Holisticare Hospice, LLC

“Upon personnel record review, 1 of 17 (Personnel #17) did not have evidence Emergency Preparedness training including: • Initial training in emergency preparedness policies and procedures to all new and existing hospice employees, and individuals providing services under arrangement, consistent with their expected roles • Demonstrate staff knowledge of emergency procedures • Provide emergency preparedness training at least annually • Periodically review and rehearse its emergency preparedness plan with hospice employees (including nonemployee staff), with special emphasis placed on carrying out the procedures necessary to protect patients and others • Maintain documentation of all emergency preparedness training Personnel #17: Upon review, there was no available evidence of emergency preparedness training for ST providing care”

“Upon patient record review, 1 of 19 (Patient #10) 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 #10: Hospice Rx Profile includes 2/16/26 Ativan 1 mg tab prn anxiety every 4 hours po. SNF Rx profile has 2/23/26 Ativan 0.5 mg tab every 4 hrs prn anxiety. (1 mg ended 2/23 on SNF orders) Facility Rx Profile has Acetaminophen supp rectally 650 mg prn, but Hospice Rx profile does not specify mg.”

“Upon patient record review, 6 of 19 (Patient #2, 3, 4, 5, 6, 10) 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: Patient has Depakote and Eliquis prescribed with no related problems, goals, interventions. Patient #3: Patient with heart disease and supporting dx of senile degeneration of the brain, dyspnea, and an order for oxygen 2 LPM prn. There are no respiratory or oxygen related problems, goals, interventions. Patient #4: Patient admitted with CVD and history of AF, PE, falls, with no related problems, goals, interventions including but not limited to no CV, respiratory, safety. Also patient has Xarelto and Plavix prescribed with no bleeding precautions. Patient #5: Patient has Eliquis prescribed and no related problems, goals, interventions. Patient #6: Patient has Xarelto and aspirin prescribed with no related problems, goals, interventions. Patient #10: Patient has Kepra for seizures, but no seizure precautions.”

“Upon patient record review, 4 of 19 (Patient #1, 2, 4, 6) 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 #1: Initial visit frequency SC 2m2, 6 prn. There are too many PRN visits ordered. Patient #2: Initial visit frequency SC 2m3 and 6 prn. There are too many PRN visits ordered. Patient #4: Initial visit frequency SC 2m3 and 6 prn; MSW 1m3 and 6 prn. There are too many PRN visits ordered. Patient #6: Initial visit frequency SC 2m3 and 6 prn. There are too many PRN visits ordered.”

“Upon patient record review, 5 of 19 (Patient #2, 3, 4, 5, 6) 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 #2: Patient had Depakote and Eliquis prescribed with no related seizure and/or bleeding precautions included on the aide plan of care. Patient #3: Patient had PRN oxygen prescribed with no related safety precautions on the aide plan of care. Patient #4: Patient had Xarelto and Plavix prescribed with no related bleeding precautions on the aide plan of care. Patient #5: Patient had PRN oxygen prescribed with no related safety precautions. Eliquis prescribed with no related bleeding precautions on the aide plan of care. Patient #6: Patient had PRN oxygen prescribed with no related safety precautions. Xarelto and aspirin prescribed with no bleeding precautions on the aide plan of care.”

“Upon patient record review, 1 of 19 (Patient #8) 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 #8: Hospice Aide Care Plan assignment includes shower and shampoo weekly on Thursdays. Patient was showered 3/5/26 (Thurs), 3/6 (Fri), 3/8 (Sun), 3/12/26 (Thurs). Shampoo was performed 3/5 (Thurs), and 3/6 (Fri).”

“Upon patient client record review, 2 of 19 (Patient #3, 7) 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: Document uploads include plan of care 12/2/25-03/01/25 for patient with same last name, different first name and different agency location under IDG updates. Upon staff interview, staff confirms not the same patient. Documents subsequently removed. Patient #7: Patient record inadvertently includes problems/precautions for gastrostomy when patient does not have one.”