Gentiva I

“Upon patient record review, 6 of 19 (Patient #1,#2,#3,#4,#8,#9) 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: The hospice medication profile indicates patient taking lorazepam 0.5mg every 4 hours PRN. However, this medication is not listed on the facility medication record. Patient#2: During facility visit, it was noted that facility medication list included Latanoprost ophthalmic 0.005% 1 drop to both eyes at bedtime for glaucoma and OCuSOFT lid scrub 1 application to right eye at bedtime. These are not on the hospice medication profile. Also noted during the facility visit, the hospice agency medication profile indicates patient as having oxygen 2L via nasal cannula PRN and acetaminophen 650mg suppository every 6 hours PRN. However, the facility medication list does not include either of these medications. Patient#3: The medication profile indicates Morphine 100/5ml give 0.25mg every hour after oxycodone if ineffective. However, the morphine on the medication profile indicates it is routine scheduled and not PRN. The medication profile indicates oxygen is scheduled routine medication not PRN. However, the nurse IDG notes indicate patient only has oxygen for PRN use. During home visit it was noted that Cefuroxime Axtel 500mg is not in the home but is active on the medication profile. The nurse states the patient no longer takes this medication. The medication profile indicates patient taking hydralazine 25mg 1 daily PRN. However, the bottle in the home indicates hydralazine is 3 times a day. The medication profile also indicates omeprazole 40mg 1 daily. However the bottle in the home states give twice a day and was filled on 08/27/26. Methenamine Hippurate 1 gram once daily is on the medication profile. However, the bottle indicates twice a day in the home. The midodrine 2.5mg is listed on the med profile for once daily PRN. However the bottle in the home is midodrine 5mg and states to give three times a day. Patient#4: Oxygen on the medication profile is scheduled daily. However, documentation in record indicates patient is using as PRN. During home visit it was noted that agency medication profile indicates patient taking Duloxetine 30mg daily. However, the bottle in the home states Duloxetine 60mg daily. The medication profile also indicates patient actively taking Haloperidol 2mg/ml. However, during home visit the caregiver states patient stopped taking this about a month ago. Patient#8: The medication profile indicates Morphine is a routine scheduled medication to be given hourly. However, instructions state to take hourly for moderate pain or mild anxiety. Patient#9: The medication profile indicates fentanyl 25mcg/hour 1 patch every 72 hours. However, there is no evidence of instructions for specified area of application or if rotation of sites if needed.”

“Upon patient record review, 2 of 19 (Patient #1,#2) 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#1: The record indicates patient has wound to sacrum stage III. There is no evidence of measurements for the weeks of 7/27/26 and 8/23/26. Patient#2: The record indicates the patient has a sacral wound. There is no evidence of wound measurements the week of 8/24/26.”

“Upon patient record review, 4 of 19 (Patient #2,#3,#8,#12) 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#2: The record indicates aide plan of care states patient requires aspiration precautions and oxygen precautions. There is no evidence of interventions or goals related to these precautions on the nursing plan of care. Patient#3: The record indicates seizure precautions are listed on the aide plan of care. The record also indicates patient is ordered seizure medications. However, there is no evidence of seizure precautions with problems, goals, or interventions on the main plan of care. Patient#8: The plan of care list intervention for skilled nurse to assess patient shunt status. However, this patient does not have a shunt. Patient#12: The record indicates the patient is ordered medication for vertigo both scheduled and PRN. There is no evidence of problems, goals, or interventions on plan of care to address the patients vertigo.”

“Upon patient record review, 3 of 19 (Patient#2,#3,#4) 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#2: During facility visit it was noted that facility medication list included Latanoprost ophthalmic 0.005% 1 drop to both eyes at bedtime for glaucoma and OCuSOFT lid scrub 1 application to right eye at bedtime. There is no indication of an order for these in the hospice record. Patient#3: During home visit it was noted that cefuroxime Axtel 500mg is not in home but is an active order in patient record. The nurse states the patient no longer takes this medication. The record indicates patient ordered hydralazine 25mg 1 daily PRN. However, the bottle in the home indicates hydralazine is 3 times a day. The medication order indicates omeprazole 40mg 1 daily. However the bottle in the home states give twice a day and was filled on 08/27/26. There is an order for Methenamine Hippurate 1 gram once daily However, the bottle in the home indicates twice a day. There is evidence of an order for midodrine 2.5mg once daily PRN. However the bottle in the home is 5mg and states to give three times a day. Patient#4: During home visit it was noted that patient ordered Duloxetine 30mg daily. However, The bottle in the home states Duloxetine 60mg daily. The record indicates patient has active order for Haloperidol 2mg/ml. However, during home visit the caregiver states patient stopped taking this about a month ago.”

“Upon patient record review, 3 of 19 (Patient #3,#10,#11) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient#3: Upon review of record, IDG 8/20/26 note was blank for RN. There was no evidence of any progress to goals or changes to patient condition or needs reviewed. MSW note states available upon request of family and chaplain states no visit recorded. Nurse on visits between the previous IDG and 8/20 indicate the patient was ordered a transfer board to assist with transfers and family educated, patient had episode nausea and vomiting lasting all night, and developed a blanchable redness to sacrum. Patient#10: On 8/25/26 nurse documents patient has +2 edema. It is also documented that nurse reviewed recommendation with ALF for furosemide that was sent by hospice last week. The ALF nurse stated she would review with the NP tomorrow. On 8/31 nurse documents patient still experiencing edema. There is no evidence of problems, goals, or interventions to plan of care being updated for the management and education on edema. Patient#11: The nurse documents that 8/9/26 the patient experienced a syncopal episode. The syncopal episodes were also discussed in IDG on 8/13/26. There is no evidence of problems, goals, or interventions updated on plan of care for the management and education on new onset of syncope.”

“Upon patient record review, 3 of 19 (Patient #7,#13,#14) 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#7: The aide plan of care states aide to give shower and shampoo weekly on Friday and shave patient weekly on Monday. However, aide did not visit patient on Mondays and Fridays consistently. Aide made one visit on Tuesday week of 7/12/26. The weeks of 7/26/26 and 8/2/26 aide went on Tuesday and Thursday. The week 8/9/26 aide went on Tuesday and Friday. The week of 8/16/26 aide went on Wednesday and Friday. The aide is marking yes to items indicated to be done on specific days of the week even when she makes visit on a different day than assigned on plan of care. Patient#13: There is no evidence of skin precautions on the aide plan of care. However, skin precautions are listed on the nursing plan of care. Patient#14: There is no evidence of aspiration precautions on the aide plan of care. However, aspiration precautions are listed on the nursing plan of care.”

“Upon patient record review 2 of 19 (Patient #1,#7) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient#1: The aide frequency is ordered for 2 times per week. There is one aide visit missing for the following weeks: 6/18/26, 6/21/26, and 7/20/26. There is no evidence of a missed visit in the record. Patient#7: Initial frequency order indicates aide frequency ordered 3 times per week. There is no evidence of the 3 visits for week of 7/19/26 being made. There is also no evidence of any missed visits for that week.”

“Upon patient client record review, 6 of 19 (Patient #3,#4,#9,#11,#12,#14) 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#3: The record indicates the Pennsylvania out of hospital DNR order is in chart. However, there is no evidence of a date or relationship to patient filled in where the surrogate signed. This section does indicate that the surrogate or other person is signing by virtue of relationship to patient and has a blank for this to be filled in. Patient#4,#12: The record indicates the Pennsylvania out of hospital DNR order is in chart. However, there is no evidence of a date where surrogate signed on behalf of patient. Patient#9,#11,#14: The record indicates the Pennsylvania out of hospital DNR order is in chart. However, there is no evidence of relationship to the patient where the surrogate signed.”

“Upon client record review, 2 of 19 (Patient #1,#5) 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 #1: The record indicates nurse frequency is ordered at 2x week for 12 weeks then 1x week for 1 week. The record indicates the week of 7/5/26 there was 1 nurse visit missed. There is no evidence of a missed visit. Patient#5: The record indicates nurse frequency was ordered for 1x week. There is no evidence of nurse visit for the week of 8/16/26. There is no evidence of a missed visit.”