Authoracare Collective

“Upon patient record review, 1 of 33 (Patient #8) 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 #8 - Medication profile contains Diazepam 5mg/ml give 2.5 mg (0.5 ml) every 6 hours injection - did not specify if IM, SQ or IV.”

“Upon patient record review, 2 of 33 (Patient #13, 29) 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 #13 - Patient has wound to L heel and L ankle - no measurements of wound effective 08/21/25 x 3 weeks. Patient #29 - Patient has wound to sacrum - wound measured and assessed on 08/23/25 then no documentation as of 09/09/25 of wound assessment or measurements.”

“Upon patient record review, 4 of 33 (Patient #11, 12, 29, 30) 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 #11 - Aide 3 x a week and does not identify for personal care. Patient #12 - Aide 2 x a week and does not identify for personal care. Patient #29 - Aide 2 x a week and does not identify for personal care. Patient #30 - Aide 2 x a week and does not identify for personal care.”

“Upon patient record review, 3 of 33 (Patient #8, 11, 18, 29) 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 #8 - SN visit note on 09/07/25 “foley catheter with 50cc output” but no related orders for the care and management of the Foley catheter. Patient #11 - Order to change indwelling 14F or 16F catheter per agency protocol. Patient #18 - SN visit note 08/18/25 patient is on O2 at 2.5 L/M there is no order in the chart for this. Patient #29- Wound care to sacrum did not have modifier for PRN dressing changes. Patient has Foley Catheter but no related orders for the care and management of the Foley catheter.”

“Upon client record review, 3 of 33 (Patient #)14, 17, 26 did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #14 - SN visit 07/03/25 “clean wound by soaking gauze with wound cleanser and leaving in place 5-10 minutes, place calcium alginate cut to size, cover and secure” there is no order in the chart for this. Patient #17 - SN visit 08/30/25 “instructed to give Miralax when patient is constipated” there is no order in the chart for this. Patient #26 - SN visit note “patient has a peripheral IV in R forearm that flushes well” no order in chart for peripheral IV or flushes.”

“Upon patient record review, 4 of 33 (Patient #11, 16, 25, 26) 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 #11 - Aide care plan did not include oxygen safety or Foley Catheter care. Patient #16 - Aide care plan tasks contain Shower every visit, bed bath every visit and partial sponge bath every visit. No documentation patient is functionally or cognitively able to make decision. Patient #25 - Aide care plan does not include oxygen safety. Patient #26 - Aide care plan includes task - perineal care as needed, shampoo as needed and change bed linen as needed. Prepare snacks and offer fluids but patient is NPO.”

“Upon patient record review 2 of 33 (Patient #12, 16) 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 #12 - Aide care plan task: ear care and nail care to be provided 1 x week. Aide provided 2 x week, week of 07/08/25 and 08/12/25. Patient #16 - Aide care plan task: shampoo every visit - did not provide shampoo 08/12/25, 08/19/25 or 08/26/25 and did not document reason for omitting shampoo.”

“Upon patient record review 2 of 33 (Patient #12, 21) 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 #12 - RN completed aide supervisory visit on 07/15/25 then again on 08/05/25 (20 days between Aide Supervisory visits) Patient #21 - RN completed aide supervisory visit on 08/21/25 - no other Aide Supervisory visits as of 09/08/25.”

“Upon patient client record review, 3 of 33 (Patient #18, 29, 31) 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. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #18 - RN completed Aide Supervisory visit on 08/04/25 and 08/18/25 but patient is not receiving aide visits. Patient #29 - RN documented on 09/09/25 patient on oxygen 4L/M in narrative of note but section where vital signs are documented, RN documented oxygen at 2L/M. Patient #31 - RN documented patient has Foley Catheter but patient has condom catheter.”

“Upon observation, there was no evidence the inpatient facility has adequate supply of hot water at all times and include plumbing fixtures with control valves that automatically regulate the temperature of hot water used by patients per facility policy, “Utilities Management Plan IPU-M90.” Location A: Patient room water temperatures were noted > than the range of 110-116. 1/3/25 119 F, 1/10/25, 118 F, 1/17/25 117 F, 1/24/25 119 F, 1/30/25 118 F, 2/6/25 119 F, 2/21/25 118 F and 3/7/25 118 F. All rooms and the break room are checked weekly per the temperature log. The log does not designate which rooms were high, facility noting highest temperature checked for all rooms. Facility did not note if and when the temperature of the water was corrected.”

“Based on agency policy, observation, clinical record review, and staff interviews, the agency failed to include an accurate list of medications for 1 of 2 patients with an observation visit conducted. (patient #1)Findings included: A policy, Medication: Management & Administration (revised 02/20/2025) received on 09/02/2025 at 4:49 PM from the Quality and Compliance Coordinator stated, “A registered nurse maintains a current medication profile and reviews all patient medications… A medication profile includes but is not limited to 1) all current medications…”Patient #1 was admitted on 04/09/2024 with a diagnosis of malignant neoplasm (cancer) of the esophagus. The plan of care for 08/02/2025-09/30/2025 included orders for skilled nurse visits 1 time a week for 9 weeks with 8 PRN (as needed). During a home visit conducted on 09/02/2025 at approximate 11:45 AM with registered nurse (RN) #7 a comprehensive medication review revealed the following:1. The patient had been prescribed Lidocaine 4% topical (for pain) patches for pain apply 1 time daily and were not included in the plan of care.2. The plan of care included Metoprolol Succinate ER 50mg (treats blood pressure) 0.5 tablet daily. The prescription bottle was dated 08/05/2025, the patient stated that he had taken 1 tablet daily “for a long time.”3. The plan of care included an order for Pantoprazole 40mg (reduces acid) 1 tablet daily. The patient stated that they do not remember ever taking that.4. The patient reported taking acetaminophen (treats pain/fever) 500mg as needed for pain for as long as he can remember. Acetaminophen was not included in the plan of care.An interview conducted on 09/02/2025 at approximately 4:05 PM with registered nurse #7 revealed that a comprehensive medication review is conducted at every nurse visit, medications should be added, discontinued, or changed as ordered by a physician. During an interview conducted on 09/02/2025 at approximately 4:45 PM the senior director of home hospice stated, “We would expect [documentation software name] to be up to date.””

“Based on agency policy, observation, and staff interviews, the agency failed to perform hand hygiene after handing personal items and failed to sanitize reusable equipment before placing it in the clinical bag for 1 of 2 patients with observations conducted. (patient #1)Findings included: A policy, Infection Control-Standard Precautions (revised 04/17/2025) received on 09/03/2025 at4:49 PM from the Quality and Compliance Control Coordinator stated, “Perform hand hygiene: After contact with patient’s intact skin (when taking a blood pressure or pulse) … After contact with inanimate objects in the immediate vicinity of the patient… Non-critical objects such as stethoscopes; BP [blood pressure] cuffs; pulse ox; etc... Should be disinfected after patient care…” Patient #1 was admitted on 04/09/2024 with a diagnosis of malignant neoplasm (cancer) of the esophagus. The plan of care for 08/02/2025-09/30/2025 included orders for skilled nurse visits 1 time a week for 9 weeks with 8 PRN (as needed). During a home visit conducted on 09/02/2025 at approximately 11:45 AM registered nurse (RN) #7 failed to perform hand hygiene after handling the patient’s medication bottles then removing vital sign equipment from the clinical bag and failed to sanitize the blood pressure cuff and pulse oximeter before returning it to the clinical bag.During an interview conducted on 09/02/2025 at 4:04 PM RN #7 stated, “I normally wipe it [equipment and bag] down when I get back to the car. I normally perform hand hygiene before entering the bag.”During an interview conducted on 09/02/2025 at approximately 4:45 PM the senior director of home hospice stated the expectation is, “To clean her equipment [after patient use] and [before entering the clinical bag] wash hands or use gel [hand sanitizer].””