Heartland Hospice Fond Du Lac

“Upon patient record review, 7 of 19 (Patients #2,#3,#4,#6,#7,#8,#10) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 2: The medication profile contained polyethylene glycol oral powder with no instructions to mix with a diluent. Corrected on site. Patient 3: Upon observation during the home visit the facility and hospice medication profiles did not match. The facility profile contained magnesium oxide and an albuterol inhaler that both discontinued 10/2/24. Patient 4: The medical record contained nursing documentation upon recertification 9/10/24 identifying patient use of oxygen. There was no evidence of oxygen on the medication profile. Corrected on site. Upon observation during home visit, the facility and hospice medication profiles did not match. The facility profile contained amlodipine that was discontinued by hospice 10/4/24, and did not contain hyoscyamine and lorazepam that was on the hospice profile. Patient 6: The medication profile contained duplicative clonazepam listing for once daily at 2pm dated 5/24/24 and for twice daily at 2pm and bedtime dated 10/8/24. Corrected on site. Patient 7: The medication profile contained a lidocaine topical patch with no area defined for administration. Corrected on site. Patient 8: The medication profile contained atropine with no defined frequency. Corrected on site. Patient 10: The medication profile contained nystatin topical powder and lidocaine patch with no areas defined for administration. Corrected on site.”

“Upon patient record review, 1 of 19 (Patient #1) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family’s needs and to coordinate 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 1: There was no evidence per agency policy of weekly assessments and measurements of wounds to left thigh and mid chest from 9/5/24 to 9/20/24 and 9/20/24 to 10/2/24.”

“Upon patient record review, 2 of 19 (Patients #3,#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 3: The medical record contained nursing documentation upon admission identifying patient issues with difficulty swallowing and coughing after eating. There was no evidence of problems, goals, and interventions related to dysphagia included in the plan of care. Corrected on site. Patient 9: The medical record contained nursing documentation upon admission identifying the patient is a high risk for falls. There was no evidence of problems, goals, and interventions related to fall safety included in the plan of care. Corrected on site.”

“Upon patient record review, 5 of 19 (Patients #2,#4,#7,#8,#10) 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: The medical record contained an order for polyethylene glycol oral powder with no instructions to mix with a diluent. Corrected on site. Patient 4: The medical record contained nursing documentation upon recertification 9/10/24 identifying patient use of oxygen. There was no evidence of an order for oxygen. Corrected on site. Patient 7: The medical record contained an order for a lidocaine topical patch with no area defined for administration. Corrected on site. Patient 8: The medical record contained an order for atropine with no defined frequency. Corrected on site. Patient 10: The medical record contained an order for lidocaine patches with no area defined for administration. Corrected on site.”

“Upon patient record review, 4 of 19 (Patients #6,#8,#10,#14) 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 6: The medical record contained nursing documentation upon admission identifying patient use of a nebulizer. There was no evidence of an order for the nebulizer included in the plan of care. Corrected on site. Patient 8: The medical record contained nursing documentation since admission identifying patient use of a walker. There was no evidence of an order for the walker included in the plan of care. Corrected on site. Patient 10: The medical record contained nursing documentation upon admission identifying patient use of a wheelchair. There was no evidence of an order for the wheelchair included in the plan of care. Corrected on site. Patient 14: The medical record contained nursing documentation upon admission identifying patient use of a walker and wheelchair. There was no evidence of orders for the equipment included in the plan of care. Corrected on site.”

“Upon patient record review, 3 of 19 (Patients #15,#16,#17) 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 15: The bereavement care plan contained tasks of sending 6 and 9 month newsletters and support group invitations. There was no evidence the 6 and 9 month tasks were completed. Patients 16,17: The bereavement care plans contained tasks of a 6 month phone call, and 3 and 6 month newsletters and support group invitations. There was no evidence the 3 and 6 month tasks were completed.”

“Upon patient record review, 4 of 19 (Patients #3,#7,#10,#14) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient 3,10,14: The medical record contained an election form identifying the Notification of Hospice Non-Covered Items was requested upon admission. There was no evidence the information was provided as requested. Corrected on site. Patient 7: The medical record contained an election form identifying the Notification of Hospice Non-Covered Items was requested upon admission 4/29/24. There was no evidence the information was provided as requested.”