Gentiva

“Upon patient record review, 1 of 19 (Patient #3) 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 3: The clinical documentation from the RN indicated that the patient had PRN oxygen in the home and oxygen supplies/equipment were listed on the current supply list. No evidence that PRN oxygen was included on the active medication profile. COS-new order written and active medication profile updated to include oxygen via NC at a rate of 2-4LPM prn for SOB during survey.”

“Upon patient record review, 2 of 19 (Patient #6, 19) 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 6: No evidence that an initial bereavement risk assessment was completed with 5 days of the election of hospice. The patient was admitted on 10/18/2024. The assessment was completed on 10/24/2024. Patient 19: No evidence that an initial bereavement risk assessment was completed. The patient was admitted on 07/20/2024. Clinical documentation indicated that the first bereavement assessment was completed 2 days post death on 11/04/2024.”

“Upon patient record review, 1 of 19 (Patient #7) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual’s attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient’s progress toward desired outcomes • Reassessment of the patient’s response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient 7: No evidence that a comprehensive assessment was completed every 15 days. The comprehensive assessment was completed 03/07/2025, the update was not completed until 03/28/2025. 21 days between comprehensive assessments.”

“Upon patient record review, 2 of 19 (Patient #4,12) did not have evidence the plan of care must 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 4: The initial visit frequency for the social worker was ordered as 1 prn visit. Patient 12: The initial visit frequency for both the social worker and the spiritual care counselor was ordered as 1 prn visit.”

“Upon patient record review, 1 of 19 (Patient #3) 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 3: The medical record indicated that patient had PRN oxygen in the home, oxygen supplies and equipment was listed on the current supply list. No evidence that an order for oxygen was ever received from the MD. COS-new order written for oxygen via NC at a rate of 2-4LPM prn for SOB during survey.”

“Upon patient record review, 1 of 19 (Patient #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 equipment and supply needs. Patient 2: The medical record indicated that the patient developed wounds while on service that were discontinued on 05/08/2025 and that a Hoyer lift was used daily for transfers due to altered mobility. Wound care supplies remained listed on the active supply list at the time of survey. No evidence that the wound care supplies were removed. No evidence that a Hoyer lift was not included on the current DME supply list. COS-order written to remove wound care supplies from the supply list and add Hoyer lift to the active DME list during survey.”

“Upon patient record review, 2 of 19 (Patient #11,12) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 11: The visit frequency for the skilled nurse was indicated at 2x/week and 2 prn on the current plan of care. No evidence that 2 visits occurred for the weeks of 02/16/2025, 03/30/2025, and 5/04/2025. No evidence that those visits were missed at the request of the patient/CG or that an order was placed to change the visit frequency for that week at the time of survey. Patient 12: The visit frequency for the chaplain was ordered at once a week to start on 05/21/2025. There was no evidence that weekly visits occurred for the weeks of 05/25/2025, 06/01/2025, 6/15/2025, and 06/22/2025. The visit frequency changed at the start of the current benefit period that started on 07/06/2025. No evidence that the visits were missed at the request of the patient/CG or that an order was placed to change the visit frequency for those months at the time of survey.”

“Upon patient record review, 1 of 19 (Patient #2) 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 2: The medical record indicated that the patient had altered mobility and a Hoyer lift was being used for all transfers. No evidence that the aide plan of care included instructions that included the use of a Hoyer lift for mobility. COS-aide plan of care updated to include a Hoyer lift for transfers during the survey.”

“Upon patient record review 1 of 19 (Patient #8) 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: POC dated 5/11/2025 contained orders for the aide to visit 3 times a week. No evidence that 3 visits occurred for the week of June 1st. No evidence that the visit was missed at the request of the patient/CG or that an order was placed to change the visit frequency for that week at the start of survey.”

“Upon patient record review 2 of 19 (Patient #7,8) 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 7: No evidence that a registered nurse made supervised visits every 14 days between the dates of 03/07/25-03/28/2025 (21 days). Patient 8: No evidence that a registered nurse made supervised visits every 14 days between the dates of 06/02/25-06/17/2025 (15 days).”

“Upon patient record review, 1 of 19 (Patient #14) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 14: The visit frequency for the SW was ordered at 2 times a month on the plan of care to start on 04/01/2025. There was no evidence that 2 visits occurred for the months of April 2025 or May 2025. The visit frequency changed to one visit a month at the start of the current benefit period that started on 06/01/2025. No evidence that the visits were missed at the request of the patient/CG or that an order was placed to change the visit frequency for those months at the time of survey.”