Choice Hospice

“Upon patient record review, 4 of 14 (Patient #1,10,11,12) 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 #1:Miconazole was listed on the medication profile with instructions for applying, “a thin layer to affected area”, but there was no evidence the specific area was identified (route). Additionally, Diclofenac was on the medication profile with instructions to “apply to muscles”, but there was no evidence of the specific area (route). Patient #10: Doxycycline was ordered on 3/4/26 with an end date of 7 days, but was still active on the medication profile. Patient #11: Cipro was ordered on 3/27/26 with an end date of 7 days, but the medication was still active on the medication profile. Patient #12: Cipro for 5 days was ordered on 3/23/26 but remained active on the medication profile with no evidence of a stop date.”

“Upon patient record review, 2 of 14 (Patient #13, #14) 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 #13: ASA was on the patient’s med profile, but there was no evidence bleeding precautions were part of the plan of care. Patient #14: Enoxaparin was on the patient’s med profile, but there was no evidence bleeding precautions were on the plan of care.”

“Upon patient record review, 4 of 14 (Patient #6,#7,#8,#9) 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 #6: The plan of care dated 08/09/25 indicated the Chaplain was ordered 1 PRN, but there was no reason documented. Patient #7: Plans of care dated 3/10/26 and 3/25/26 showed PRN visits were part of the RN frequency, but there was no evidence of a reason for PRN. Patient #8: The plan of care dated 10/28/25 showed the frequencies for both SW and Chaplain were 1 PRN, but there was no evidence of a reason for PRN. Patient #9: The plan of care dated 03/05/26 showed the Chaplain and SW frequencies were ordered as 1 PRN, but there was no evidence of a reason for PRN.”

“Upon client record review, 2 of 14 (Patient #8, #13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #8: On 04/22/26, an order was written for SN visits 3x week for wound care, but on the week of 4/26/26 - 5/2/26 there were 2 visits on 4/28 and 5/1/26 without evidence of a 3rd or a missed visit order. Patient #13: SW was accepted per RN at admission on 09/22/25. An order written for SW routine visits, but there was no evidence of a SW visit and no evidence of documentation indicating the patient declined SW services.”

“Upon patient record review, 1 of 14 (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: ASA was on the medication profile, but there was no evidence of bleeding precautions on the aide care plan dated 07/27/25.”

“Upon patient record review 1 of 14 (Patient #2) 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: The aide care plan dated 08/18/25 indicated the patient was to receive a shower every visit. However, on 08/20/25, 08/21/25 and 08/22/25, the aide gave the patient a bed bath and documented the patient was unable to get in the shower.”