Gentiva

“Upon patient record review, 1 of 23 (Patient #13) 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 13: Medication list reflects Triple Antibiotic Ointment for right heel wound only. No evidence of update to reflect new order for left heel effective 5/13/24.”

“Upon patient record review, 2 of 23 (Patient #6 & 7) 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 6: MSW documents at 5/2/24 visit pt. “appears disheveled. Pt presents lethargic. Pt denies pain but pt. displays s/s of pain.” Further states, “SW notes pt. appears more confused”. “IDG team updated” There is no evidence of RN follow up with patient and/or facility either by visit or telephone, after “IDG team” notification to assess increased confusion, s/s pain, lethargy, or lack of grooming. Patient 7: RN documentation reveals change in respiratory status at visit on 5/1/24. Crackles noted to left lower lung in pt. with significant history of aspiration per prior visit notes. There is no evidence of report and coordination of care with physician.”

“Upon patient record review, 1 of 23 (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: At the time of admission on 03/20/24 Volunteer services were accepted. There were no visit frequencies added to the Plan of Care, no problem(s), interventions, or goals present related to volunteer services and no evidence that volunteer services were initiated.”

“Upon patient record review, 3 of 23 (Patient #5,#7,#11) 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 5: Documentation shows Spiritual Care was declined per pt/cg. Plan of Care noted to have interventions and goals open for spiritual care services. Patient 7: Documentation shows Spiritual Care and MSW were declined per pt/cg. Plan of Care noted to have interventions and goals open for both spiritual care and MSW services. Patient 11: Oxygen precautions present on Plan of Care but no documentation of Oxygen therapy present in visit notes, interventions/goals, or medication list from SOC to present date. In addition, LPN documents on 2/1/24 and 2/6/24 visits the use of “Health Shakes PRN”. The updated plan of care does not contain this supplement.”

“Upon client record review, 2 of 23 (Patient #3,#11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 3: Volunteer services requested upon admission, 8/3/23. Supplemental order completed 8/16/23 with frequency of once monthly. There was no volunteer visit completed September 2023 or November 2023. There is no evidence of an MD order to decrease frequency or any documentation of a refused visit. In December 2023 there were two volunteer visits conducted on 12/5/23 & 12/28/23 with no evidence of a change in frequency per MD order. Patient 11: Plan of Care lists frequency for Spiritual Care Services at 1M1, 2M2 until discontinued on 3/1/24. There are no spiritual care visits for the month of February and no evidence of missed/refused visits. Also, HHA visit frequency of twice weekly was not met the week of 2/25/24. No evidence of missed/refused visit documented.”

“Upon patient record review, 2 of 23 (Patient #21 & 22) 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 21: No evidence of any bereavement support offered/provided past patient expiration. Patient had no family or friends listed as contacts however, patient did reside in a facility. No evidence found of facility staff refusal or acceptance r/t bereavement needs and services. Patient 22: Bereavement services were initiated for survivors at the patients’ time of death 10/08/23. Services were continued through third month with bereavement activity documented 12/23/23. There is no further documentation present with bereavement services ended in EMR on2/9/24. There is no evidence of the bereaved requesting services to end.”

“Upon patient record review, 3 of 23 (Patient #5, 11, & 16) 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 5: Aide instructions at the time of chart review, dated 5/10/24 did not contain Oxygen precautions, address the presence and instructions for dressing to right knee, nor alert for infectious disease. Patient 11: Patient noted to have decreased visual acuity requiring glasses and hearing impairment at time of initial assessment. These are not listed on the aide instructions for patient safety and communication needs. Patient 16: Patient noted to have decreased visual acuity requiring glasses and hearing impairment at time of initial assessment4/26/24. These are not currently listed on the aide instructions for patient safety and communication needs. Fall precautions are not listed on the aide instructions but are present on patient plan of care.”

“Upon patient record review 4 of 23 (Patient #8, 11, 12, &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 8: HHA visit 5/6/24 includes “other” task documented per aide, “ assisted with eating lunch”. The task of offering/assisting with meals is not included in the aide instructions. Patient 11: HHA visit frequency of twice weekly was not met the week of 2/25/24. No evidence of missed/refused visit documented. Patient 12: HHA frequency of twice weekly per Plan of Care. HHA visits the week of 5/5/24 reflect no evidence of missed visit documentation or refusal for the first visit of the week. Patient 13: HHA frequency twice weekly. There is only one visit documented the week of 4/15/24 with no evidence of missed/refused visit.”

“Upon patient record review 1 of 23 (Patient #11) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient’s needs. Patient 11: No evidence of RN supervisory visit performed from initiation of HHA services on 1/15/24 until 2/23/24. Also, supervisory visit completed for HHA services on 3/19/24 but not again until 4/16/24.”