Royal Hospice Care

“Upon patient record review, 3 of 14 (Patient #2, 3, 7) 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 Patients #2, 3, 7: Patients were prescribed MiraLAX. There was no evidence of reconstitution instructions in the record.”

“Upon patient record review, 3 of 14 (Patients #2, 4, 8) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family’s needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #2: On 03/10/26, Spouse called stating the patient was calling out in pain. Instructed over the phone to give oxycodone liquid, 5mg. Spouse called back stating he accidently gave 20mg. There was no follow up phone call or visit for 3 days. Patient #4: On 04/20/26, Patient caregiver called. Visit made and pulse ox was 88% on 4 liters, temperature was 99.9. RN educated about medications and oxygen was increased to 5 liters. There was no follow up phone call or visit for 7 days. Patient #8: On 09/24/25 at MSW visit, patient was having nausea and vomiting. Son wondering if they need a feeding tube. MSW called RN during visit to report symptoms and son’s request. There was no RN visit or phone call for 7 days on 09/30/25. The patient had been at the emergency department on 09/29/25 for symptom management. The son reported he had just given Haldol but that patient continued to have nausea and vomiting daily. No follow up phone call of visit until day of patient death on 10/12/25.”

“Upon patient record review, 3 of 14 (Patient #2, 5, 7) 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. Patients #2, 5, 7: Patients were prescribed anticoagulants. There was no evidence of interventions or goals for use of anticoagulants or bleeding precautions in the record.”

“Upon personnel record review, 1 of 11 (Personnel # 9) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel #9: There is no evidence that the aide had a competency assessment performed with direct observation with a patient.”

“Upon patient record review, 4 of 14 (Patients #1, 2, 5, 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 #1: The Aide plan of care stated complete bed bath and shower. The task must be specific and not give choice between types of shower/bath. Patient #2: The Aide plan of care stated complete bed bath and shower. The task must be specific and not give choice between types of shower/bath. The patient was on thickened liquids. The aide plan of case states “encourage Fluids” however, there is no evidence that it states patient is on thickened liquids. The patient has an indwelling foley. There is no evidence of a foley or care of on aide plan of care. Patient #5: The Aide plan of care stated partial bed bath and shower. The task must be specific and not give choice between types of shower/bath. Patient #7: The Aide plan of care stated complete bed bath and shower. The task must be specific and not give choice between types of shower/bath.”