Allegiance Healthcare, LLC

“It is required that the documented comprehensive assessment includes a drug profile that contains the patient’s current prescription and over the counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: the effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, and drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by clinical record review, interview and observation. In 1 of 14 (7%) clinical records reviewed, revealed the agency did not ensure that the drug profile included the current medications. Clinical Record 2/Home Visit 2: This patient elected the hospice benefit on 11/11/2024 with a terminal diagnosis of corticobasal degeneration. In review of the clinical record, the comprehensive assessment, dated 11/11/2024, stated the patient was bedbound and at risk for skin breakdown. During the home visit, on 11/20/2024, the Registered Nurse (Personnel Record 2) was observed applying Zinc ointment to the patient’s coccyx. The drug profile, dated 11/20/2024, did not include the Zinc ointment. This resulted in the medication reconciliation review was complete. The Administrator/Director of Clinical Operations was interviewed 11/20/2024 and stated that she delivered Zinc ointment to the patient on 11/15/2024 but forgot to add Zinc ointment to the drug profile.”

“It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following: drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review, interview and observation. In 2 of 14 (14%) clinical records reviewed, it was revealed that the agency did not ensure that the drugs and treatments necessary to meet the needs of the patient were included in the plan of care. Clinical Record 2/Home Visit 2: This patient elected the hospice benefit on 11/11/2024 with a terminal diagnosis of corticobasal degeneration. In review of the clinical record, the comprehensive assessment, dated 11/11/2024, stated the patient was bedbound and at risk for skin breakdown. During the home visit, on 11/20/2024, the Registered Nurse (RN) (Personnel Record 2) was observed applying Zinc ointment to the patient’s coccyx. The plan of care dated 11/11/2024-11/20/2024 did not include the treatment instruction to apply Zinc ointment to the patient’s coccyx. Clinical Record 5: This patient elected the hospice benefit on 02/28/2024 with a terminal diagnosis of Chronic Obstructive Pulmonary Disease (COPD). On 04/15/2024 the physician performed a face-to-face visit with the Registered Nurse, and it was documented that the patient was experiencing labored breathing, an oxygen saturation of 90% on 3 LPM oxygen, and moderate sputum yellow green in color and was diagnosed with an upper respiratory infection. On 04/15/2024, an order was written for Rocephin 1 gram IM daily x 3 days and Lidocaine 1% reconstitute with 2.1 ml daily for IM anesthetic for Rocephin injection and Levaquin 500 mg 2 tablets po daily x 10 days. The medications were documented on the drug profile, but in review of the plan of care for the dates of 04/15/2024-05/20/2024, there was no evidence of the medications/interventions for treatment of the upper respiratory infection. The Administrator/Director of Clinical Operations was interviewed 11/20/2024 and confirmed that the plan of care did not include all the services necessary for the needs of the patients.”

“It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as: hand hygiene. This standard was not met as evidenced by document review, interview and observation. In 2 of 3 (67%) home visit observations it was revealed that the agency did not ensure that hand hygiene was performed in adherence with the hospice policy. Agency policy, Infection Control & Safety, Policy #602 (no date), stated in part, “4. Employees perform hand hygiene before reaching into the bag to obtain supplies.” Home Visit 2/Clinical Record 2: During the home visit on 11/20/2024 the Registered Nurse (RN) (Personnel Record 2) donned gloves and cleansed the patient’s rectal area. The RN removed the gloves and reached into the bag to obtain new gloves. The RN did not perform hand hygiene before reaching into the bag to obtain supplies. Home Visit 3/Clinical Record 3: During the home visit on 11/20/2024 the Hospice Aide (HA) (Personnel Record 3) donned gloves and obtained the patient’s vital signs. She wiped the SaO2 (pulse oximetry) monitor with a sanitizer wipe and placed it in the bag. The HA did not perform hand hygiene before reaching into the bag. The Administrator/Director of Clinical Operations was interviewed 11/20/2024 and agreed that the policy required that hands hygiene be performed before reaching into the visit bag.”

“It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum: physician orders. This standard was not met as evidenced by clinical record review, interview and observation. In 1 of 14 (7%) clinical records reviewed, it was revealed that the agency did not ensure that a physician’s order was obtained for a medication. Clinical Record 2/ Home Visit 2: This patient elected the hospice benefit on 11/11/2024 with a terminal diagnosis of corticobasal degeneration. During the home visit, on 11/20/2024 the Registered Nurse (Personnel Record 2) was observed applying Zinc ointment to the patient’s coccyx. A review of the clinical record revealed that no physician order was written for the Zinc ointment. The RN reported that during the admission visit the hospice medical director gave a verbal order for the Zinc ointment, but the order was not written as a verbal order. The Administrator/Director of Clinical Care was interviewed 11/20/2024 and stated that she had delivered Zinc ointment to the patient on 11/15/2024 but forgot to add the physician order into the electronic medical record (EMR).”