Divin Roses Hospice Care

“Upon patient record review, 5 of 16 (Patient #2,4,5,11,12) 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 #2 upon review an order dated 7/24/24 was written to increase Lactulose, however medication not added to medication profile. Patient #4 upon review an order dated 2/21/24 was written to discontinue routine meds,however all medications remain on medication profile. Patient #5 upon review an order dated 6/23/24 was written to discontinue routine meds and start comfort meds, however medication profile not updated. Patient #11 upon review an order dated 6/1/22 was written to discontinue routine meds, however all medications remain on medication profile. Patient #12 upon review an order dated 1/20/23 was written for Tylenol, Dulcolax, Atropine, Promethazine, Lorazepam and Morphine, however no medications are on medication profile.”

“Upon patient record review, 3 of 16 (Patient #4,6,8) 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 #4: An initial bereavement call was made on 2/23/24, upon review there is no evidence of additional bereavement counseling. Patient #6: Patient had a 3 month call due 11/2023, a 6 month call due 2/2024, a 6 month mailing due 2/2024, a 9 month mailing due 5/2024, a 12 month mailing due 8/2024 and a 12 month call due 8/2024, upon review there is no evidence of the bereaved receiving any calls or mailings. Patient #8: The 12 month mailing was due 6/2023 and upon review there was no evidence of it being sent.”

“Upon patient record review, 1 of 16 (Patient #1) 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 #1: The plan of care for patient shower, change linens and make bed states “often”, no evidence of the specific frequency of these tasks.”

“Upon patient record review 6 of 16 (Patient #2,10,11,13,14,16) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #2: An order dated for 6/14/24 states the aide task of linen change is to be completed weekly and the aide is documenting the tasks are completed at visits on 8/24, 8/27, 8/28, 9/3 and 9/5/24. Patient #10: An order dated for 6/6/24 states the aide task of linen change is to be completed weekly and the aide is documenting the tasks are completed at visits on 6/6, 6/7, 6/10 and 6/11/24. Patient #11: An order dated for 5/26/22 states for the aide task of linen change, shave and shampoo to be completed weekly and the aide is documenting the tasks are completed at visits on 5/31 and 6/1/22. Patient #13: An order dated for 5/25/23 states for the aide task of linen change, shave and shampoo to be completed weekly and the aide is documenting the tasks are completed at visits on 7/7, 7/10, 7/11, 7/12 and 7/13/23. Patient #14: An order dated for 5/2/22 states for the aide task of linen change, make bed and shampoo to be completed weekly and the aide is documenting the tasks are completed at visits on 7/22, 7/25, 7/26, 7/28 and 7/29/22. Patient #16: An order dated for 11/3/21 states for the aide task of linen change and shampoo is to be completed weekly and the aide is documenting the tasks are completed at visits on 11/28, 11/29, 12/1, 12/3 and 12/6/21.”

“Upon patient record review 2 of 16 (Patient #2,13) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient’s needs. Patient #2 received an on-site visit on 8/23, no evidence of an on-site visit being completed by 9/6/24. Patient #13 received on-site visits on 6/8 and 7/6/23 which were more than 14 days apart.”