Rth Home Care Service

“Observed in Record Review. In 1 of 5 patient records reviewed, the record did not contain an accurate list of medications. In review of the medical record RRNHV # 5 the medication list includes Rexulti 1 mg tablet by mouth daily which the caregiver/granddaughter reports the patient has not taken for sometime, as well as Lisinopril 10 mg 1 tablet by mouth daily which the patient receives prn. The caregiver/granddaughter also reported that the patient started Flomax about two weeks ago which is not included on the medication list and reports that the hospice nurse made a visit on 10/22/2025. This was validated with the Owner/Administrator.”

“Observed in Record Review. In 10 of 13 patient records reviewed, the initial bereavement assessment was not completed. In HOSRRHV #2 the caregiver daughter, and her two brothers did not have a bereavement assessment completed. In HOSRRNHV #1 there is no bereavement assessment for the daughter. In HOSRRNHV #2 the caregiver and friend did not have a bereavement assessment completed. In HOSRRNHV #3 the son did not have a bereavement assessment completed. In HOSRRNHV #5 and HOSRRBRV #2 the wife did not have a bereavement assessment done. In HOSRRNHV #6 the niece did not have a bereavement assessment completed. In HOSRRDC #1 there is no bereavement assessment for the wife or the daughter. In HOSRRDC #2 and HOSRRBRV #1 the son did not have a bereavement assessment done. Per the agency policy on Bereavement, a bereavement assessment must be completed on all family members or caregivers involved in the patient’s care. This was reviewed and validated with the Administrator.”

“Observed in Record Review. In 5 of 9 patient records reviewed, the hospice surveyor observed that the organization did not ensure that the goals established on the plan of care were measurable and individualized. In HOSRRHV #1 the pain goal stated, Pt will maintain pain controlled at an acceptable level for Pt/CG. In HOSRRHV #3, HOSRRNHV #2, and HOSRRNHV #3, and HOSRRNHV #5 the care plan states that the patient will have acceptable level of pain. The Pain Management policy states that the nurse will assess the patient’s pain goal, in order to develop an individualized and measurable plan of care. This was reviewed and validated with the Administrator.”

“Observed in Record Review. In 1 of 9 patient records reviewed, the hospice surveyor noted that in HOSRRHV #2 there were PRN orders for 2 pain medications Norco 10 mg-325 mg tablet one tablet by mouth every 6 hours as needed for pain and Acetaminophen 300 mg codeine 30 mg tablet one tablet by mouth every 4 hours as needed for pain. The orders did not include which medication to use first or for what type of pain, e.g. mild moderate or severe.. This was reviewed and validated with the Administrator. Observed in Record Review. In 1 of 9 patient records reviewed, the organization failed to plan the patient’s care. The hospice surveyor observed in HOSRRHV #2 where the patient had a foley catheter present and the provider submitted an order that stated change foley catheter. The order did not include documentation on the catheter size, the size of the balloon, and how much and what type of fluid to use to fill the balloon. The order was incomplete. This was reviewed and validated by the Administrator.”

“Observed in Record Review. In 4 of 9 patient records reviewed, the hospice surveyor noted that the RN did not have a care plan for bleeding precautions. In HOSRRHV #1 the patient was on Apixaban 5 mg by mouth twice a day, and the RN did not include a care plan on bleeding precautions. In HOSRRHV #3 the patient had orders for Plavix 75 mg every day and ASA 81 mg every day and the RN care plan did not include a care plan for bleeding precautions. In HOSRRNHV #1 the patient is on Apixaban 75mg every day and there is no care plan on bleeding precautions. In HOSRRNHV #6 the patient was on ASA 81 mg every day and Clopidogrel 75 mg per day and there was no RN care plan for bleeding precautions. This was reviewed and validated with the Administrator.”

“Observed in Patient Home. In 1 of 3 home visits conducted, the plan of care was not followed. In HOSRRHV #3 also had an order for PEG tube flushes the order for water flushes were 30 ml of water before administering meds and flush with 10 ml of water between each med and after final medication flush with 30 ml of water. Per the daughter she is not following this but flushing with about 60 ml of water before and after meals and some with medication. The administrator stated they did not have a protocol.The RN care plan stated that the PEG tube should be flushed per protocol. This was reviewed and validated with the Administrator.”

“Observed in Patient Home. In 1 of 3 home visits conducted, the home health aide failed to follow the Hand Hygiene Policy. In HOSRRHV #1 the home health aide entered the home and did not sanitize her hands prior to touching the patient and before donning her gloves per the organizations Hand Hygiene Policy. The home health aide did not bring in any hand sanitizer for the visit. The Administrator stated that the staff are given hand sanitizer and that they are instructed to come to the office to pick up as needed. This was reviewed and validated with the Administrator.”

“Observed in HR File Review. In 1 of 9 HR files reviewed, the hospice surveyor observed that the home health aide competencies at hire were not completed. The aide was hired 2 months ago. This was reviewed and validated with the HR Director. Observed in Tracer Activities. In 1 of 9 HR files reviewed, the organization failed to deem the initial competency of the home health aide. The home health aide did not have a completed initial competency and she had been hired 2 months ago. This was reviewed and validated with the HR Director. Observed in HR File Review. In 1 of 9 HR files reviewed, the deemed hospice did not have a completed competency assessment on the home health aide who was hired 2 months ago. This was reviewed and validated with the HR Director.”

“Observed in Record Review. In 1 of 9 patient records reviewed, the hospice surveyor noted n HOSRRNHV #3 that the home health aide visit assignment did not include specific tasks. The Plan of Care only included frequency of two times per week. This was reviewed and validated with the Administrator. Observed in Record Review. In 3 of 9 patient records reviewed, the hospice surveyor observed that the aide care plan did not include safety precautions. In HOSRRHV #1 the patient was on an anticoagulant and was a fall risk and neither were entered into the aide care plan. In HOSRRNHV #1 the aide care plan failed to include, fall risk, bleeding precautions or instructions what to do if wound dressing is compromised. In HOSRRNHV #5 the aide care plan did not include fall risk as a precaution. This was reviewed and validated with the Administrator.”

“Observed in Patient Home. In 2 of 3 home visits conducted, the hospice surveyor observed that the medication list in the home was inaccurate. In HOSRRHV #1 the nurse surveyor observed that the patient was taking FeroSul 325 mg tablets, the medication list states the patient is taking this by mouth daily but the prescription bottle states the patient is to take the medication twice a day. The patient is also taking Tamsulosin 0.4 mg the medication list states to take the medication at bedtime but the prescription bottle states a dinner. The patient is also taking Carvedilol 12.5 mg , the medication list states to take twice a day and to hold if diastolic BP<110 and pulse <60, the bottle states to take one in the morning and one in the evening with no indication when to hold the medication. In HOSRRHV #3 the patient has an order on the medication list for Zoloft 50 mg every day via G tube but daughter states she only gives it as needed for agitation. This patient has recurrent agitation and combativeness. This was reviewed and validated with the Administrator.”