any follow-up by agency with the ER visit documented in the chart. There is no evidence of discharge papers or ER report noted in patient chart. Patient went to ER for evaluation and returned home. However, patient did not discharge from hospice. There is no evidence in the record of the communication/sharing of information with the IDG and the ER regarding the visit for seizure activity.”

“Upon patient record review, 2 of 19 (Patient #5,#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#5: Skin precautions are noted on the main plan of care. There is no evidence of this noted on the aide plan of care. Patient#9: The aide plan of care states patient has functional /mobility limitations. There is no evidence on the aide plan of care to specify the functional limitations of left hemiparesis.”

“Upon patient client record review, 2 of 19 (Patient #3,#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#3: MSW entered a missed visit note on 3/19/26. The note states missed visit was 3/13. However patient admitted 3/15. Patient#6: Nurse documentation on 7/28/26 indicates patient has a PEG tube. Further review of record revealed this patient does not have a peg tube and this was documented in the wrong chart.”