Promedica Hospice (Virginia Beach)

“Upon patient record review, 2 of 19 (Patient #7,#8) 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#7: The medication profile contained lidocaine 4% topical patch with no specified area of application. Corrected on site. Patient#8: The record indicates that RN documented on 4/11/25 visit that patient was starting to take CBD oil gummies to assist with ongoing issues with insomnia. There is no evidence of this remedy listed on medication profile. Corrected on site.”

“Upon patient record review, 3 of 19 (Patient #2,#8,#9) 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#2: The record indicates patient requires foley catheter and compression boots. There is no evidence of goals and interventions for these items noted on plan of care. Corrected on site. Patient#8: The record indicates the patient has bleeding precautions noted on aide plan of care but there is no evidence of this on plan of care. Additionally, it is documented on RN visit 4/11/25 and 4/8 that patient is having recurrent issues with insomnia and started CBD gummies, There is no evidence of problems with goals or interventions related to this issue noted on plan of care. Corrected on site. Patient#9: The record indicates that patient requires use of suction. There is no evidence of goals or interventions related to this. Additionally, the aide plan of care indicates the need for respiratory and fall precautions. There is no evidence of goals and interventions for these precautions on the plan if care. Corrected on site.”

“Upon patient record review, 4 of 19 (Patient #1,#6,#9,#11) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient#1: The record indicates that oxygen was discontinued. There is no evidence of an order to discontinue oxygen. Corrected on site. Patient#6: The record indicates that wound care was discontinued and that patient was placed on a pureed diet with thickened liquids. There is no evidence of an order for these needs. Corrected on site. Patient#9: The record indicates the patient requires ensure as a nutritional supplement. There is no evidence of an order for this. Corrected on site. Patient#11: The record indicates the patient requires boost as a nutritional supplement. There is no evidence of an order for this. Corrected on site.”

“Upon patient record review, 2 of 19 (Patient #2,7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient#2: The record indicates SN frequency is ordered at 2 times per week. There is only evidence of one SN visit for the week of 12/22/24. In addition, the record indicates that the foley was discontinued. There is no evidence of an order to discontinue the foley. Foley order-Corrected on site. Patient#7: The record indicates that the foley was discontinued. There is no evidence of an order to discontinue the foley. Corrected on site.”

“Upon patient record review, 1 of 19 (Patient #12) 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#12: The aide plan of care states for aide to shave patient “per patient request as needed”. Corrected on site.”

“Upon patient record review 1 of 19 (Patient #2) 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: The aide supervisory visit on 11/18/24 states that no aide services provided and did not complete the supervisory visit. However an aide documented a completed visit on 11/17/24.”

“Upon observation, there was no evidence the hospice documented the cost savings achieved through the use of volunteers. Documentation must include the following: • The identification of each position that is occupied by a volunteer • The work time spent by volunteers occupying those positions • Estimates of the dollar costs that the hospice would have incurred if paid employees occupied the positions identified in paragraph (d)(1) of CFR 418.78 for the amount of time specified in paragraph (d)(2) of CFR 418.78 There is no evidence of a completed cost savings report.”

“Upon patient record review, 1 of 19 (Patient #2) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 2: An aide supervisory visit was completed on 1/21/25 however, there were no aide services at this time. Additionally, an aide supervisory visit was made on 2/4/25 states that yes an aide visit was completed in that last 14 days. There were no aide services provided during the last 14 days.”