Sky Hospice Care Inc.

“Upon patient record review, 5 of 10 (Patient #1,3,4,5,8) 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 - Admission order O2 at 2L/M nasal cannula PRN SOB may increase to 4L/M if saturation below 90% but not on medication profile. Patient #3 - SN initial assessment has patient receiving 02 at 2L/M but not on medication profile. Patient #4 - SN initial assessment has patient receiving 02 at 2L/M but not on medication profile. Patient #5 - Medication profile contained Nystatin 100,00u/g apply topically to affected areas 3 times a day and PRN - did not contain affected area or modifier for PRN. Patient #8 - SN initial assessment has patient receiving 02 at 2L/M but not on medication profile.”

“Upon patient record review, 1 of 10 (Patient #5) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual’s attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient’s progress toward desired outcomes • Reassessment of the patient’s response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient #5 - The comprehensive assessment was completed 05/29/25, the update was not completed until 6/16/25, greater than 15 days.”

“Upon patient record review, 1 of 10 (Patient #5) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient’s plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #5 - The MSW and Chaplain visit orders included prn visits without a frequency for those visits.”

“Upon patient record review, 4 of 10 (Patient #3,4,5,8) 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 #3 - SN initial assessment has patient receiving 02 at 2L/M but not on POC. Patient #4 - SN initial assessment has patient receiving 02 at 2L/M but not on POC. Patient #5 - POC contained Nystatin 100,00u/g apply topically to affected areas 3 times a day and PRN - did not contain affected area or modifier for PRN. Patient #8 - SN initial assessment has patient receiving 02 at 2L/M but not on POC.”

“Upon patient record review, 3 of 10 (Patient #5,6,7) 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 #5 - Aide Care Plan did not contain frequency for tasks ROM, meal preparation, feeding and set up, house keeping, make bed and change linen. Patient #6 - Aide Care Plan did not contain frequency for tasks perineal care or moisturize skin. Patient #7 - Aide Care Plan did not contain frequency for tasks ROM, meal preparation, feeding or set up, house keeping, make bed and change linen.”