Ahc Hospice of Las Vegas

“Upon patient record review, 1 of 19 (Patient #13) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient 13: The patient’s son had signed the NOE on admission accepting the hospice medical director as the attending. The agency had a change in their medical director and had the patient sign the change of attending form. This patient has a diagnosis of Senile dementia of the brain. The signature was a scribble and not on the correct line of the form with an arrow drawn to the patient signature line. It was not the signature of the son which was on all consents that were legible.”

“Upon patient record review, 3 of 19 (Patient #1,2,5) 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 1: The POC 2/16/25 contains an order to add thickener to patient’s beverages. It does not state how much thickener to add to get desired thickness. Thickener was not included on the medication profile. The facility has an order on their MAR for Aspercreme. The Hospice medication profile does not have this medication ordered. The Hospice medication profile contains orders for Dulcolax suppository started 12/2/24, lidocaine topical film started 8/19/24, Vitamin D3 8/19/24, refresh opthalmic 8/19/24. The AL facility did not have these medications on their MAR. Corrected on site. Patient 2: The POC 1/29/25 contains an order for “Oxygen via device 2 liters as needed for shortness of breath”. There is no route. Corrected on site. Patient 5: The POC 12/31/24 contains Nystatin powder applied topically twice daily for rash. It does not state where. Corrected on site.”

“Upon patient record review, 3 of 19 (Patient #2,4,11) 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: The POC 1/29/25 contains orders for ASA and Eliquis. There was no at risk for bleeding care plan initiated with goals and interventions. Corrected on site. Patient 4: The POC 2/19/25 has an order for nectar thickened liquids. There was no at risk for aspiration care plan initiated with goals and interventions. Corrected on site. Patient 11: The pt has a diagnosis of dysphagia on initial comprehensive assessment. There was not risk for aspiration care plan initiated with goals and interventions. Corrected on site.”

“Upon patient record review, 4 of 19 (Patient #1,2,5,14) 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 1: The POC 2/16/25 contains an order to add thickener to patient’s beverages. It does not state how much thickener to add to get desired thickness. The facility has an order on their MAR for Aspercreme. The Hospice POC does not have this medication ordered. The Hospice POC contains orders for Dulcolax suppository started 12/2/24, lidocaine topical film started 8/19/24, Vitamin D3 8/19/24, refresh opthalmic 8/19/24. The AL facility did not have these medications on their MAR. Corrected on site. Patient 2: The POC 1/29/25 contains an order for “Oxygen via device 2 liters as needed for shortness of breath”. There is no route. Corrected on site. Patient 5: The POC 12/31/24 contains Nystatin powder applied topically twice daily for rash. It does not state where. Corrected on site. Patient 14: The POC 1/8/25 contains an order “Insert foley as ordered”. There is not a size, frequency, nor who is to perform. Corrected on site.”

“Upon patient record review, 3 of 14 (Patient #1,8,14) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient 1: The updated POC contains an order to add thickener to patient’s beverages effective 12/30/24. A risk for aspiration care plan was not added with goals and interventions. Corrected on site. Patient 8: The Physician documented on the CTI 1/18/25 “pt is a high fall risk”. There was no at risk for falls added to the POC with goals and interventions. Corrected on site. Patient 14: The SN documented on 3/4/25 “The patient is at risk for aspiration”. There was no risk for aspiration care plan initiated with goals and interventions. Corrected on site.”

“Upon client record review, 4 of 19 (Patient #3,5,9,10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 3: The POC 2/4/25 contains an order for Chaplain once per month. The chaplain did not make a visit the month of February 2025. There was no missed visit documentation or evidence of refusal. Corrected on site missed visit added. Patient 5: The POC 12/31/24 contains an order for SC once per month. There were no SC visit completed 12/31/24-2/28/24. There was no evidence of refusal or missed visit documentation. Corrected on site, missed visit documentation added. Patient 9: The SN documented on 2/27/25 in the area for performing wound care “wound care per care plan”. There is no order for wound care on the POC. Wound care order added for a stage I pressure ulcer to correct on site. Patient 10: The POC 1/5/25 contains an order for: cleanse sacral coccyx wound with dermal cleanser,pat dry, cover with border foam twice weekly. The SN documented on 2/20/25 “4x4 foam dressing applied to coccyx” and on 2/24/25 “4x4 foam dressing changed skin intact”. The nurse did not follow the POC and there is no new order to cover just the coccyx with foam dressing with out cleansing. Corrected on site.”

“Upon patient record review 3 of 19 (Patient #4,6,11) did not have evidence documentation in the patient record that a hospice aide provides services that are: Patient 4: The aide made visits on 2/24/25 and 2/26/25. The aide POC has orders for make bed, change linens, assist with dressing, and oral care all to be performed every visit. The aide documented “Not Due” after each of these interventions. There was no evidence the aide called the RN to get orders to not complete these tasks. Patient 6: The aide POC 3/5/25 contains an order for shampoo once per week. The aide documented shampoo on 2/12/25 and 2/16/25 with no evidence of calling the RN for the extra shampoo that week. Patient 11: The aide POC contains an order for shampoo once a week. The aide documented shampoo on 2/24/25 and 2/28/25. There was no evidence the aide called the RN for orders to perform the second shampoo that week.”

“Upon patient record review 2 of 19 (Patient #2,9) 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 2: The POC 1/29/25 contains orders for aides 5 days a week. The last supervisory visit was completed 2/6/25. Patient 9: The medical record does not contain evidence that the RN has made an aide supervisory visit since 1/24/25. The aide is seeing the patient 4 times per week.”

“Upon patient client record review, 3 of 19 (Patient #8,12,13) did not have evidence that each patient record contains: Patient 8,12: The caregiver indicated on the consents that they wanted a copy Notice of noncovered items and there is not evidence this was received by the caregiver. Patient 13: The caregiver indicated on the consents they wanted a copy of the list of non covered items,services and/or drugs and there was no evidence that the addendum was given to the caregiver. The patient’s son had signed the NOE on admission accepting the hospice medical director as the attending. The agency had a change in their medical director and had the patient sign the change of attending form. This patient has a diagnosis of Senile dementia of the brain. The signature was a scribble and not on the correct line of the form with an arrow drawn to the patient signature line. It was not the signature of the son which on all consents was legible.”

“Upon patient client record review, 7 of 19 (Patient #1,5,6,8,9,11,12) 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 1: The SN documented the following abbreviations: GH, CG. These are not approved abbreviations. Patient 5: The SN documented the following abbreviations on 1/28/25: pta and 6li. These are not approved abbreviations. Patient 6: On 2/7/25 the aide documented a missed visit but also documented “patient refused transfer”. Patient 8: The aide documented a missed visit on 2/28/25 pt declined the visit. The aide also documented “assist with positioning not due”. Patient 9: The SN documented an LVN supervisory visit on 2/4/25, there was no LVN seeing the patient at that time. Patient 11: The aide documented a missed visit on 2/17/20 and also documented each task as refused. Patient 12: The SN documented on 2/21/25 and 2/27/25 “wound care done per POC”. There is no evidence the POC was followed.”