Haven Hospice

“Upon patient record review, 1 of 8 (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: Medication list-Patient has order for lidocaine 4 percent patch. Place one patch onto skin daily; on for 12 hours, off for 12 hours. There is no evidence of application site. Patient has order for mometasone furoate 0.1 percent ointment. Apply topically every 12 hours as needed for dermatitis. There is no evidence of application site or dosage.”

“Upon patient record review, 3 of 8 (Patient #2,5,8) 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 2: Patient with order for Keppra for seizures and an order for thickener in PO liquids. There is no evidence of seizure or aspiration precautions in the patient’s plan of care or care plan. COS. Patient 5: Patient with order for Oxygen. There is no evidence of interventions for oxygen in the patient’s care plan. COS. Patient 8: Patient with an order for Eliquis 5mg PO twice daily. There is no evidence of bleeding precautions in the patient’s plan of care or care plan.”

“Upon patient record review, 1 of 8 (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: Plan of care-Patient has order for lidocaine 4 percent patch. Place one patch onto skin daily; on for 12 hours, off for 12 hours. There is no evidence of application site. Patient has order for mometasone furoate 0.1 percent ointment. Apply topically every 12 hours as needed for dermatitis. There is no evidence of application site or dosage.”

“Upon patient record review, 3 of 8 (Patient #4,5,8) 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 4,5: Patient’s aide care plan has instructions to shower patient twice weekly. There is no evidence of instruction to utilize shower chair during showers, despite DME order for shower chair on patient’s plan of care. COS. In addition, the patient’s aide care plan has instructions for weekly linen change. There is no evidence that patient’s linen was changed during the week of 08/05/2024. Patient 8: Patient’s aide care plan has instructions to assist with transfer/ambulate and dressing per patient/family request. There is no evidence in the aide care plan that patient or family members are cognitively able to make these requests.”

“Upon patient record review 4 of 8 (Patient #1,2,4,6) 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 1,2: Patient’s aide care plan has instructions for weekly weights. Aide is documenting that weights are being checked every week. There is no evidence of weights being documented in the patient’s medical record on the following dates: 07/17/2024, 07/24/2024, 08/07/2024, 08/14/2024. COS. Patient 2: - Patient’s aide care plan has instructions for weekly linen change. There is no evidence that patient’s linen was changed during the week of 08/05/2024. Patient 4: Patient’s aide care plan has instructions for weekly weights. Aide is documenting that weights are being checked every week. There is no evidence of weights being documented in the patient’s medical record on 08/08/2024. COS. Patient 6: Patient’s aide care plan has instructions for weekly weights. Aide is documenting that weights are being checked every week. There is no evidence of weights being documented in the patient’s medical record on the following dates: 07/17/2024, 07/24/2024, 08/07/2024, 08/14/2024. COS.”

“Upon patient record review, 5 of 8 (Patient #1,2,4,6,7) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient’s life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination: • The primary terminal condition • Related diagnosis • Current subjective and objective medical findings • Current medication and treatment orders • Information about the medical management of any of the patient’s conditions unrelated to the terminal illness. Patient 1: Patient admitted on 06/06/2024. CTI signed by medical director on 06/13/2024. There is no evidence of a physician’s narrative on the CTIs. Patient 2: Patient admitted on 06/06/2024. CTI signed by medical director on 06/13/2024. There is no evidence of a physician’s narrative on the CTIs. Patient 4: Patient admitted on 08/07/2024. There is no evidence of a physician’s narrative on the CTI. Patient 6: Patient admitted on 06/05/2024. CTI signed by medical director on 06/13/2024. There is no evidence of a physician’s narrative on the CTIs. Patient 7: Patient admitted on 06/04/2024. CTI signed by medical director on 06/13/2024. There is no evidence of a physician’s narrative on the CTIs.”

“Upon patient client record review, 5 of 8 (Patient #1, 2,4,6,7) did not have evidence that each patient record contains Physician certification and recertification of terminal illness. Patient 1: Patient admitted on 06/06/2024. Initial CTI signed by attending NP on 06/14/2024 and not the Attending MD. Patient 2: Patient admitted on 06/06/2024. Initial CTI signed by attending NP on 06/10/2024 and not the Attending MD. Patient 4: Patient admitted on 08/07/2024. Initial CTI signed by attending NP on 08/12/2024 and not the Attending MD. Patient 6: Patient admitted on 06/05/2024. Initial CTI signed by attending NP on 06/14/2024 and not the Attending MD. Patient 7: Patient admitted on 06/04/2024. Initial CTI signed by attending NP on 06/06/2024 and not the Attending MD.”