Cozy Transitional Hospice Care Inc.

“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; supplements; herbal remedies; other alternative treatments that could affect drug therapy. This standard was not met as evidenced by clinical record review, interview, and observation. In 3 of 5 (60%) clinical records reviewed revealed the agency did not ensure the drug profile contained the patient’s current prescription and over-the-counter drugs. Clinical Record 1/Home Visit 1: The patient elected the hospice benefit on 1/23/2024 for the diagnosis of congestive heart failure. The initial nursing assessment and physician orders dated 1/23/2024 noted the patient had oxygen at 2 to 4 liters per minute as needed. During Home Visit 1 with the Medical Social Worker (MSW) (Personnel Record 6) on 3/20/2024, the patient was observed to be on continuous oxygen at 2 liters per minute. The patient reported she “always uses the oxygen or she gets chest pain and headaches.” The clinical record review revealed the oxygen was not listed on the medication profile during the initial comprehensive assessment. Clinical Record 2/Home Visit 2: The patient elected the hospice benefit on 11/20/2023 for the diagnosis of Alzheimer’s disease. The drug profile in the clinical record lists the following medication orders dated 11/20/2023: 1. Carbidopa 10 mg/Levodopa 100 mg 1 tablet daily/evening. A review of the medication bottle during Home Visit 2 with the registered nurse (RN) (Personnel Record 5) on 3/20/2024 revealed the instructions were to take 1/2 tablet. 2. Memantine Hydrochloride 10 mg oral tablet twice daily, 1/2 tablet in the AM and 1 tablet in the PM. The RN confirmed the drug profile did not contain the current prescriptions. Clinical Record 3/Home Visit 3: The patient elected the hospice benefit on 2/19/2024 for the diagnosis of congestive heart failure. The drug profile in the clinical record lists the following medication orders dated 2/19/2024: 1. Donepezil Hydrochloride 10 mg 2 tablets twice daily. A review of the medication bottle during the Home Visit 3 with the RN (Personnel Record 3) on 3/20/2024 revealed the instructions were to take 1 tablet twice daily. The review also revealed the patient had been taking Memantine 10 mg tablet twice daily and this was not listed on the medication list. During an interview and joint record review with the Director of Nursing on 3/21/2024, it was confirmed the drug profiles did not contain the current prescriptions as noted during the home visits.”

“It is required that the Interdisciplinary Group, in collaboration with the individual’s attending physician (if any), reviews, revises, and documents the individualized care plan as frequently as the patient’s condition requires. This standard was not met as evidenced by clinical record review and interview. In 1 of 5 (20%) clinical records reviewed revealed the agency did not ensure the individualized plan of care (POC) was updated as frequently as the patient’s condition required. Clinical Record 5: The patient elected the hospice benefit on 4/20/2023 for the diagnosis of hypertensive heart disease. The nursing assessment dated 5/12/2023 noted “son is concerned that patient feet and legs getting worse. Son instructed to follow up with a scheduled wound specialist. Bandage was removed and a new bandage placed.” Hospice aide visit notes dated 4/26/2023, 5/5/2023, and 5/17/2023 commented “notified RN of wound to bilateral lower extremities.” The initial plan of care did not include a skin or wound problem and it was not added to the plan of care. During an interview and joint record review with the Director of Nursing on 3/21/2024, it was confirmed the plan of care did not include updates to include treatment of the wounds on patient’s legs and feet.”

“It is required that written patient care instructions for a hospice aide are prepared by an RN 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 1 (100%) clinical record reviewed in which aide services were accepted revealed the agency did not ensure the hospice registered nurse provided the aide with specific instructions. Clinical Record 5: The patient elected the hospice benefit on 4/20/2023 for the diagnosis of hypertensive heart disease. The aide care plan dated 4/20/2023 had the relevant tasks of showering and assistance with dressing every visit. The aide care plan also included a notation that stated, “do not bathe open wounds.” The notification was not specific on wound location(s) and did not include any further instructions to the hospice aide regarding the wounds. During an interview and joint record review with the Director of Nursing on 3/21/2024, it was confirmed the aide care plans did not include specific instructions for the aide regarding the wound(s).”