Gentiva

“Upon patient record review, 1 of 19 (Patient #1) 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 medication profile contains MiraLAX 17 gram oral powder. However, there is no evidence of dilutant instructions. Corrected on site.”

“Upon patient record review, 8 of 19 (Patient #1,#2,#3,#4,#5,#7,#8,#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#1: The record indicates fall precautions are indicated on the aide plan of care, however is not included on plan of care. Corrected on site. Patient#2: The record indicates patient has PEG for feedings. There is no evidence of goals or interventions related to PEG care or for aspiration precautions. Corrected on site. Patient#3: The record indicates patient is ordered oxygen. There is no evidence of goals or interventions for oxygen safety precautions on plan of care. Corrected on site. Patient#4: The record indicates patient takes seizure medications daily and requires nebulizer treatments. However, there is no evidence of goals or interventions related to seizure precautions or nebulizer use. Corrected on site. Patient#5: Nurse documentation in 1/30/25 indicates patient is a high fall risk with unsteady gait. Fall precautions are indicated on aide plan of care. There is no evidence of goals and interventions for fall precautions on plan of care. Corrected on site. Patient#7: Bleeding precautions are listed on aide plan of care. There is no evidence of goals or interventions for bleeding precautions on plan of care. Corrected on site. Patient#8: Oxygen safety precautions are on aide plan of care. There is no evidence of goals or interventions for oxygen safety precautions on pan of care. Corrected on site. Patient#10: The record indicates patient is taking insulin and requires monitoring of blood sugar. There is no evidence of problems, goals, or interventions related to these needs. Corrected on site.”

“Upon patient record review, 4 of 19 (Patient #1,#5,#6,#10) 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: The medical record contained an order for MiraLAX 17 gram oral powder. There is no evidence of dilutant instructions on order. Corrected on site. Patient#5: The medical record contained an order for thickener. There is no evidence of instructions for preparing for thickness needed for patient or patient. Corrected on site. Patient#6: The record indicates patient is taking ensure for nutrition supplement. There is no evidence of an order for ensure. Corrected on site. Patient#10: The record indicate patient was admitted with a PICC line in place. There is no evidence of order for PICC removal in record.”

“Upon patient record review, 6 of 19 (Patient #2,#4,#7,#8,#10,#14) 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#2: During home visit it was noted that patient is bedbound in hospital bed and also requires oxygen. There is no evidence of bed or oxygen on plan of care order. Corrected on site. Patient#4: The record indicates per nurse documentation that patient requires use of rollator. There is no evidence of rollator on plan of care order. Corrected on site. Patient#7,#8: The record indicates patient requires use of hospital bed. There is no evidence of a bed listed on plan of care order. Corrected on site. Patient#10: During home visit it was noted that patient requires use of hospital bed and suction. IDG on 2/19/25 indicates patient requires use of Hoyer lift for transfers. There is no evidence of these items on plan of care order. Corrected on site. Patient#14: The record indicates the patient requires bed bolsters, however there is no evidence of hospital bed or over the bed table listed on plan of care order. The supply order list feeding/nutritional supplies. There is no documentation that patient requires these supplies. Per conversation with administrator these supplies were listed in error. Corrected on site.”

“Upon patient record review, 1 of 19 (Patient #10) 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#10: The plan of care includes an intervention for SN to assess shunt. There is no evidence in record that patient has a shunt. Upon discussion with Administrator it was determined that patient does not have a shunt and intervention was entered in error. Plan of care was not updated. Corrected on site”

“Upon patient record review, 3 of 19 (Patient #17,#18,#19) 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#17,#18,#19: There is no evidence of Holiday letter being sent after Christmas as listed on bereavement plan of care.”

“Upon patient record review, 5 of 19 (Patient #2,#3,#10,#11,#13) 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: The record indicates patient is ordered oxygen and requires peg tube feedings. The aide care plan did not contain aspiration precautions or oxygen safety precautions. Corrected on site. Patient#3: The record indicates bleeding precautions are included on plan of care. There is no evidence of bleeding precautions on aide plan of care. Additionally, the record indicates patient requires use of oxygen. There is no evidence of oxygen safety precautions on aide plan of care. Corrected on site. Patient#10: The record indicates patient has a foley catheter. There is no evidence of foley catheter on aide plan of care. Corrected on site. Patient#11: The plan of care indicates patient requires aspiration precautions. There is no evidence of aspiration precautions on aide plan of care. Corrected on site. Patient#13: The record indicates patient has a foley catheter in place. There is no evidence of foley catheter on the aide plan of care. Corrected on site.”

“Upon patient record review, 1 of 19 (Patient #10) did not have evidence that the hospice provided the following information: • The most recent hospice plan of care specific to each patient • Hospice election form and any Advance Directives specific to each patient • Physician certification and recertification of the terminal illness specific to each patient • Names and contact information for hospice personnel involved in hospice care of each patient • Instructions on how to access the hospice’s 24-hour on-call system • Hospice medication information specific to each patient • Hospice physician and attending physician (if any) orders specific to each patient Patient#10: There is no evidence of hospice election form found at facility.”