Hillcrest Hospice

“Upon patient record review, 1 of 19 (Patient #14) did not have evidence that the patient has received effective pain management and symptom control from the hospice for conditions related to the terminal illness. Patient #14 - Patient is a cancer patient and has severe pain related to that cancer being treated with an intravenous patient controlled analgesic pump. The on call record showed that the patients husband called after hours to say patient is in extreme pain, and that he felt the pump wasn’t working. The on call triage nurse told the husband to give the patient Tylenol as ordered. There was no evidence of an RN assessment of that pump until the next day.”

“Upon patient record review, 2 of 19 (Patient #2,9) 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 #2 - Patient on senna and bisacodyl prn - med list did not define the progression of the drug regimen. Corrected onsite. Patient #9 - Patient had orders for Bisacodyl, MiraLAX, Milk of Magnesia and an enema all ordered as prn for constipation. The medication list did not define the progression of the drug regimen. Corrected onsite.”

“Upon patient record review, 2 of 19 (Patient #2,14) 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 #2 - On 09/22/25, an after hours call was placed by patient’s son regarding the facility and patient’s suspected wound on coccyx and was concerned the facility was not treating that wound. The triage nurse placed a call to the facility and found that there was a treatment order and the facility nurse was providing that care. There was no evidence that a timely visit was made by the hospice nurse to follow up on this complaint until 09/25/25. Patient #14 - Patient is a cancer patient and has severe pain related to that cancer being treated with an intravenous patient controlled analgesic pump. The on call record showed that the patients husband called after hours to say patient is in extreme pain, and that he felt the pump wasn’t working. The on call triage nurse told the husband to give the patient Tylenol as ordered. There was no evidence of an RN assessment of that pump until the next day.”

“Upon patient record review, 2 of 19 (Patient #3,5) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #3 - Patients medication list showed patient taking senna prn and lomotil prn for GI problems. There were no problems, goals, or interventions related to GI on patient plan of care. Corrected onsite Patient #5 - The patient’s medical record showed an order for ciprofloxin 1 drop in both eyes four times per day for eye infection. There was no problems, goals, or interventions related to infection on patient’s plan of care. Corrected onsite”

“Upon patient record review, 2 of 19 (Patient #2,9) 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 #2 - The bowel regimen outlined in the physician order included 2 different medications senna and bisacodyl - both prn, with no instruction on the progression of that regimen. Corrected onsite Patient #9 - The bowel regimen outlined in the physician order included Bisacodyl, MiraLAX, Milk of Magnesia and an enema all prn. There was no evidence of the progression of that medication regimen. Corrected onsite”

“Upon client record review, 2 of 19 (Patient #2,5) 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 #2 - The initial plan of care noted a wound care order to “clean the wound with soap and water, pat dry, and add calazime then cover with a dressing.” It also stated hospice was to perform that wound care once the facility clinicians demonstrated competence in performing that wound care. There was no evidence that a competency was performed, and there was no additional documentation or collaboration with the facility regarding who was to continue to perform that wound care. Patient #5 - The initial plan of care noted a wound care order of Calazinc topically three times per day to stage two on left buttocks. It also stated hospice was to perform that wound care once the facility clinicians demonstrated competence in performing that wound care. There was no evidence that a competency was performed, and there was no additional documentation or collaboration with the facility regarding who was to continue to perform that wound care.”