Eden Hospice at the Inland Northwest LLC

“Upon patient record review, 3 of 19 (Patient #2,#7,#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 contained Lokelma powder packet with no instructions for a dilutant when preparing medication. During medication reconciliation, the facility and hospice medications did not match. The facility medication profile contained Acetaminophen suppository, Bio freeze Gel 4%, Glucagon Emergency Kit, Guaifenesin ER tab, Hydrocortisone Cream 1%, Nasal Spray, PreserVision AREDS, Thiamine, Tussin DM, Loperamide tab, and Vitamin B12 tab. There was no evidence of these medications on the hospice medication profile. The hospice med profile contained Haloperidol, Hyoscyamine, Lorazepam, and Morphine which were absent from the facility medication profile. Patient 7: Medication profile contained duplicate orders for oxygen 3-6L/min to be delivered continuously. Patient 14: Oxygen and Vashe wound cleanser and triple antibiotic ointment were all duplicated on the medication profile.”

“Upon patient record review, 1 of 19 (Patient #18) 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 18: RN documented on visit dated 5/8/2026 that patient had a fall the night before with emergency services called to assist patient from the floor. However, there was no documentation of assessment for injury following the fall or communication with the IDG. No visit made on 5/9/2023. Patient expired on 5/10/2026.”

“Upon patient record review, 3 of 19 (Patient #3,#7,#10) 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 3: Admission nurse documented patient is high risk for aspiration; however, there was no evidence of problems, interventions and goals for aspiration risk. Patient 7: Patient admitted with anticoagulant Xarelto; however, there was no problems, interventions and goals for bleeding precautions. Patient 10: The nursing documentation since admission identified patient as having dysphagia and a foley catheter. There was no evidence of problems, goals, and interventions related to the issues included in the plan of care.”

“Upon patient record review, 3 of 19 (Patient #2,#7,#14) 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 medical record contained order for Lokelma powder packet with no instructions for a dilutant when preparing medication. During medication reconciliation, the facility and hospice medications did not match. The facility medical record contained orders for Acetaminophen suppository, Bio freeze Gel 4%, Glucagon Emergency Kit, Guaifenesin ER tab, Hydrocortisone Cream 1%, Nasal Spray, PreserVision AREDS, Thiamine, Tussin DM, Loperamide tab, and Vitamin B12 tab. There was no evidence of orders for these medications in the hospice medical record. The hospice medical record contained orders for Haloperidol, Hyoscyamine, Lorazepam, and Morphine which were absent from the facility medical record. Patient 7: Medical record contained duplicate orders for oxygen 3-6L/min to be delivered continuously. Order written on 6/8/26 with oxygen delivery via nasal canula and updated order written on 7/22/26 with delivery via mask due to patient decline. Patient 14: Medical record contained duplicate orders for oxygen and Vashe wound cleanser and triple antibiotic ointment.”

“Upon patient record review, 6 of 19 (Patient #2,#3,#4,#6,#9,#13) 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 2: During home visit, observed patient had walker, raised toilet seat, over bed table and shower chair. There was no evidence of orders for the DME included in the plan of care order. Patient 3: Patient observed having walker, wheelchair and 1/2 rails; however, there was no evidence of the DME items on the plan of care order. Patient 4: During home visit, observed patient had wheelchair and over bed table; however, there was no evidence of DME on the plan of care order. Patient 6: Admission documentation identified patient having walker and electric scooter with no evidence of DME on the plan of care order. Patient 9: Documentation identified patient having a bedside commode and wheelchair with no evidence of DME on the plan of care order. Patient 13: The medical record contained nursing documentation upon admission identifying patient use of Hoyer lift. There was no evidence of orders for the DME included in the plan of care.”

“Upon patient record review, 7 of 19 (Patient #1,#3,#4,#5,#6,#7,#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: Aide care plan does not contain task or instructions for bathing type of bed bath or shower. Patient uses a wheelchair for mobility; however, the aide care plan does not contain tasks or instructions for transfers to and from the wheelchair. Patient 3: Patient uses a wheelchair for mobility; however, the aide care plan does not contain tasks or instructions for transfers to and from the wheelchair. Patient 4: Aide care plan contains tasks for partial sponge bath, bed bath and shower to be provided every visit with patient ability to choose between the types. However, patient unable to make choices related to documented confusion. Patient 5: Patient identified as having a shower chair, walker and power wheelchair; however, there was no tasks or instructions on the aide care plan for use of these DME items. Patient 6: The aide care plan did not contain tasks or instructions for patient’s use of walker and electric scooter. Patient 7,10: The aide care plan did not contain tasks or instructions for foley catheter care. Patient 10: Aide care plan contained instructions to apply antifungal cream; however, the medical record contains order for antifungal powder and not the antifungal cream.”

“Upon patient record review 3 of 19 (Patient #2,#3,#11) 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 2: Aide observed taking patient’s vital signs (temperature, pulse and blood pressure); however, there was no evidence of this task on the aide care plan. Patient 3: During home visit, observed aide providing a bed bath; however, the aide care plan contains task for a shower. Patient 11: Aide care plan contained task for RN delegation of task to wrap bilateral lower legs with tubigrip bandage or ace wrap from feet to below knees due to edema; however, there was no evidence of aide training and competencies to perform this task.”