Gentiva

“Upon observation, and record review there was not evidence that all alleged violations involving mistreatment, neglect, or verbal, mental, sexual and physical abuse, including injuries of unknown source, and misappropriation of patient property by anyone furnishing services on behalf of the hospice, are reported immediately to the Administrator or appropriate designee. Patient #6: Nurse documentation dated 9/13/23 indicated that the patient was on a respite stay at a SNF and the patient told the hospice nurse that she had been in New York and was raped. A visit by the NP on 9/15/23 revealed the same verbiage but the NP also indicated that the patient was having periods of confusion and forgetfulness. There was not evidence that the Administrator of the SNF or the Hospice Administrator was notified of the claim.”

“Upon patient record review 3 of 19 records (Patient #6,#9,#10) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual’s attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #6: The patient was admitted on 4/14/23. The record indicated that the spiritual assessment was completed on 4/20/23. Patient #9: The patient was admitted on 5/26/23. The record indicated that the spiritual assessment was completed on 6/1/23. Patient #10: The patient was admitted on 5/10/23. The record indicated that the spiritual assessment was completed on 5/16/23.”

“Upon patient record review, 3 of 19 records (Patient #6,#8,#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 #6: The medication profile contained Oxygen 3L/min via nasal cannula. There was not evidence of prn in the order and there was not evidence that the patient was wearing oxygen from 10/1/23 to current. Corrected on site. Patient #8: The record indicated oxygen at 2L/min continuous via nasal cannula, dated 9/30/23. From 11/2/23 to current, nurse documentation indicated that oxygen was not in use and the patient was not short of breath. There was not evidence the oxygen was changed to prn or discontinued. Corrected on site. Patient #12: The record indicated for Miralax 17 Gm powder, 1 daily prn if no BM in 3 days. There was not evidence of a diluent. Corrected on site.”

“Upon patient record review, 3 of 19 records (Patient #8,#11,#13) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #8: The patient was admitted on 9/30/23. The record indicated that the bereavement assessment was not completed until 10/6/23. Patient #11: The patient was admitted on 8/11/23. The record indicated that the bereavement assessment was not completed until 8/31/23. Patient #13: The patient was admitted on 6/27/23. The record indicated that the bereavement assessment was not completed until 7/5/23.”

“Upon patient record review, 1 of 19 records (Patient #18) did not have evidence that a Registered Nurse ensured continuous assessment of the patient and family’s needs and coordinated activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #18: The record indicated a call through triage on 4/29/23 at 1658 that the patient’s oxygen saturation was 64%, heart rate 31, and the patient was declining. The facility requested a visit by the nurse. There was not evidence of a visit by a nurse until 4/30/23 at 1009. The patient expired on 5/1/23 at 0621.”

“Upon patient record review, 1 of 19 records (Patient #14) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient that reflects 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 #14: The patient was admitted with a diagnosis of ALS. The record indicated that she had difficulty eating/swallowing, she had some paralysis and had a gastrostomy tube. There was not evidence that the plan of care reflected patient/family goals and interventions based on the patient’s neurological problems or the gastrostomy tube. Corrected on site.”

“Upon patient record review, 3 of 19 records (Patient #6,#8,#12) 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 #6: The record contained an order for Oxygen 3L/min via nasal cannula, dated 6/28/23. There was not evidence of prn in the order and there was not evidence that the patient was wearing oxygen from 10/1/23 to current. Corrected on site. Patient #8: The record indicated oxygen at 2L/min continuous via nasal cannula, dated 9/30/23. From 11/2/23 to current, nurse documentation indicated that oxygen was not in use and the patient was not short of breath. There was not evidence the oxygen was changed to prn or discontinued. Corrected on site. Patient #12: The record indicated an order for Miralax 17 Gm powder, 1 daily prn if no BM in 3 days, dated 10/30/23. There was not evidence of a diluent. Corrected on site.”

“Upon patient record review, 3 of 19 records (Patient #2,#8,#13) 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 including alerts and precautions for a hospice aide that 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 specifically indicate what tasks are to be done by the Aide and the frequency of these tasks. Patient #2: Nurse recertification documentation dated 8/31/23 and 10/31/23 indicated that the patient remains a high fall risk. In addition, the record indicated that the patient had a fall during the certification period of 5/22/23-7/20/23. There was not evidence that fall risk was on the aide plan of care. Corrected on site. Patient #8: The aide plan of care indicated to provide routine catheter care at every visit. From 10/24/23 to current, there was not evidence that the patient had a catheter in place. Corrected on site. Patient #13: The record indicated that the patient was on Eliquis 5mg daily. There was not evidence that bleeding precautions were on the aide plan of care. Corrected on site.”

“Upon client record review, 1 of 19 records (Patient #8) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. patient #8: The record indicated an order for the hospice nurse/or facility nurse to provide wound care to the sacral area wound BID. Cleanse with Dakin’s solution, sprinkle with collagen particles to wound bed, pack with Dakin’s soaked gauze. Cover with foam dressing. There was not specific evidence of which provider was to perform the wound care. Corrected on site.”