Grace Hospice of Nevada LLC

“Upon patient record review, 2 of 14 (Patient #6,#7) 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 6: RN documentation dated 05/01/2026 indicates patient reported generalized pain and had run out of Norco, with delivery expected that day. There was no evidence of follow-up visit or communication to verify medication was received or that pain was reassessed and resolved. Patient 7: RN visit narrative dated 04/30/2026 indicates patient reported severe pain with medications not effective. Group home manager reported oxycodone had not been delivered and morphine supply was nearly depleted. There was no evidence of follow-up visit or further assessment to evaluate pain relief or medication availability.”

“Upon patient record review, 4 of 14 (Patient #1,#5,#7,#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: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient 1: On 03/28/2026, the RN documented that the patient was taking Senna tablets as needed for constipation; however, there is no evidence of this on the medication profile. On 04/28/2026, the RN documented the patient as dependent on continuous Oxygen at 5 L/min via nasal cannula; however, the medication profile contains continuous Oxygen at 3 L/min via nasal cannula. Patient 5: The hospice medication profile contained Zoloft 25mg; however, this medication was absent from facility medication profile. Patient 7: The medication profile includes MiraLAX with no instructions for diluent when preparing this medication. Patient 8: Bactrim remains current on the medication profile; however, the medication was to be discontinued on 04/22/2026.”

“Upon patient record review, 4 of 14 (Patient #3,#4,#8,#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 3,4,8,11: Patient on anticoagulant therapy with no evidence of identified problems, goals, or interventions related to risk for bleeding in the care plan.”

“Upon patient record review, 4 of 14 (Patient #1,#5,#7,#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 1: On 03/28/2026, the RN documented that the patient was taking Senna tablets as needed for constipation; however, there is no order for this in the medical record. On 04/28/2026, the RN documented the patient as dependent on continuous Oxygen at 5 L/min via nasal cannula; however, the medical record contains an order for continuous Oxygen at 3 L/min via nasal cannula. Patient 5: Medical record contains order written on 4/6/2026 for Zoloft 25mg; however, this medication was absent from facility medication profile. Patient 7: The medical record contained an order for MiraLAX; however, there were no instructions for diluent when preparing this medication. Patient 8: Order written on 04/12/2026 for Bactrim to be given for 10 days. However, the medication remains current in the medical record.”

“Upon client record review, 6 of 14 (Patient #1, 2, 3, 4, 5, 9) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: The aide documentation for visits provided on 02/06/2026, 02/07/202, and 02/08/2026 is incomplete. Patient 2: RN narrative documentation for visit provided on 04/30/2026 is incomplete. Patient 3: Medical record contains order for chaplain visit frequency of once monthly. There was no evidence of a visit in April. Patient 4: RN assessment and narrative documentation for visits provided on 04/07/2026 and 04/27/2026 is incomplete. Also, aide documentation for visits provided on 04/22/2026, 04/23/202, and 04/24/2026 is incomplete. Patient 5: SC assessment and narrative documentation for visits provided on 04/22/2026 and 04/30/2026 is incomplete. Also, RN narrative documentation for visit provided on 05/02/2026 is incomplete. Patient 9: RN assessment and narrative documentation not started for visits provided on 04/30/2026, 05/01/2026, 05/02/2026, 05/03/2026, and 05/04/2026.”

“Upon patient record review, 2 of 14 (Patient #3,#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 3,8: Patient on anticoagulant therapy with no evidence of instructions for bleeding precautions.”

“Upon personnel record review, 4 of 11 (Personnel #2,#5,#6,#8) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel 2: No evidence of registered nurse or volunteer competencies completed on personnel file. Personnel 5: The personnel file does not contain competencies for the role of MSW. Personnel 6: There was no evidence of competencies for the roles of SC or BC on the personnel file. Personnel 8: There was no evidence of competencies for the Medical Director role in the personnel file.”