Every finding on record at Ahc Home Health of Coeur D'Alene, LLC

Upon patient record review, 6 of 14 (Patient #1,4,5,6,7,8) 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 1,4,5,7: Duplicate drug therapy: Senna 8.6 tab PRN daily and Bisacodyl 10mg PRN daily for constipation listed on the active medication list. No evidence that instructions were given on which medication for constipation to take first. Corrected on site. Patient 6,8: Miralax 17gram orally once daily for constipation listed on the active medication list. No evidence that instructions were giving on how to diluent. Corrected on site.

Upon patient record review, 6 of 14 (Patient #1,4,5,6,7,8) 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 1,4,5,7: The record has an active order for Senna 8.6 1-4 tabs PRN daily and Fleet Bisacodyl supp 10mg PRN daily for constipation. No evidence that instructions were given on which medication for constipation to take first. Corrected on site. Patient 6,8: The record has an active order for Miralax 17gram powder orally once daily for constipation. No evidence that instructions were giving on how to diluent. Corrected on site.

Upon client record review, 1 of 14 (Patient #3) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 3: The record indicated that there was a missed RN visit on 12/25/2024 for "Holiday". No evidence that the CG/patient refused or that an order was received to decrease the visit frequency for the week.

Upon patient record review 2 of 14 (Patient #3,5) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 3: The record indicated that there was a missed aide visit on 11/15/2024 for "aide admitted to the hospital" with no evidence that CG/patient refused the visit or that an order was received to decrease the visit frequency for the week. Patient 5: The record indicated that there was a missed aide visit on 11/25/2024 for "aide sick" with no evidence that CG/patient refused the visit or that an order was received to decrease the visit frequency for the week.

Upon patient record review 2 of 14 (Patient #1,7) 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 1: No evidence that a registered nurse made an on-site visit every 14 days between the following dates: 12/11/2024 and 12/26/2024, 15 days between on-site visits. Patient 7: No evidence that a registered nurse made an on-site visit every 14 days between the following dates: 11/27/2024 and 12/17/2024, 20 days between on-site visits.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. The documented annual volunteer usage for the year 2024 was 2.95%.

Upon patient client record review, 1 of 14 (Patient #10) 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 10: No evidence that the election statement was signed by the representative at the time of admit. The representative's name was printed on the form but the signature was blank.

Upon client record review, 1 of 14 (Patient #12) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patient 12: No evidence that a discharge summary was completed or sent to the attending.

Upon patient record review 3 of 11 (Patient #4, 5, 6) 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 #4 - SOC dated 09/23/2021 SC did not complete spiritual assessment until 10/07/2022. Patient #5 - SOC 01/12/2022 MSW did not complete psychosocial assessment until 01/21/2022 due to scheduling conflict. Patient #6 - SOC -1/14/2022 MSW did not complete psychosocial assessment until 01/24/2022 due to scheduling conflict.

Upon patient record review, 1 of 11 (Patient #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. Patient #3 - Fleets enema and S/S enema not on medication profile. Corrected on site.

Upon patient record review, 1 of 11 (Patient #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 medications and treatments. Patient #3 - Order for Fleets enema and S/S incomplete - did not contain frequency. Corrected on site.

Upon client record review, 3 of 11 (Patient #2, 3, 5,) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2 - POC dated 02/24/2022 MSW frequency 1wk1, then effective 02/26/2022 1 wk 3. No visit made week of 02/26/2022. During home visit the nurse changed the dressing to the g-tube and instructed husband to flush tube daily if not using g-tube for medications or feedings. No order on the POC for g-tube feeding, care or flushing. Corrected on site. Patient #3 - POC dated 02/24/2022 - Check for fecal impaction and disimpaction PRN - no modifier for PRN. Corrected on site. Patient #5 - POC dated 01/12/2022 - wound care to coccyx ..... daily and PRN - no modifier for PRN. Corrected on site.

Upon patient record review 2 of 11 (Patient #1, 4) did not have evidence documentation in the patient record that a hospice aide provides services that are ordered by the IDG and included in the plan of care. Patient #1 - Aide care plan instructs Aide to document BM every visit report to RN if no BM within 3days. Aide documented as 'done'. Unclear documentation as to when last BM occurred. Aide shaving patient every visit but shaving not on aide care plan. Patient #4 - Aide care plan instructs Aide to document BM every visit report to RN if no BM within 3days. Aide documented as 'done'. Unclear documentation as to when last BM occurred. Aide provided nail care 2 x week the weeks of 01/02/2022, 02/06/2022 and 02/27/2022 but only ordered weekly.

Upon patient client record review, 1 of 11 (Patient #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. Patient #9 - RN visit note on 11/26/2021 nurse documented "wound care provided per POC" did not document specific care provided.