Hospice of the Plains, Inc.

“Upon patient record review, 4 of 14 (Patient # 2, 4, 7 and 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: Patient 2: During home visit, patient reports taking pain relief cream and Neosporin not on medication profile. The medication profile on 05/10/26 contains an order for Lidocaine patch with no specific instructions for where to place and when to remove patch. Patient 4: The medication profile on 07/01/26 contains multiple orders for acetaminophen for 500 mg 2 tabs every 6 hours PRN and Tylenol PM 500 mg 2 tabs once daily with no maximum limit for acetaminophen in 24 hours. Patient 7: The medication profile contains an order from 3/12/26 for MiraLAX with no diluent instructions and multiple orders for Tylenol 500 mg every 8 hours and Tylenol arthritis 650 mg 2 tabs every 8 hours with no maximum limit for acetaminophen in 24 hours. Patient 8: The medication profile on 7/8/26 contains an order for MiraLAX with no diluent instructions.”

“Upon patient record review, 2 of 14 (Patient # 7 and 8) 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 7: The updated POC on 7/08/26 contains an order for Warfarin with no evidence of bleeding risk on POC. Patient 8: The updated POC on 7/8/26 contains an order for Clopidogrel daily with no evidence of bleeding risk noted on POC.”

“Upon patient record review, 4 of 14 (Patient # 2, 4, 7 and 8) 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 updated POC on 07/08/26 contains an order for Lidocaine patch with no specific instructions for where to place and when to remove patch. During home visit, patient reports “taking pain relief cream and Neosporin cream and there is no evidence of creams on POC. Patient 4: The updated POC on 07/08/16 contains multiple orders for acetaminophen for 500 mg 2 tabs every 6 hours PRN and Tylenol PM 500 mg 2 tabs once daily with no maximum limit for acetaminophen in 24 hours. Patient 7: The updated POC on 7/08/26 contains an order for MiraLAX with no diluent instructions and multiple orders for Tylenol 500 mg every 8 hours and Tylenol arthritis 650 mg 2 tabs every 8 hours with no maximum limit for acetaminophen in 24 hours. Patient 8: The initial POC on 6/23/26 contains an order for MiraLAX with no diluent instructions.”

“Upon patient record review, 4 of 14 (Patient # 5, 6, 8 and 10) did not have evidence in the patient record that hospice aide assignments and duties are: Patient 5: The Aide POC on 07/14/26 provides non-specific instructions for Aide to assist with ADLs including bathing, toileting, transfers and mobility as tolerated allowing for aide choice of bathing and mobility. POC States “If the patient is unable to tolerate a bed bath, partial bath or alternative hygiene, the aide will notify RN.” Patient 6: The updated Aide POC on 07/09/26 provides non-specific instructions for Aide to assist with ADLs including bathing, toileting, transfers and mobility as tolerated allowing for aide choice of bathing and mobility. POC States “If the patient is unable to tolerate a bed bath, partial bath or alternative hygiene, the aide will notify RN.” Patient 8: The updated Aide POC on 07/09/26 provides non-specific instructions for Aide to assist with ADLs including bathing, toileting, transfers and mobility as tolerated allowing for aide choice of bathing and mobility. POC States “If the patient is unable to tolerate a bed bath, partial bath or alternative hygiene, the aide will notify RN.” Patient 10: The updated Aide POC on 07/09/26 provides non-specific instructions for Aide to assist with ADLs including bathing, toileting, transfers and mobility as tolerated allowing for aide choice of bathing and mobility. POC States “If the patient is unable to tolerate a shower or bath, the aide will notify the supervising RN.””

“Upon patient record review 1 of 14 (Patient #5) did not have evidence in the patient record that the hospice aides report: • Changes in the patient’s medical, nursing, rehabilitative, and social needs to a registered nurse, as the changes relate to the plan of care and quality assessment and improvement activities • Hospice aides must also complete appropriate records in compliance with the hospice’s policies and procedures Patient 5: There is evidence the Aide documents “patient stood up and reported feeling lightheaded and slightly dizzy. She remained standing for a few minutes until the dizziness resolved.” Then ambulated to BR and showered with assistance.” There is no evidence the aide updated the RN on change in condition and symptoms or dizziness and lightheadedness.”