Serene Palliative Care & Hospice, Inc.

“Upon patient record review, 2 of 10 (Patient #1,2) 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 residing in ALF, Hospice Medication profile did not match what patient is taking per ALF med profile as follows: present on ALF profile but not on Hospice profile, Ipratropium-Albuterol Inhalation solution 0,5-2.5MG/3ML, inhale four times daily, also same medication ordered for every 2 hours PRN shortness of breath. Losartan Potassium-HCTZ oral tablet 100-25mg one tablet by mouth in the morning. Ibandronate sodium oral tablet 150mg by mouth every morning. Azithromycin oral tablet 250mg by mouth every Mon-wed-fri. Calcium-Vitamin D tablet 600-200mg-unit, one by mouth in the afternoon. Discrepancies in orders as follows: Hospice, Ondansetron 4mg tablet every 4 hours as needed for N/V. ALF order is for 4mg every 6 hours as needed for nausea and vomiting. Hospice, Potassium oral tablet 10mEq daily, ALF, 20mEq daily. Hospice, Tylenol 500mg tablet one tablet by mouth every night at HS and a PRN order for three times a day as needed for pain or fever. ALF 1 tablet TID for pain and 1 tab q6h PRN. Patient 2 residing in ALF, Hospice Medication profile did not match what patient is taking per ALF med profile as follows: present on Hospice profile but not on ALF profile, Morphine Concentrate 100 mg/5ml, 20mg/ml solution Take 5mg/0.25ml orally every 2 hours as needed for Severe pain, may use for Shortness of breath, Levsin 0.125mg tablet, administer 1 tablet orally every 4 hours as needed for secretions. Discrepancies in orders as follows: Hospice, Ativan 0.5mg oral tablet take one every 4 hours as needed for anxiety, ALF states give one tablet every 6 hours as needed for anxiety. Hospice, Tylenol 650mg tablet three times a day for pain, ALF Tylenol 650mg every 6 hours as needed for pain or fever.”

“Upon patient record review, 2 of 14 (Patient #1,2) 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 residing in ALF, Hospice Plan of Care did not match what patient is taking per ALF med profile as follows: present on ALF profile but not on Hospice Plan of Care, Ipratropium-Albuterol Inhalation solution 0,5-2.5MG/3ML, inhale four times daily, also same medication ordered for every 2 hours PRN shortness of breath. Losartan Potassium-HCTZ oral tablet 100-25mg one tablet by mouth in the morning. Ibandronate sodium oral tablet 150mg by mouth every morning. Azithromycin oral tablet 250mg by mouth every Mon-wed-fri. Calcium-Vitamin D tablet 600-200mg-unit, one by mouth in the afternoon. Discrepancies in orders as follows: Hospice, Ondansetron 4mg tablet every 4 hours as needed for N/V. ALF order is for 4mg every 6 hours as needed for nausea and vomiting. Hospice, Potassium oral tablet 10mEq daily, ALF, 20mEq daily. Hospice, Tylenol 500mg tablet one tablet by mouth every night at HS and a PRN order for three times a day as needed for pain or fever. ALF 1 tablet TID for pain and 1 tab q6h PRN. Patient 2 residing in ALF, Hospice Plan of Care did not match what patient is taking per ALF med profile as follows: present on Hospice Plan of Care but not on ALF profile, Morphine Concentrate 100 mg/5ml, 20mg/ml solution Take 5mg/0.25ml orally every 2 hours as needed for Severe pain, may use for Shortness of breath, Levsin 0.125mg tablet, administer 1 tablet orally every 4 hours as needed for secretions. Discrepancies in orders as follows: Hospice, Ativan 0.5mg oral tablet take one every 4 hours as needed for anxiety, ALF states give one tablet every 6 hours as needed for anxiety. Hospice, Tylenol 650mg tablet three times a day for pain, ALF Tylenol 650mg every 6 hours as needed for pain or fever.”

“Upon patient record review, 2 of 14 (Patient #7,11) 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. • 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 7 had a Bereavement Risk Assessment result of “moderate” per the MSW note on 9/16/24. There was no evidence of updating the POC or creating a Bereavement POC.”

“Upon patient record review, 3 of 14 (Patient #2,4,10) did not have evidence in the patient record that hospice aide assignments and duties are: • 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 2 contained tasks that leave a choice/decision for the aideas follows: “May trim/ file uneven nails every visit” and “Assist with transfers if needed each visit”. Patient 4 contained tasks that leave a choice/decision for the aide as follows: “May trim/ file uneven nails every visit”. Patient 10 contained tasks that leave a choice/decision for the aide as follows: “May trim/ file uneven nails 1x weekly”,”