Gentiva

“Upon patient record review, 3 of 19 records (Patient #4,#5,#6) 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 #4: The certification of terminal illness and nurse documentation indicated that the patient was on oxygen at 5L/min. There was not evidence that oxygen was in the medication profile. Corrected on site. Patient #5: The record indicated duplicate orders for Hydrocodone5 - Acetaminophen325 q6h prn pain, dated 3/8/24 and 4/19/24. Corrected on site. Upon home visit, Nystatin powder was on the medication profile at the SNF but not on the hospice medication profile. Bisacodyl supp was on the hospice medical record but not the facility MAR. Corrected on site. Patient #6: Lidocaine patch was on the medication profile at the SNF but not on the hospice medication profile. Acidophilus was on the hospice medical record but not the facility MAR. Corrected on site.”

“Upon patient record review, 3 of 19 records (Patient #1,#7,#14) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #1: The patient was admitted on 2/17/24. The record indicated that the bereavement assessment was completed on 2/23/24. Patient #7: The patient was admitted on 9/8/23. The record indicated that the bereavement assessment was completed on 9/14/23. Patient #14: The patient was admitted on 2/19/24. The record indicated that the bereavement assessment was completed on 2/26/24.”

“Upon patient record review, 1 of 19 records (Patient #13) did not have evidence the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient’s plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #13: The visit frequency on the initial plan of care for the social worker and the spiritual care counselor was 1 prn. There was not evidence of a routine visit frequency.”

“Upon patient record review, 4 of 19 records (Patient #4,#5,#6,#8) did not have evidence the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #4: The certification of terminal illness and nurse documentation indicated that the patient was on oxygen at 5L/min. There was not evidence of an order for oxygen. Corrected on site. Patient #5: Upon home visit, Nystatin powder was on the medication profile at the SNF but the hospice record did not contain order. Corrected on site. Patient #6: Lidocaine patch was on the medication profile at the SNF but the hospice record did not contain order. Corrected on site. Patient #8: An order dated 5/2/24 indicated to insert a 16F Foley with a 10cc balloon. There was not evidence that the order included when to change the catheter and if and when to flush the catheter. Corrected on site.”

“Upon client record review, 1 of 19 records (Patient #13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #13: The visit frequency for the spiritual care counselor was 2 every 2m2, 2m1, 1m1 and 2 prn. The record indicated that an evaluation was conducted on 2/24/24, with subsequent routine visits on 3/14/24, 3/28/24, 4/8/24, 4/23/24, and 5/6/24. In addition, the record contained an order, dated 2/22/24 for care of the pleural drainage system insertion site; Clean catheter site and surrounding area with alcohol swab. Apply split sponge around catheter. Cover with gauze pad and cover with occlusive dressing. There was not evidence of dressing changes.”

“Upon patient record review 2 of 19 records (Patient #4,#9) did not have evidence of 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 #4: There was not evidence of an aide supervisory visit between 2/27/24 and 3/21/24. Patient #9: There was not evidence of an aide supervisory visit between 4/5/24 and 4/22/24.”

“Upon patient client record review, 4 of 19 records (Patient #1,#2,#3,#6) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #1: The benefit election statement, dated 2/17/24 indicated that the patient/caregiver wished to receive the Patient Notification of Hospice Non-Covered Items, Services, and Drugs. There was not evidence that this document was furnished. Patient #2: The benefit election statement, dated 3/8/24 indicated that the patient/caregiver wished to receive the Patient Notification of Hospice Non-Covered Items, Services, and Drugs. There was not evidence that this document was furnished. Patient #3: The benefit election statement, dated 9/15/23 indicated that the patient/caregiver wished to receive the Patient Notification of Hospice Non-Covered Items, Services, and Drugs. There was not evidence that this document was furnished until 9/21/24. Patient #6: The benefit election statement, dated 3/12/24 indicated that the patient/caregiver wished to receive the Patient Notification of Hospice Non-Covered Items, Services, and Drugs. There was not evidence that this document was furnished. A second document indicated a request was made on 3/22/24 but the document was not furnished until 3/27/24”

“Upon patient client record review, 1 of 19 records (Patient #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. Patient #7: The record indicated that an LPN supervisory visit was conducted on 4/3/24. There was not evidence that an LPN provided care to this patient. In addition, the question for aide supervision, asking if the aide plan of care was updated and the nurse documentation indicated, ‘yes.’ There was not evidence that an aide had provided care to this patient.”

“Upon client record review, 3 of 19 records (Patient #4,#5,#6) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient #4: The record contained a wound care order dated 2/24/24, for wound care to a stage II left heel wound daily. Cleanse with wound cleanser and allow to dry. Apply Santyl to areas of slough. Cover and secure with bordered foam. Wound care to be performed by hospice nurse or facility nurse. There was an update to the wound care on 4/25/24 which still indicted that the hospice nurse or the facility nurse could provide the wound care. The order did not specifically indicate which provider was to perform the wound care. Corrected on site. Patient #5: The record contained a wound care order dated 2/20/24, to cleanse back, buttock, and peri area with NS wound cleanser and cover with calmoseptine BID and prn to be performed by facility staff or hospice nurse. The order did not specifically indicate which provider was to perform the wound care. Patient #6: There were wound care orders dated 3/18/24 for a DTI to the right heel, and on 4/4/24 to the right lateral elbow. Both orders indicated for the facility nurse or the hospice nurse to provide the wound care without specifically indicating which provider was to perform the wound care. Corrected on site.”