Gentiva

“Upon patient record review, 5 of 14 (Patient #2, 4, 5, 6, 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 2 AYR nasal spray on medication profile does not include which nostril or both. Nursing visit on 10/2/24 includes oxygen at 2-4LPM, medication profile includes 2LPM. Patient 4 Flonase nasal spray on medication profile does not include which nostril or both. Patient 5 nursing visit 4/29/24 documents oxygen 2-4LPM, and nursing visit 11/1/24 documents encouraged use of prn oxygen. NO evidence of oxygen on medication profile. Patient 6 nursing visits 10/4/24, 10/9, 10/11, 10/15 document the use of Zoloft, no evidence of Zoloft on medication profile. Patient 9 artificial tears are on medication profile without including which eye or both. Oxygen on medication profile at 2LPM, no evidence of a route. Miralax on medication profile, no evidence of mixing instructions.”

“Upon patient record review, 3 of 14 (Patient 4, 6, 7) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient 4 admitted 4/16/24, initial bereavement risk assessment completed on 6/13/24. Patient 6 admitted 10/1/24, no evidence of an initial bereavement risk assessment. Patient 7 admitted 8/19/24, no evidence of an initial bereavement risk assessment.”

“Upon patient record review, 6 of 14 (Patient #1, 2, 4, 7, 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 initial nursing visit documents high risk for aspiration, no evidence of aspiration precautions. Patient 2 on Aspirin, no evidence of bleeding precautions. Diet mechanical soft with high risk for aspiration, no evidence of aspiration precautions. Patient 4 initial plan of care under Advance Directives includes POST, no evidence of code status on the plan of care. Patient 7 nursing visit on 8/19/24 documents dysphagia. Nursing visits in October document change of diet to mechanical soft. No evidence of aspiration precautions. Patient 8 on Aspirin, no evidence of bleeding precautions. Patient 9 initial plan of care under Advance Directives states none, no evidence of the code status on the plan of care.”

“Upon patient record review, 5 of 14 (Patient #2, 4, 5, 6, 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 2 AYR nasal spray order does not include which nostril or both. Nursing visit on 10/2/24 includes oxygen at 2-4LPM, order includes 2LPM. Patient 4 Flonase nasal spray order does not include which nostril or both. Patient 5 nursing visit 4/29/24 documents oxygen 2-4LPM, and nursing visit 11/1/24 documents encouraged use of prn oxygen. No evidence of an order for oxygen. Nursing visits throughout the hospice admission document a foley in place, no evidence of an order for the foley. Patient 6 nursing visits 10/4/24, 10/9, 10/11, 10/15 document the use of Zoloft, no evidence of an order for Zoloft. Patient 9 artificial tears are ordered without including which eye or both. Oxygen ordered at 2LPM, no evidence of a route. Miralax ordered, no evidence of mixing instructions.”

“Upon patient record review, 3 of 14 (Patient #1, 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 equipment and supply needs. Patient 1 nursing visit on 4/18/24 documents walker and over bed table in use, nursing visit on 10/9 documents a wheelchair in use. No evidence of an ordered for the needed DME. Patient 5 nursing visits on 4/29/24 and 11/1 document oxygen in use, no evidence of a DME order for oxygen. Patient 8 nursing visits on 5/10/24 and 10/24/24 document hospital bed, mattress, over bed table and wheelchair in use. No evidence of an order for the needed DME.”

“Upon client record review, 3 of 14 (Patient #1, 2, 4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1 order on 7/31/24 for SW effective 8/10/24 of 1m3 and 2prn. No evidence of visit or refusal in October that was due by 10/9 (10/9 new cert period). Patient 2 order on 8/21/24 for SW effective 9/1/24 of 2m2 and 2prn. No evidence of 2 visits or refusal on October that was due by 10/24 (10/25 began the new cert period). Patient 4 Order on 7/3/24 for SW effective 7/15/24 of 1m4 and 2prn. Routine SW visits completed on 8/21 and 8/29. Order on 10/2/24 for SW effective 10/13/24 of 2m3 and 2prn. Routine SW visit completed on 10/28/24, no evidence of a second visit or refusal for October.”

“Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient 2 SC placed computer bag, tablet, and devotional book on the table in the facility’s community room without a barrier and without cleaning the surface. The devotional book was placed into the computer bag without cleaning the book. Patient 3 RN reached into nursing side pocket to obtain gloves several times throughout the visit with dirty hands, she provided patient care and did not sanitize or wash hands prior to reaching into the nursing bag to obtain more gloves.”

“Upon patient record review, 2 of 14 (Patient #13, 14) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient 13- 1 month bereavement letter due to be sent on 5/7/24 and 3 month letter due to be sent on 7/6/24, both were sent 9/19/24. Patient 14- 2 week letter due to sent on 2/19/24, it was sent on 4/17/24. 1 month bereavement letter due to be sent on 3/5/24, it was sent on 4/24/24. 3 month letter due to be sent on 5/4/24, it was sent on 9/19/24. 6 month letter due to be sent on 8/2/24, it was sent on 9/19/24.”

“Upon patient record review, 3 of 14 (Patient #1, 8, 10) 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 initial nursing visit documents high risk for aspiration, no evidence of aspiration precautions on aide care plan. Patient 8 care plan includes aspiration precautions, no evidence of aspiration precautions on the aide care plan. Patient 10 care plan includes fall and aspiration precautions, no evidence of fall or aspiration precautions on the aide care plan.”

“Upon patient record review 6 of 14 (Patient #1, 2, 3, 4, 7, 9) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 1 the 10/9/24 aide visit documented bath, shampoo, and hair care not needed. The 10/17 aide visit documented tub bath, shampoo and hair care not needed this visit. The 10/21 aide visit documented tub bath and shampoo not needed this visit. The 10/28 aide visit documented shampoo and tub bath not needed this visit. All tasks were every visit on the aide care plan. Patient 2 aide care plan included shower every visit, dressing weekly, skin care weekly. The following visits the aide documented shower not needed this visit: 10/8/24, 10/14, 10/23, 10/29. The aide completed dressing and skin care on the following visits: 10/2/24, 10/4, 10/8, 10/11. Patient 3 aide care plan included shower, dressing, hair care, nail care and skin care all as weekly. These were all completed on the following visits: 9/30/24, 10/4, 10/16, 10/18, 10/21, 10/24. Patient 4 the 10/30/24 aide visit documented tub bath not needed this visit, should be every visit. Patient 7 aide care plan included skin care weekly. Aide completed skin care on 10/21/24, 10/24, 10/28, 10/29. Patient 9 aide care plan includes hair care and nail care weekly. Hair care and nail care were completed 2x week throughout October.”

“Upon client record review, 2 of 14 (Patient #7, 8) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 7 order on 8/21/24 for SW effective 8/19/24 of 1m1, 2m2, and 2prn. SW visits completed on 8/21 and 8/29, ordered for one visit. No evidence of any visits or a refusal for October. Patient 8 order on 5/16/24 for SW effective 5/10/24 of 2m3 and 2prn. SW visit completed 5/16, no evidence of a second visit for May or refusal. SW visit completed on 8/6 and no order for this visit.”