Envision Hospice

“Upon patient record review, 2 of 19 (Patient #2,3) 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 2: On the home visit the caregiver stated the patient is using a medicated shampoo, ketoconazole 2% ordered on 10/15/25. This medication is not on the hospice medication profile. Corrected on site. Patient 3: There is an order for acetaminophen 325mg 2 tabs three times per day; give with tramadol, acetaminophen 325mg 2 tabs every 4 hours as needed, acetaminophen 650mg rectal suppository every 4 hours as needed. A daily limit for acetaminophen is not included in the order. In addition, on the home visit the SNF states the patient does not have Sertaline 25mg tablet daily on their medication list, this is listed on the hospice medication profile, the SNF has fleet enema prn and MiraLAX 17g as needed ordered and is not on the hospice medication profile. ALL corrected on site.”

“Upon patient record review, 3 of 19 (Patient #3,4,14) 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/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 3: In the patient record there is an order for Aspirin 81mg daily. There is not a risk for bleeding on the plan of care with goals and interventions. Corrected on site. Patient 4: On 12/29/25 there is evidence of a photo of right knee wound. There is not goals and interventions for the wound care. Corrected on site. Patient 14: In the patient record there is an order for Eliquis 5mg daily. There is not a risk for bleeding on the plan of care with goals and interventions. Corrected on site.”

“Upon patient record review, 7 of 19 (Patient #2,3,5,7,8,9,11) 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 2: There is evidence in the patient record that the patient has a foley catheter. There are no orders for the foley catheter or orders to care for the foley catheter on the plan of care. Corrected on site. Patient 3: There is an order for acetaminophen 325mg 2 tabs three times per day; give with tramadol, acetaminophen 325mg 2 tabs every 4 hours as needed, acetaminophen 650mg rectal suppository every 4 hours as needed. A daily limit on acetaminophen is not included in this order. In the patient record there is evidence that the patient as a wound for assessment and skin around it, there are no wound care orders on the plan of care. Corrected on site. Patient 5: On the recent plan of care there is MiraLAX 17g daily as needed, there is not a diluent included with this order. Corrected on site. Patient 7: On the plan of care there is an order for acetaminophen 500mg 2 tabs BID and Acetaminophen 650mg one suppository every 4-6 hours as needed. A daily limit on acetaminophen is not included in this order. Corrected on site. Patient 8: On the recent plan of care there is MiraLAX 17g daily as needed, there is not a diluent included with this order. Corrected on site. Patient 9: On the plan of care there is an order for acetaminophen 500mg 2 tabs 3 times daily and acetaminophen 650mg suppository every 4-6 hours as needed. A daily limit on acetaminophen is not included in this order. Corrected on site. Patient 11: In the patient record there is documentation “ patient does not swallow any solids” and documentation of a PEG tube placed. On the plan of care the route for mediations is oral. Ensure is ordered four times daily route is oral and does not have a rate for the PEG tube, the route should be PEG tube. In addition, there are not orders to care for the PEG tube, including orders for wound care on the plan of care. Corrected on site.”

“Upon patient record review, 2 of 19 (Patient #4,6) 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 4: Upon a home visit the patient had a Hoyer lift, shower chair, bedside commode, hospital bed, elevated toilet seat, over the bed table in her room. These DME/supplies are not listed on the plan of care. Corrected on site. Patient 6: On 8/25/25 during a SN visit the nurse ordered a walker from DME. There is not a walker listed on the current plan of care. Corrected on site.”

“Upon patient client record review, 2 of 19 (Patient #8,9) 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 8: On the SN assessment 12/30/25 there is documentation, “BT active x4” BT is not an approved abbreviation. Corrected on site. Patient 9: On the SN assessment 12/23/25 there is documentation, “No acute concerns at EOV”. EOV is not an approved abbreviation. Corrected on site.”