Advanced Home Health and Hospice of Reno

“Upon patient record review, 4 of 19 (Patient #1,2,4,16) 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: Upon home visit finding, the facility MAR contains order for Tramadol 50mg 1/2 tab 3 times daily prn. This is not on the hospice medication profile. This was not a new change per the facility nurse. Patient 2: The medication profile contains an order for Synthroid. Upon home visit finding, patient states she has not taken Synthroid “In a long time”. Patient 4: Upon home visit finding, the hospice medication profile contains Anoro Ellipta1 inhalation daily, Zonisamide 100mg daily and Acetaminophen 325mg 2 tabs every 8 hour prn. These were not included on the facility MAR. The facility MAR has Lorazepam 0.5mg every 2 hours prn for behaviors, the hospice medication profile has the Lorazepam every 6 hours prn. These changes were not new since last visit per the facility nurse. Patient 16: The medication profile contains Miralax 17gram oral powder with no diluent.”

“Upon patient record review, 5 of 19 (Patient #1,2,4,12,16) 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: Upon home visit finding, the facility MAR contains order for Tramadol 50mg 1/2 tab 3 times daily prn. This is not on the hospice POC. This was not a new order per facility nurse. Patient 2: The POC contains an order for Synthroid. Upon home visit finding, patient states she has not taken Synthroid “In a long time”. Patient 4: Upon home visit finding, the hospice POC contains Anoro Ellipta1 inhalation daily, Zonisamide 100mg daily and Acetaminophen 325mg 2 tabs every 8 hour prn. These were not included on the facility MAR. The facility MAR has Lorazepam 0.5mg every 2 hours prn for behaviors, the hospice POC has the Lorazepam every 6 hours prn. These changes were not new since last visit per Facility nurse. Patient 12: The POC 8/2/26 contains the orders from the 5/4/26 certification period to remove the staples from surgical site. This was completed during the 5/4/25 certification period. Patient 16: The POC contains Miralax 17gram oral powder with no diluent.”

“Upon patient client record review, 7 of 19 (Patient #6,7,9,12, 13,15,16) 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 6: The SN documented on 8/21/26 “wound care performed and foam dressing applied”. It is unclear the POC was followed, the details of the wound care were not clearly documented. Patient 7: The SN documented on 8/7/26 and 8/10/26 “performed wound care per plan of care”. It is unclear the POC was followed, the details of the wound care were not clearly documented.. Patient 9: The SN documented on 7/22/26 “performed wound care per plan of care”. It is unclear the POC was followed, the details of the wound care were not clearly documented. Patient 12: The SN documented on 8/5/26, 8/7/26, 8/10/26 flushing the foley, there is no documentation of what the foley was flushed with or an amount of fluid used. Patient 13: The SN documented in the narrative on 8/3/26 and 8/6/26 flushing foley catheter with 30ml of saline water though documented in care plan that the foley was flushed with the sterile water. The order on POC 7/15/26 is to flush the foley catheter with 30ml of sterile Water. It is unclear which type of fluid was used to flush the foley. Patient 15: The SN documented on 8/10/26 “wound care performed per plan of care”. It is unclear the POC was followed, the details of the wound care were not clearly documented. Patient 16: The SN documented on 8/4/26 “Dressing was changed. Provided dressing to peg tube as well”. It is unclear if the POC was followed, the details of the wound care were not clearly documented.”

“Upon client record review, 2 of 19 (Patient #7,9) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 7: The SN documented on 8/19/26 performing wound care of “cleansed wound with wound cleanser, applied bordered dressing. There is no order on the POC for this wound care. Patient 9: The SN documented she obtained a urine specimen for urinalysis on 7/27/26 and 8/10/26, this was an old order that was resolved 7/12/26 and the SN continued to document performed at these visits.”