Gentiva

“Upon patient record review, 1 of 14 (Patient #2) did not have evidence that the patient has received effective pain management and symptom control from the hospice for conditions related to the terminal illness. Patient 2: The medical record indicated that the patient’s caregiver at the ALF called triage on 05/25/2026 due to patient’s complaints of pain while walking. According to the medical record, the patient’s pain medication was changed on 05/13/26 to hydrocodone from tramadol. During the triage call, the triage nurse inquired about the hydrocodone. It was confirmed during the call that the patient’s pain medications had not been delivered to the facility from the pharmacy. The nurse documented during the 05/27/2026 visit that the patient’s ordered pain medication had still not arrived from the pharmacy and remained unavailable at that time.”

“Upon patient record review, 2 of 14 (Patient #2,5) 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 2: During home visit, the assisted living facility medication profile included Vitamin C, vitamin B12, a complete multi-vitamin, calcium, zinc, fish oil, magnesium, folate, and vitamin D. Hospice medication profile did not have orders for those medications. Hospice medications profile had orders for Losartan 25mg 2 times a day that were not on the ALF’s medication profile. Patient 5: During home visit, the patient reported that he uses Lidocaine patch 5% 2-3 times a week as needed for his lower back pain. The hospice medication profile did not have an order for Lidocaine patches.”

“Upon patient record review, 1 of 14 (Patient 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 2: The medical record indicated that the assisted living facility aide called triage on 05/25/26 stating that the patient was having pain while walking. The hospice nurse changed the patients pain medication on 05/13/26 from tramadol to hydrocodone. The triage nurse confirmed with the facility aide that they did not have the ordered hydrocodone at the facility that was started on 05/13. The triage nurse documentation indicated there was a need for the on-call nurse to make a visit. The on-call nurse replied back to triage stating that she would follow up with the facility and that the patient’s case manager was scheduled to made a visit the following day, 05/26/26. The follow-up to the triage call was the hospice nurse calling the facility back to speak to the aide about the patient’s pain. No evidence of documentation in the patient chart that the nurse did any follow-up on the patient’s pain until 05/27/26. During the follow-up visit the nurse documented that the patient was in pain at the time of the visit.”

“Upon patient record review, 2 of 14 (Patient #3,8) 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 3: The aide plan of care has instructions for aspiration precautions. The medical record indicated that the patient has dysphagia. No evidence of problems, goals, and interventions related to aspiration precautions. Patient 8: The medical record indicated that the patient uses a walker daily due to altered mobility. No evidence that problems, goals, and interventions related altered mobility.”

“Upon patient record review, 1 of 14 (Patient #3) 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 3: The plan of care has orders for volunteer visits to be available “as requested by the caregiver”. No evidence that a routine frequency was included in the order.”

“Upon patient record review, 2 of 14 (Patient #2,5) 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 the home visit, the ALF medication profile included Vitamin C, vitamin B12, a complete multi-vitamin, calcium, zinc, fish oil, magnesium, folate, and vitamin D. The hospice plan of care does not have orders for those previously stated medications. Patient 5: During the home visit, the patient reported that he uses Lidocaine patch 5% 2-3 times a week as needed for his lower back pain. No evidence that hospice plan of care has an order for Lidocaine patches.”

“Upon patient record review, 2 of 14 (Patient #3,5) 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: The current plan of care had goals and interventions related to respite care at the time that the chart was reviewed. The medical record indicated that the patient was no longer in respite care, patient was transitioned to a resident of the SNF and was now receiving routine home-care at the facility. Patient 5: The plan of care had interventions related to being at risk for bleeding due to anticoagulant therapy usage. No evidence that the patient was on anticoagulation therapy currently. Eliquis was stopped on 05/18/2026.”

“Upon client record review, 2 of 14 (Patient #8,10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 8: The medical record has orders for a volunteer referral. No evidence that the referral occurred. In addition, the nurse documentation indicated that the patient had severe diarrhea for several days. The family requested a stool sample for C-diff be completed. The nurse documented that the MD gave a verbal order for the lab to be completed. No evidence that the stool sample was obtained or that the lab test was ever completed. Patient 10: Plan of care has orders for INR checks weekly to be completed by the hospice nurse/facility nurse and to be reported to the physician. No evidence that those checks were competed weekly and reported to the physician.”

“Upon observation, there was no evidence the hospice investigates all adverse events, incidents, accidents, variances or unusual occurrences that involve patient care and develops a plan of correction to prevent the same or similar event from occurring again. Patient 5: During the home visit, the patient reported that he did not have a positive experience with one of the agencies on-call nurse who visited him on 05/15/26. He stated that instead of helping him, she accused him of selling his pain medications for ‘uppers’ and that was the reason why he was having the increased anxiety. Stated that he did not want that nurse back in his home. When asked if he reported his concerns he stated that he reported it to his RNCM, RW. No evidence that the nurse entered an occurrence report at the time that she took the report.”

“Upon patient client record review, 3 of 14 (Patient #2,8,10) did not have evidence that each patient record contains Advance Directives. Patient 2: The RN documentation indicated the patient was a DNR. It is noted in the medical record in IDG notes completed by the nurse that the patient is a DNR. There was no evidence of a DNR form in chart. Patient 8: The RN documentation indication the patient was a DNR. It is noted in the medical record in IDG notes completed by the nurse that the patient is a DNR. There was no evidence of a DNR form in chart. Patient 10: The RN documentation indicated the patient was a DNR. It is noted in the medical record in IDG notes completed by the nurse that the patient is a DNR. There was no evidence of a DNR form in chart.”

“Upon patient client record review, 2 of 14 (Patient #4,11) 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 4: Aide missed visit documentation indicated that the visits occurred for future dates in September 2026 - 09/3, 09/05, 09/08, 09/10, 09/12. Patient 11: During medical record review it was noted that the Notice of Medicare Non-coverage form had the incorrect date of non-coverage listed as 02/08/2026. The medical record indicated that the patient was not discharged on 02/08/2026 but was discharged on 02/10/2026.”