Choice Hospice

“Upon patient record review, 3 of 19 (Patient #3, #11,#12) 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 #3:Cholestyramine and Natural Fiber supplement were listed on the medication profile without evidence of diluent instructions. Additionally, the indication for Cholestyramine was for diarrhea, but instructions stated for constipation. Furthermore, there were 4 ordered medications with acetaminophen and no evidence of max dose instructions: Tylenol #3, Hydrocodone, Tylenol 650mg, Tylenol ES. Patient #11: Patient was taking Ivermectin/Fenbendazole as an alternative therapy; however, neither were on the medication profile. There would not be an associated order for this since MD did not approve. Patient #12: Oxygen was 2-4 L on medication profile; however, the visit note dated 8-4-26 indicated 5 L was being used.”

“Upon patient record review, 7 of 19 (Patient #1,#2,#4,#6,#10,#11,#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 #1:The medication profile listed Clopidogrel and oxygen; however, there were no bleeding precautions or interventions for oxygen on the plan of care. Additionally, the patient was losing weight and there were no care plans for nutrition. Patient #2: Clopidogrel and oxygen were listed on the medication profile; however, there was no evidence of bleeding or oxygen precautions on the plan of care. Patient #4:There was no evidence of wound goals or interventions were on the plan of care; however, the RN is doing appropriate assessment and wound care per orders. Patient #6: The medication profile listed Clopidogrel and ASA, but there was no evidence of bleeding precautions. Additionally, the patient was diagnosed with CHF, but there was no cardiac care plan. Patient #10: The patient had prostate cancer; however, there was no evidence of a genitourinary care plan. Patient #11:The patient was diagnosed with Prostate Ca with Mets to bone; however, there was no evidence of a genitourinary or musculoskeletal care plan. Patient #12: Clopidogrel was on the medication profile; however, there was no evidence of bleeding precautions on the plan of care.”

“Upon patient record review, 2 of 19 (Patient #5,#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 #5: There was no evidence of SW frequency on the plan of care starting 03/26/26. Patient #6: Volunteer for companion needs documented at admission, but there was no evidence a volunteer was part of the plan of care.”

“Upon patient record review 2 of 19 (Patient #5, #8) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient #5: The social worker documented contact with the family within 5 days of the admission and schedule a visit on 01/12/26; however, no follow-up on the 12th to meet the patient/family needs as scheduled. Patient #8: On 7/10/26 THC gummies ordered by hospice per the nursing notes. On, 7/13/26 the nurse wrote the gummies were not processed and the family was buying their own. On 7/27/26, the nurse documented the family expressed frustration that the gummies were still not being provided by the hospice.”

“Upon patient client record review, 3 of 19 (Patient #1,#12,#13) 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 #1: Chaplain frequency orders were 3 x month. The IDG care plan narrative dated 7/9/26 indicated 2 x month. Additionally, the initial RN assessment documented “wound care”; however, the assessment indicated there was no evidence of a wound. Patient #12: An aide supervisory visit was done on 6/29/26;however, there was no evidence of an aide visit until 6/30/26. Patient #13: An LPN supervisory visit was done 8/10/26; however, there was no evidence of an LPN prior to supervision.”

“Upon patient record review, 1 of 19 (Patient #1) 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#1: During a review of the LTCF/Hospice chart at the home visit, there was no evidence the physician certification and recertification or the election forms were provided to the LTCF.”