Eleos Hospice Care

“Upon patient record review, 4 of 19 (Patients #1, 2, 4, 10) 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, 2, 4, 10: The patient is prescribed MiraLAX. There is no evidence of specific instructions for the reconstitution.”

“Upon patient record review, 1 of 19 (Patient #4) 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 #4: Patient was admitted and developed a stage 1 coccyx wound on 2/19. This was documented as stage 3 on 04/23/26 with measurements of 2x2 with 0cm depth. The wound was not assessed again until 05/07/26. During this visit the wound is described as stage 3, though now with worsening depth of 1cm and including tunneling of 1cm. Although Nursing visits are occurring twice weekly, there is no evidence of further documentation on worsening wound.”

“Upon patient record review, 4 of 19 (Patient #1, 2, 4, 5) 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. Patients #1, 4: The patient is prescribed daily anticoagulants. There is no evidence of interventions or goals for use of anticoagulants or bleeding precautions in the plan of care. Patients #1, 2, 4, 5: The patient is receiving music therapy. There is no evidence of interventions or goals related to the discipline of music therapy.”

“Upon personnel record review, 1 of 15 (Personnel #11) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel #11: There was no evidence of a competency assessment with a patient for the following tasks: Shampoo, sink, tub, bed, nail and skin care.”

“Upon patient record review, 7 of 19 (Patients #1, 2, 5, 9, 10, 11, 13) 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: The patient is has oxygen ordered as needed. The patient is also on anticoagulants. There is no evidence of oxygen or bleeding precautions on the aide plan of care. Patients #2, 5, 9, 10, 11, 13: The aide plan of care states, “May trim or file long or uneven toenails” and “May trim or file long or uneven fingernails”. The use of “may” is not acceptable as it must be concrete.”

“Upon patient record review 8 of 19 (Patient #1, 2, 4, 5, 9, 10, 11, 13) 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 aide is performing the following tasks without evidence of competency for the task: Assisting with dressing, Shampoo, skin care, made patient bed, and change patient linens. Patient #2: The aide is performing the following tasks without evidence of competency for the task: Trim and file long or uneven toenails/fingernails, shampoo, skin care, shave, foot care, made patient bed, and change patient linens, assist with dressing. Patient #4: The aide is performing the following tasks without evidence of competency for the task: Diet, assist with meal preparation, set up and feeding, shampoo, skin care, foot care. Patient #5, 9, 10, 11, 13: The aide is performing the following tasks without evidence of competency for the task: Trim and file long or uneven toenails/fingernails, shampoo, skin care, foot care, made patient bed, and change patient linens, assist with dressing.”