Heartland Hospice

“Upon patient record review, 3 of 19 (Patients #1,#3,#6) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 1: Upon medication reconciliation during the home visit, the facility and hospice medication profiles did not match. The facility ativan instructions were for 2mg/ml concentrate, give 1 ml every four hours as needed. Hospice profile contained instructions for ativan 0.5mg tablets every four hours as needed. Corrected on site with order clarification and update to medication profile. Patient 3: Upon medication reconciliation during the home visit, the facility and hospice medication profiles did not match. The facility profile contained pantoprazole that was not on hospice, and hospice profile contained aspirin that was not on the facility profile. Corrected on site with order clarification and update to medication profile. Patient 6: Upon medication reconciliation during the home visit, the facility and hospice medication profiles did not match. The facility acetaminophen instructions were for 1000 mg scheduled three times daily. Hospice profile contained instructions for 100 mg every six hours as needed. The medication profile also contained two seroquel instructions for 25 mg twice daily and 50 mg at bedtime without instructions to take the second 25 mg dose with the 50 mg dose at bedtime. Corrected on site with order clarification and update to medication profile.”

“Upon patient record review, 3 of 19 (Patients #1,#3,#6) 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 medication reconciliation during the home visit, the facility and hospice medication orders did not match. The facility ativan order instructions were for 2mg/ml concentrate, give 1 ml every four hours as needed. Hospice ativan order contained instructions for ativan 0.5mg tablets every four hours PRN. Corrected on site with order clarification. Patient 3: Upon medication reconciliation during the home visit, the facility and hospice medication orders did not match. The facility contained a pantoprazole order that hospice did not have, and hospice had an aspirin order that the facility did not have. Corrected on site with order clarification. Patient 6: Upon medication reconciliation during the home visit, the facility and hospice medication orders did not match. The facility acetaminophen instructions were for 1000 mg scheduled three times daily. Hospice acetaminophen order contained instructions for 100 mg every six hours as needed. The hospice medical record also contained two seroquel orders for 25 mg twice daily, and 50 mg at bedtime without instructions to take the second 25 mg dose with the bedtime dose. Corrected on site with order clarifications.”

“Upon patient record review, 3 of 19 (Patients #3,#6,#7) 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 equipment and supply needs. Patient 3: The medical record contained nursing documentation since admission identifying patient use of a Hoyer lift for transfers. There was no evidence of an order for the lift included in the plan of care. Corrected on site with order clarification. Patient 6: The medical record contained nursing documentation 9/3/25 identifying patient use of a low air loss mattress. There was no evidence of an order for the mattress included in the plan of care. Corrected on site with order clarification. Patient 7: The medical record contained nursing documentation 6/30/25 identifying patient use of a wheelchair. There was no evidence of an order for the wheelchair included in the plan of care. Corrected on site with order clarification.”

“Upon patient record review, 1 of 19 (Patient #16) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient 16: The bereavement care plan contained tasks to send 6 month letters to the bereaved. There was no evidence of task completion. Corrected on site with letters sent.”

“Upon client record review, 3 of 19 (Patients #4,#13,#14) 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 4: The medical record contained an order for nursing visits twice weekly. There was no evidence of a second visit completed the week of 7/20/25. Patient 13: The medical record contained an order for social work visits once monthly. There were two scheduled visits completed in August. Patient 14: The medical record contained an order for spiritual care visits twice monthly for two months effective 6/1/25. There was no evidence of a second visit completed in July.”