Changing Seasons Hospice

“It is required that the documented comprehensive assessment includes a drug profile that contains the patient’s current prescription and over-the-counter (OTC) drugs. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by clinical record review, document review and interview. In 4 of 14 (29%) records reviewed revealed that the agency did not ensure that the medication profiles included all prescription medications. Document 3: Policy PC.85 Medication List and Monitoring read in part, “I. The Hospice will maintain a current, accurate list of all prescription and over the counter (OTC)medications taken by the patient. (Medication Profile).” Clinical Record 6: The hospice election of benefit was dated 07/18/2023. During review of the 12/10/2023 hospice episode of care the 12/10/2023, 12/14/2023, 12/29/2023, 01/12/2024 and 01/26/2024 updated hospice plans of care and interdisciplinary team meeting notes that included completion of medication profile review read in part, “Oxygen @ 2-5LPM via nasal cannula for comfort.” At the time of the review on 01/30/2024, Oxygen was not included on the medication profile. Clinical Record 8: The hospice election of benefit was dated 11/02/2023. The 11/02/22023, 11/08/2023, 11/22/2023, 12/06/2023, 12/20/2023, 01/03/2024 and 01/172024 updated hospice plans of care and interdisciplinary team meeting notes that included completion of medication profile review read in part, “Oxygen @ 2LPM via nasal cannula for comfort.” At the time of the review on 01/30/2024, Oxygen was not included on the medication profile. Clinical Record 13: The hospice election of benefit was dated 12/15/2023. The 12/15/2023 initial, and the 12/20/2023 updated hospice plans of care and the interdisciplinary team meeting notes that included completion of medication profile review read in part, “Oxygen @ 2-5LPM via nasal cannula for comfort.” At the time of the review on 01/30/2024, Oxygen was not included on the medication profile. Clinical Record 14: The hospice election of benefit was dated 09/14/2023. During review of the 12/13/2023 hospice episode of care the 12/13/20023, 12/20/2023 and the 12/30/2023 updated hospice plans of care and interdisciplinary team meeting notes that included completion of medication profile review read in part, “Oxygen @ 2LPM via nasal cannula for comfort.” At the time of the review on 01/30/2024, Oxygen was not included on the medication profile. During interview 01/31/2024, the Alt DPCS reviewed the associated records and stated that Oxygen had inadvertently been omitted from the medication profiles and had since been corrected.”

“It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review, document review and interview. In 1 of 14 (7%) records reviewed the agency did not ensure that the hospice plan of care included treatments necessary to meet the needs of the patient. Document 4: Policy PC.30 Plan of Care Process read in part, “VI. The POC includes but is not limited to: D. Drugs and treatments necessary to meet the needs of the patient.” Clinical Record 10: The 11/21/2023 hospice plan of care read in part, “Foley cath 16Fr 10cc change every 30 days and as needed.” The order did not include any as needed qualifiers at the time of the review on 01/30/2024. During interview 01/31/2024, the Alt. DPCS reviewed the associated record and stated that the incomplete order had since been corrected.”

“It is required that counseling services include an organized program for providing bereavement services delivered by or under the supervision of a qualified professional with experience or education in grief or loss counseling. The bereavement services reflect the needs of the bereaved per a bereavement plan of care that includes. The types of bereavement services to be offered and the frequency of service delivery. This standard was not met as evidenced by clinical record review, document review and interview. In 2 of 2 (100%) bereavement records reviewed revealed that the agency did not ensure that a bereavement plan of care was developed hat included the types of bereavement services to be offered and the frequency of service delivery. Document 2: Policy PC.130 Bereavement read in part, ‘VII. After the death of the patient: A. The Bereavement Coordinator will complete a follow-up assessment and develop a POC for bereavement services based on the re-assessment and the family and/or caregiver’s willingness to receive services. This POC will be discussed at the next IDG/IDT meeting. IX. The bereavement POC will include delineation of services and frequency to be provided.’ Clinical Record 13: The hospice election of benefit was dated 12/15/2023. The patient expiration date was 12/27/2023. At the time of the review on 01/31/2024, there was no evidence of a bereavement plan of care. Clinical Record 14: The hospice election of benefit was dated 09/14/2023. The patient expiration date was 12/30/2023. At the time of the review on 01/31/2024, there was no evidence of a bereavement plan of care. During an interview on 01/31/2024, the Alt DPCS reviewed the associated records and stated that the care plans were not created. The Alt Administrator collaborated with the Administrator and the Chaplain and stated that while bereavement follow up had been completed a care plan would need to be created to reflect current bereavement services. Alt DPCS stated working with EMR vendor to ensure proper creation of bereavement plan of care.”

“It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a registered nurse who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 13 (8%) records reviewed with the provision of aide services, the agency did not sure the registered nurse completed written patient care instructions. Clinical Record 3: The 12/08/2023 hospice plan of care included left heel wound care orders for the registered nurse to complete 3xweek and an aide visit frequency of 2xweek. The 12/10/2023 aide care plan created by the registered nurse included a task assignment of shower every visit but did not include instructions/guidance for the aide regarding the wound dressing at the time of the review on 01/30/2024 . During interview on 01/31/2024, the Alt. DPCS reviewed the associated record and stated wound care guidance was inadvertently omitted for the aide assignment sheet and had since been corrected.”

“It is required that a hospice aide provides services ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 8 of 13 (62%) records reviewed with the provision of aide services, the agency did not ensure that the aide services were provided as ordered. Clinical Record 2: The hospice election of benefit was dated 09/21/2023. The hospice plan of care (POC) dated 12/20/2023 included an aide frequency of 3xweek. The week of 12/25/2023 and 01/01/2024 there was only documentation for two aide visits and no explanation of why services were not provided as ordered at the time of the review on 01/30/2024. Clinical Record 3: The 12/08/2023 hospice plan of care included an aide frequency of 2xweek. The week of 12/08/2023 there were no documented aide visits and no explanation of why services were not provided as ordered at the time of the review on 01/30/2024. Clinical Record 4: The 12/07/2023 hospice plan of care included an aide frequency of 2xweek. The week of 12/07/2023 there were no documented aide visits and no explanation of why services were not provided as ordered at the time of the review on 01/30/2024. Clinical Record 5: The 11/22/2023 hospice plan of care included an aide frequency of 3xweek. The week of 11/22/2023 there was only one aide visit documented and no explanation of why services were not provided as ordered at the time of the review on 01/30/2024. Clinical Record 6: The hospice election of benefit was dated 07/18/2023. The POC dated 12/10/2023 included an aide frequency of 3xweek. The week of 01/01/2024 there was only documentation for two aide visits and no explanation of why services were not provided as ordered at the time of the revie on 01/30/2024. Clinical Record 7: The 11/08/2023 hospice plan of care included an aide frequency of 2xweek. The week of 11/10/2023 there was only one aide visit documented and no explanation of why services were not provided as ordered at the time of the review on 01/30/2024. Clinical Record 8: The 11/02/2023 hospice plan of care included an aide frequency of 2xweek. The week of 11/02/2023 there was no aide visit documented and no explanation of why services were not provided as ordered at the time of the review on 01/30/2024. Clinical Record 9: The hospice election of benefit was dated 09/06/2023. The 12/03/2023 POC dated 12/03/2023 included an aide frequency of 3xweek. The week of 12/25/2023 and 01/01/2024 there was only documentation for two aide visits and no explanation of why services were not provided as ordered at the time of the review on 01/30/2024. During interview 01/31/2024, the Alt. DPCS reviewed the associated records and stated that at start of care incorrect frequencies had inadvertently been entered and during the holiday season patient honored requests had failed to be entered and had since been corrected.”

“It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least the following: a summary of the patient’s hospice stay, including treatments, symptoms, and pain management and the patient’s latest physician orders. This standard was not met as evidenced by clinical record review, document review and interview. In 2 of 4 (50%) discharge records reviewed the agency did not ensure that the discharge summary included a summary of the patient’s hospice stay and the latest physician’s orders. Document 5: Policy PE.20 Patient Discharge read in part, ‘VIII. The Hospice will forward copies of the following to the patient’s Attending Physician upon discharge from the Hospice’s services: A. The Hospice discharge summary which includes but is not limited to: 1. A summary of the patient’s care (pain management, symptoms, and treatments), 2. The patient’s current Plan of Care, including the current medication profile, 3. The latest physician orders, and 4. Any other documentation requested or that may assist with the patient’s post-discharge continuity of care.’ Clinical Record 11: The hospice election of benefit was dated 06/19/2023. The hospice revocation date was documented as 11/21/2023. The discharge summary sent to the physician following the patient post discharge did not include a summary of care or current physician’s orders at the time of the review on 01/31/2024. Clinical Record 12: The hospice election of benefit was dated 10/23/2023. The hospice discharge date was documented as 11/26/2023. The discharge summary sent to the physician following the patient post discharge did not include a summary of care or current physician’s orders at the time of the review on 01/31/2024. During interview 01/31/2024, the Alt. DPCS reviewed the associated records and stated the discharge summaries were incomplete and had since been corrected.”

“Based on observation, record reviews and interviews, the agency failed to enforce its written policy to ensure Patient care was coordinated among all agency staff/service providers to promote optimal patient outcomes for one of three patients (Patient #1), whose records were reviewed in that, LVN G did not communicate to the Registered Nurse (RN) Case Manager (CM) or the interdisciplinary group (IDG), changes to Patient #1s medication order. The failure placed Patient #1 at risk of receiving inadequate care/services and/or negative outcomes when a service provider does not communication any changes to the client’s among all service providers involved in the patient’s care to ensure prompt medical attention is provided. The findings included: Review of Health and Human Services Commission (HHSC) Complaint Intake Investigation (CII) general intake information for complaint #463044 dated 11/08/23 at 10:10 a.m., revealed that Patient #1 had two orders for Haldol (an anti-psychotic medication given for agitation) one order was for Haldol two milligrams, one tablet, by mouth at bedtime; and the other was for Haldol one milligram, one tablet by mouth daily. Further review of the CII revealed that on 08/02/23 there was a physicians order to “;Hold Haldol until further notice.” However, the facility staff where Patient #1 resided were not aware of the physicians telephone order dated 08/02/23 to “;hold Haldol ...” and the patient continued to receive Haldol. Further review of the CII revealed that when the Complainant questioned the order to “;hold Haldol...” and an order was sent effective 11/07/23 to discontinue Haldol two milligrams. Further review of the CII revealed that Patient #1s family member (FM) was aware that the hospice agency had adjusted the clients medications and stated that she (FM) did not want the client to take Haldol. Review of the agencys policy PC.110, titled, “;Coordination of Care” dated 10/01/21, read in part, “;I. The Hospice will provide for and ensure the ongoing sharing of information between disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement, by the Hospice, or by other providers. II. The Hospice will provide for an ongoing sharing of information with the non-hospice healthcare providers furnishing services unrelated to the terminal illness and related conditions...VII. All communications and coordination of care is documented in the clinical record.” Review of Patient #1s electronic clinical record (ECR) revealed a start of care (SOC) date of 03/08/23 and a terminal illness diagnosis of Alzheimers disease (most common type of dementia. It is a progressive disease that begins with mild memory loss and affects thought, memory and language). Review, of the plan of care (POC) included orders for skilled nurse visits once a week. Further review revealed that Patient #1 was a resident in a memory care unit located on the same grounds as the hospice agency. Review of Patient #1s medication profile on 11/09/23 included Haldol one milligram to be given one time daily, order date was 07/28/23. Further review did not include Haldol two milligrams. Review of Patient #1’s ECR revealed a physicians order dated 07/27/23 to discontinue Haldol 2 milligrams. Further review of the ERC did not include physician’s orders dated 08/02/23 to, “;Hold Haldol until further notice.” Further review of Patient #1s ECR did not reveal documented evidence that LVN G communicated to the RNCM, the Medical Director or the IDG that Patient #1s FM requested that Haldol be held or discontinued, and that telephone order was written to hold Haldol dated 08/02/23. During an interview on 11/10/23 at 3:20 p.m., the Alternate Supervising Nurse stated that all medications are reviewed and reconciled weekly with the facility staff or family members. She stated that any changes to the orders are faxed over to the local pharmacy contracted by the hospice agency. She further stated that a follow up is done to ensure that any changes in the medication orders are reflected in the MARs, to ensure that the orders are implemented. During the same interview, the Alternate Supervising Nurse stated that she was not aware of the telephone order dated 8/2/23 to “;Hold Haldol until further notice.” and would speak with the RNCM F regarding the matter. During an interview on 11/10/23 at 3:55 p.m., RNCM F stated that a telephone order dated 08/02/23 that stated, “;Hold Haldol until further notice” was written by LVN G. She stated that LVN G wrote it because Patient #1s FM wanted the Haldol discontinued due to the patient not being alert and sleeping during the day. She stated that she was not informed by LVN G until 11/07/23 when the telephone orders dated 08/02/23 to hold Haldol came into question and that there was no documentation in the skilled nurse notes or communication notes. She stated that she then called the physician and an order to discontinue Haldol two milligrams effective 11/07/23. During an interview on 11/10/23 at 5:00 p.m., the Facility Director Individual H stated that Patient #1s FM was going back/forth with the medication aide and with the hospice nurse [LVN G] regarding whether to give or hold the Haldol. She stated, “;that she believes the Haldol is a prn (given as needed) so the medication aide in the facility will only give as needed and/or if the patient/FM or patient’s physician makes a request to withhold any medication, but will check to be sure.” During an interview on 11/13/23 at 10:12 a.m., the Administrator stated, “that he had contacted LVN G to follow up on the issues/concerns regarding the telephone order dated 08/02/23 to “;hold Haldol until further notice.” He stated that per LVN G, it was requested by Patient #1s FM, and that the order was not written on the hospice agencys physicians order form. He stated that the LVN G did not communicate this to the RNCM, the Supervising nurse or during the IDG meetings. He stated that LVN G did this on her own to appease Patient #1’s FM.” During an interview on 11/13/23 at 11:49 a.m., the contracted pharmacist Individual J stated, “;that the pharmacy is informed only when theres a new medication order or when theres an order to discontinue a medication. He stated that the pharmacy is not notified when theres an order to hold a medication. Individual J stated, that an order was received on 07/28/23 for Patient #1, to discontinue Haldol 2 mg, and a new order to start Haldol 1 mg tablet at bedtime was received on 07/28/23. Individual J stated, “that Haldol is given for increased agitation and restlessness at night. He stated that Haldol 1-2 mg are low doses and that they can give up to 5 mg of Haldol. He stated that the medication is given based on the patients level of agitation, restlessness and combativeness and added that it’s not unusual to see the changes in medication orders when trying to manage symptoms.” An onsite visit was conducted on 11/14/23 at 12:30 p.m., with the Alternate Supervising Nurse and the Facilitys Director, Individual H. During the onsite visit a reconciliation of all medications for Patients #1, #2 and #3 were conducted, with no discrepancies identified. During the same visit, the Surveyor requested a copy of the MARs from August 2023 to current for Patient #1. Review of the facilities medication administration record (MAR) for Patient #1 revealed the following for Haldol administration: Haldol 1 mg tablet. Give one tablet by mouth at bedtime. was given to Patient #1 by the facility staff on: August: 8/1, 8/3, 8/4, 8/5, 8/6, 8/7, 8/8, 8/9, 8/10/, 8/11, 8/20, 8/22, 8/23, 8/30 and 8/31. September: 9/1, 9/2, 9/3, 9/4, 9/5, 9/6, 9/7, 9/8, 9/9, 9/10, 9/11, 9/12, 9/13, 9/14, 9/15, 9/16, 9/17, /9/18, 9/19, 9/20, 9/21, 9/22, 9/23, 9/24, 9/25, 9/26, 9/27, 9/28, 9/29, 9/30. October: 10/1, 10/2, 10/3, 10/4, 10/5, 10/6, 10/7, 10/8, 10/9, 10/10, 10/11, 10/12, 10/13, 10/14, 10,15, 10/20, 10/21, 10/22, 10,23, 10/24, 10/28, 10,30/ and 10/31. November: 11/1, 11/2, 11/3, 11/4, 11/5, 11/6, 11/7, 11/8, 11/9, 11/10, 11/11, 11/12 and 11/13. Haldol 2 mg tablet. Give one tablet by mouth at bedtime. August: 8/2, 8/3, 8/4, and 8/5. September: Not administered. October: Not administered. November: 11/1, 11/2, 11/3, 11/4, 11/5 and 11/6. Further review of the MAR revealed that Haldol 2 mg was discontinued effective 11/07/23. During the onsite visit on 11/14/23 at 1: 00 p.m., the Surveyor observed Patient #1 outside in the garden accompanied by his FM during a group listening activity. Patient #1 was alert but non-verbal and responded to tactile stimuli [looking up at surveyor]. During an interview with Patient #1s FM on 11/14/23 at 1:10 p.m., she stated, “that the hospice staff communicated any changes in the patient’s condition/medication regimen, and stated that the patient was on Haldol for his agitation and behaviors. She stated that she [FM] requested that the Haldol be put on hold because the patient was always sleepy in the morning, and wanted it stopped to see how he [Patient #1] would do, and spoke with LVN G regarding her concerns. “”

“Based on observation, record review and interview, the agency failed to have documentation of all known services and significant events to ensure that all entries were appropriately authenticated and dated in accordance with the hospice policy and current accepted standards of care for one of three patients (Patient #1) whose records were reviewed, in that LVN G did not document that Patient #1s family member (FM) requested that the patients Haldol one milligram be held and that LVN G received a telephone order from the patients physician. This failure placed Patient #1 t risk of inadequate care and services and negative outcomes when all staff involved in the care of the patients, do not document all known services and significant events. The findings included: Review of Health and Human Services Commission (HHSC) Complaint Intake Investigation (CII) general intake information for complaint #463044 dated 11/08/23 at 10:10 a.m., revealed that Patient #1 had two orders for Haldol (an anti-psychotic medication given for agitation) one order was for Haldol two milligrams, one tablet, by mouth at bedtime; and the other was for Haldol one milligram, one tablet by mouth daily. Further review of the CII revealed that on 08/02/23 there was a physicians order to “;Hold Haldol until further notice.” However, the facility staff where Patient #1 resided were not aware of the physicians telephone order dated 08/02/23 to “;hold Haldol ...” and the patient continued to receive Haldol. Further review of the CII revealed that when the Complainant questioned the order to “;hold Haldol...” and an order was sent effective 11/07/23 to discontinue Haldol two milligrams. Further review of the CII revealed that Patient #1s family member (FM) was aware that the hospice agency had adjusted the clients medications and stated that she (FM) did not want the client to take Haldol. Review of the agencys policy PC.110, titled, “;Coordination of Care” dated 10/01/21, read in part, “;I. The Hospice will provide for and ensure the ongoing sharing of information between disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement, by the Hospice, or by other providers. II. The Hospice will provide for an ongoing sharing of information with the non-hospice healthcare providers furnishing services unrelated to the terminal illness and related conditions...VII. All communications and coordination of care is documented in the clinical record.” Review of Patient #1s electronic clinical record (ECR) revealed a start of care (SOC) date of 03/08/23 and a terminal illness diagnosis of Alzheimers disease (most common type of dementia. It is a progressive disease that begins with mild memory loss and affects thought, memory and language). Review, of the plan of care (POC) included orders for skilled nurse visits once a week. Further review revealed that Patient #1 was a resident in a memory care unit located on the same grounds as the hospice agency. Review of Patient #1s medication profile on 11/09/23 included Haldol one milligram to be given one time daily, order date was 07/28/23. Further review did not include Haldol two milligrams. Review of Patient #1’s ECR revealed a physicians order dated 07/27/23 to discontinue Haldol 2 milligrams. Further review of the ERC did not include physician’s orders dated 08/02/23 to, “;Hold Haldol until further notice.” Further review of Patient #1s ECR did not reveal documented evidence that LVN G communicated to the RNCM, the Medical Director or the IDG that Patient #1s FM requested that Haldol be held or discontinued, and that telephone order was written to hold Haldol dated 08/02/23. During an interview on 11/10/23 at 3:20 p.m., the Alternate Supervising Nurse stated that all medications are reviewed and reconciled weekly with the facility staff or family members. She stated that any changes to the orders are faxed over to the local pharmacy contracted by the hospice agency. She further stated that a follow up is done to ensure that any changes in the medication orders are reflected in the MARs, to ensure that the orders are implemented. During the same interview, the Alternate Supervising Nurse stated that she was not aware of the telephone order dated 8/2/23 to “;Hold Haldol until further notice.” and would speak with the RNCM F regarding the matter. During an interview on 11/10/23 at 3:55 p.m., RNCM F stated that a telephone order dated 08/02/23 that stated, “;Hold Haldol until further notice” was written by LVN G. She stated that LVN G wrote it because Patient #1s FM wanted the Haldol discontinued due to the patient not being alert and sleeping during the day. She stated that she was not informed by LVN G until 11/07/23 when the telephone orders dated 08/02/23 to hold Haldol came into question and that there was no documentation in the skilled nurse notes or communication notes. She stated that she then called the physician and an order to discontinue Haldol two milligrams effective 11/07/23. During an interview on 11/10/23 at 5:00 p.m., the Facility Director Individual H stated that Patient #1s FM was going back/forth with the medication aide and with the hospice nurse [LVN G] regarding whether to give or hold the Haldol. She stated, “;that she believes the Haldol is a prn (given as needed) so the medication aide in the facility will only give as needed and/or if the patient/FM or patient’s physician makes a request to withhold any medication, but will check to be sure.” During an interview on 11/13/23 at 10:12 a.m., the Administrator stated, “that he had contacted LVN G to follow up on the issues/concerns regarding the telephone order dated 08/02/23 to “;hold Haldol until further notice.” He stated that per LVN G, it was requested by Patient #1s FM, and that the order was not written on the hospice agencys physicians order form. He stated that the LVN G did not communicate this to the RNCM, the Supervising nurse or during the IDG meetings. He stated that LVN G did this on her own to appease Patient #1’s FM.” During an interview on 11/13/23 at 11:49 a.m., the contracted pharmacist Individual J stated, “;that the pharmacy is informed only when theres a new medication order or when theres an order to discontinue a medication. He stated that the pharmacy is not notified when theres an order to hold a medication. Individual J stated, that an order was received on 07/28/23 for Patient #1, to discontinue Haldol 2 mg, and a new order to start Haldol 1 mg tablet at bedtime was received on 07/28/23. Individual J stated, “that Haldol is given for increased agitation and restlessness at night. He stated that Haldol 1-2 mg are low doses and that they can give up to 5 mg of Haldol. He stated that the medication is given based on the patients level of agitation, restlessness and combativeness and added that it’s not unusual to see the changes in medication orders when trying to manage symptoms.” An onsite visit was conducted on 11/14/23 at 12:30 p.m., with the Alternate Supervising Nurse and the Facilitys Director, Individual H. During the onsite visit a reconciliation of all medications for Patients #1, #2 and #3 were conducted, with no discrepancies identified. During the same visit, the Surveyor requested a copy of the MARs from August 2023 to current for Patient #1. Review of the facilities medication administration record (MAR) for Patient #1 revealed the following for Haldol administration: Haldol 1 mg tablet. Give one tablet by mouth at bedtime. was given to Patient #1 by the facility staff on: August: 8/1, 8/3, 8/4, 8/5, 8/6, 8/7, 8/8, 8/9, 8/10/, 8/11, 8/20, 8/22, 8/23, 8/30 and 8/31. September: 9/1, 9/2, 9/3, 9/4, 9/5, 9/6, 9/7, 9/8, 9/9, 9/10, 9/11, 9/12, 9/13, 9/14, 9/15, 9/16, 9/17, /9/18, 9/19, 9/20, 9/21, 9/22, 9/23, 9/24, 9/25, 9/26, 9/27, 9/28, 9/29, 9/30. October: 10/1, 10/2, 10/3, 10/4, 10/5, 10/6, 10/7, 10/8, 10/9, 10/10, 10/11, 10/12, 10/13, 10/14, 10,15, 10/20, 10/21, 10/22, 10,23, 10/24, 10/28, 10,30/ and 10/31. November: 11/1, 11/2, 11/3, 11/4, 11/5, 11/6, 11/7, 11/8, 11/9, 11/10, 11/11, 11/12 and 11/13. Haldol 2 mg tablet. Give one tablet by mouth at bedtime. August: 8/2, 8/3, 8/4, and 8/5. September: Not administered. October: Not administered. November: 11/1, 11/2, 11/3, 11/4, 11/5 and 11/6. Further review of the MAR revealed that Haldol 2 mg was discontinued effective 11/07/23. During the onsite visit on 11/14/23 at 1: 00 p.m., the Surveyor observed Patient #1 outside in the garden accompanied by his FM during a group listening activity. Patient #1 was alert but non-verbal and responded to tactile stimuli [looking up at surveyor]. During an interview with Patient #1s FM on 11/14/23 at 1:10 p.m., she stated, “that the hospice staff communicated any changes in the patient’s condition/medication regimen, and stated that the patient was on Haldol for his agitation and behaviors. She stated that she [FM] requested that the Haldol be put on hold because the patient was always sleepy in the morning, and wanted it stopped to see how he [Patient #1] would do, and spoke with LVN G regarding her concerns. “”