A Touch of Grace Hospice LLC

“Upon patient record review, 4 of 14 (Patient #4,#5,#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#4: During the home visit, an oxygen concentrator was noted in the home. There is no evidence of oxygen on the medication profile. Patient#5: The medication profile indicates that polyethylene glycol and nitroglycerin are active medications for the patient. However, there is no evidence of instructions for dilutant for the polyethylene glycol. Also, there is no evidence of instructions regarding how many doses to take of nitroglycerin and when to call if no relief. Patient#7: The medication profile indicates patient has acetaminophen 650mg rectal suppository prn for pain and fever every 6 hours. The medication profile also shows patient taking acetaminophen 500mg take 2 every 8 hours for pain. However, there is no evidence of a maximum dose for acetaminophen. Patient#8: The medication profile indicates polyethylene glycol is an active medication for the patient. However, there is no evidence of instructions for dilutant for the polyethylene glycol.”

“Upon patient record review, 3 of 14 (Patient #4,#5,#10) 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#4: During home visit there was an oxygen concentrator noted in the home. There is no evidence of problems goals or interventions related to oxygen on the plan of care. Patient#5: The plan of care list Ativan and Thorazine in intervention on plan of care. However, the patient is not ordered Thorazine. Patient#10: The record indicates patient is taking aspirin daily for anticoagulation. There is no evidence of bleeding precautions on the plan of care.”

“Upon patient record review, 4 of 14 (Patient #4,#5,#7,#8) 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#4: During the home visit it was noted that there was an oxygen concentrator in the home. There is no evidence of an order for oxygen. Patient#5: The record indicates orders for polyethylene glycol and nitroglycerin are active medications for the patient. However, there is no evidence of instructions for dilutant for the polyethylene glycol. Also, there is no evidence of instructions regarding how many doses to take of nitroglycerin and when to call if no relief. Patient#7: The record indicates patient has an order for acetaminophen 650mg rectal suppository prn for pain and fever every 6 hours. The patient also has order for acetaminophen take 2 every 8 hours for pain. However, there is no evidence of a maximum dose for acetaminophen. Patient#8: The record indicates an order for polyethylene glycol is an active medication for the patient. However, there is no evidence of instructions for dilutant for the polyethylene glycol.”

“Upon patient record review, 2 of 14 (Patient #1,#3) 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 equipment and supply needs. Patient#1: The record indicates the patient requires use of a hospital bed and a wheelchair. There is no evidence of an order on plan of care for these items. Patient#3: The plan of care order list hospital bed, bedside commode, and wheelchair. However, during home visit these items were not present and not being used by patient.”

“Upon patient record review, 1 of 14 (Patient #10) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient#10: The record indicates per physician documentation on recertification for 5/12/26 that patient has had a decrease in cardiovascular status which includes 1+ edema to left foot, poor pedal pulses and discoloration to feet secondary to poor circulation. There is no evidence of plan of care being updated to include problems goals and interventions related to symptoms of decline in cardiovascular status.”

“Upon patient record review, 2 of 14 (Patient #13,#14) 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#13,#14: There is no evidence of a bereavement plan of care in patient chart that notes the kind of bereavement services to be offered or the frequency of service delivery. The bereavement plan of care only states that bereavement services will be offered for 13 months.”

“Upon patient record review, 4 of 14 (Patient #3,#4,#5,#10) 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#3: The record indicates the nurse ha documented the patient has had multiple falls. There is no evidence of fall precautions on the aide plan of care. Patient#4: During home visit it was noted that oxygen concentrator in the home. There is no evidence of oxygen precautions on the aide plan of care. The record also indicates the patient is taking Eliquis. There is no evidence of bleeding precautions on the aide plan of care. Patient#5: The medical records indicates the patient has a history of falls with hospitalizations and also had a wound 3/11/26-3/23/26. There is no evidence of fall precautions or skin precautions on the aide plan of care. Patient#10: The patient is taking aspirin daily for anti-coagulation therapy. There is no evidence of bleeding precautions on the aide plan of care.”