Elara Caring I

“Upon patient record review, 4 of 19 (Patient #1,4,5,6) 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 1,4,5,6:The patients medication profile includes an entry for oxygen at 2-5 liters per minute PRN. There is no evidence that the medication profile includes the route or titration instructions for oxygen. Patient 6:The patients medication profile includes an entry for MiraLAX 17gms po q day as needed for constipation. There is no evidence on the medication profile of the type and amount of diluent needed for administration of MiraLAX.”

“Upon patient record review, 1 of 19 (Patient #1) 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 medical record includes documentation upon admission of oxygen 2-5 liters per minute prn for dyspnea. There is no evidence of problems, goals and interventions related to oxygen use and safety.”

“Upon patient record review, 4 of 19 (Patient #1,#4,#5,#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 1,4,5,6:The initial plan of care includes on order upon admission for oxygen at 2-5 liters per minute PRN. There is no evidence that the order includes the route or titration instructions for oxygen. Patient 6:The initial plan of care includes an order for MiraLAX 17gms po q day as needed for constipation. There is no evidence of the type and amount of diluent needed for administration of MiraLAX.”

“Upon patient record review, 1 of 19 (Patient #13) 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 13:The medical record contains documentation on 12/19/23 of an new stage II pressure ulcer to left heel that includes an order to cleanse with wound cleanser, pat dry, apply therahoney and a petroleum jelly dressing followed by an ABD pad and wrap with kerlex. There is no evidence of an update to the plan of care to include problems, goals and interventions related to wound care to pressure ulcer.”

“Upon patient record review, 1 of 19 (Patient #17) 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 17: The bereavement plan of care included letters to the bereaved to be generated and mailed at 30, 60 and 90 days post death. There is no evidence that letters were sent to the bereaved.”

“Upon patient record review, 1 of 19 (Patient #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 10:The aide plan of care includes the task of shampoo hair every visit. There is evidence of documentation by the aide every visit from 10/18/23 until 1/9/24 that the patient goes to the beauty shop for all hair related tasks.”