Heartland Hospice (Frankfort)

“Upon patient record review, 4 of 14 (Patient #1,#2,#3,#5) 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: The medication profile indicate the patient has an active order for Aspirin to be taken daily. However, there is evidence in the record of an order to discontinue the aspirin dated 5/8/26. Patient#2: The order indicates ammonium lactate 12% lotion to be applied daily to entire body except face. However, the medication profile does not include the “except face” on the instructions. This medication is active but was not found in the home during home visit. It was also noted in the home that the patient has a bottle of atorvastatin 80 mg and a bottle of atorvastatin 40mg. Patient states she is taking both. However, only atorvastatin 80mg is listed on the medication profile. Patient#3: During the home visit it was noted that oxygen and Eliquis are both active medications on the hospice medication profile. However, there is no evidence of these on the facility MAR or their order sheet. Patient#5: The medication profile indicates patient to take lactulose 30ml daily if senna and milk of magnesia do not provide BM. Senna and milk of magnesia are ordered as PRN. However, the lactulose is scheduled to take daily.”

“Upon patient record review, 3 of 14 (Patient #3,#7,#10) 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#3: The record indicates the plan of care order for supplies/equipment includes a nebulizer. However, there is no evidence the patient is ordered any medication requiring a nebulizer. Patient#7: The record indicates the plan of care order for supplies/equipment includes ostomy supplies. However, there is no evidence the patient has an ostomy. Patient#10: The record indicates the patient is ordered humidified oxygen. However, there is no evidence of that or humidifier for the oxygen on the plan of care order for supplies/equipment.”

“Upon patient record review 1 of 14 (Patient #6) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient#6: On visit 4/6/26 and in IDG 4/15/26 the nurse documented that patient wants to start taking cranberry pill for UTI since she cannot take the antibiotic. Nurse documents she will follow up with the physician. There is no evidence of any follow up decision from physician or reporting back and discussing with physician recommendation with patient.”

“Upon patient record review, 2 of 14 (Patient #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#8: The aide plan of care indicates patient is on oxygen precautions. However, this patient is not ordered oxygen. Patient#10: The record indicates this patient is on oxygen. There is no evidence of oxygen precautions on the aide plan of care.”

“Upon patient client record review, 3 of 14 (Patient #1,#6,#7) 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#1: On 4/16/26 and 4/28/26 the aide documents “Patient SOB FSN and RNCM notified”. She also documents “patient unable to sign FSN Shamir”. FSN is not an acceptable abbreviation per company policy. Patient#6: On 3/14/26 the nurse uses “FSN” during her documentation. This is not an acceptable abbreviation per company policy. Patient#7: On 3/26/26 the chaplain documents “conveyed by SCC to BU” and “SCC to schedule subsequent visits”. These are not acceptable abbreviations per company policy.”

“Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the hospice assumes responsibility for professional management of the resident’s hospice services in accordance with the hospice plan of care. The hospice is responsible for providing all hospice services including: • Ongoing assessment, care planning, monitoring, coordination and provision of care by the Hospice IDG • Assessment, coordination and provision of any needed general inpatient or continuous care • Consultation about the patient’s care with facility staff • Coordination by the hospice RN for the implementation of the plan of care for the patient • Provision of hospice aide services, if these services are determined necessary by the IDG to supplement the nurse aide services provided by the facility • Provision, in a timely manner, of all supplies, medications, and DME needed for the palliation and management of the terminal illness and related conditions • Financial management responsibility for all medical supplies, appliances, medications and biologicals related to the terminal illness and related conditions • Determination of the appropriate level of care to be given to the patient (routine homecare, inpatient, or continuous care) • Arranging any necessary transfers from the facility, in consultation with the facility personnel Patient#1: The record indicates that on 4/30/26 the facility contacted the hospice triage to report that the patient had a low blood pressure and was requesting transfer to the hospital. Triage recommended a nursing visit. The on-call hospice RN subsequently contacted the facility and discussed the patient’s condition with the facility nurse. During that conversation, the hospice RN informed the facility nurse that the patient’s blood pressure typically ran low. Documentation indicated that the patient continued to express a desire to go to the hospital; however, the hospice RN relied upon the facility nurse’s assessment and determined that there was no reason for hospitalization rather than directly assessing the condition.”