Every finding on record at Ahc Home Health of Kansas City, LLC

Upon patient record review, 6 of 14 (Patients #1,#3,#4,#6,#8,#10) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 1: The medication profile contained oxygen without instructions for a delivery method and polyethylene glycol oral powder without instructions for a diluent. Corrected on site. Patient 3: The medication profile contained a lidocaine topical patch with no instructions for area of administration. Corrected on site. Patient 4: The medication profile contained oxygen without instructions for a delivery method and Miralax oral powder without instructions for a diluent. Corrected on site. Patient 6: The medication profile contained oxygen without instructions for a delivery method and Miralax oral powder without instructions for a diluent. Corrected on site. Patient 8: The medication profile contained Miralax with no instructions for a diluent. Corrected on site. Patient 10: The medication profile contained polyethylene glycol oral powder without instructions for a diluent. Corrected on site.

Upon patient record review, 2 of 14 (Patients #7,#8) 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 7: The medical record contained nursing documentation upon admission identifying patient was an insulin dependent diabetic and there were orders for sliding scale insulin administration. There was no evidence of problems, goals, and interventions related to endocrine dysfunction. Corrected on site. Patient 8: The medical record contained nursing documentation upon last recertification visit identifying patient is risk for aspiration. There was no evidence of problems, goals, and interventions related to the risk for aspiration. Corrected on site.

Upon patient record review, 6 of 14 (Patients #1,#3,#4,#6,#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 1: The medical record contained orders for oxygen without instructions for a delivery method and polyethylene glycol oral powder without instructions for a diluent. Corrected on site. Patient 3: The medical record contained an order for a lidocaine topical patch with no instructions for area of administration. Corrected on site. Patient 4: The medical record contained orders for oxygen without instructions for a delivery method and Miralax oral powder without instructions for a diluent. Corrected on site. Patient 6: The medical record contained orders for oxygen without instructions for a delivery method and Miralax oral powder without instructions for a diluent. Corrected on site. Patient 8: The medical record contained an order for Miralax with no instructions for a diluent. Corrected on site. Patient 10: The medical record contained an order for polyethylene glycol oral powder without instructions for a diluent. Corrected on site.

Upon patient record review, 2 of 14 (Patients #11,#12) did not have evidence the hospice offers bereavement counseling that includes: • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery. Patient 11: There was no evidence of a bereavement care plan to describe the bereavement services to be offered and frequency of delivery. A performance improvement project was developed 1/27/23, however, audits did not go retroactive and patient died prior to project enactment. Corrected on site. Patient 12: There was no evidence of a bereavement care plan to describe the bereavement services to be offered and frequency of delivery. A performance improvement project was developed 1/27/23, however, audits did not go retroactive and patient died prior to project enactment. Corrected on site.

Upon observation, there was no evidence the hospice documented the cost savings achieved through the use of volunteers. Documentation must include the following: • The identification of each position that is occupied by a volunteer • The work time spent by volunteers occupying those positions • Estimates of the dollar costs that the hospice would have incurred if paid employees occupied the positions identified in paragraph (d)(1) of CFR 418.78 for the amount of time specified in paragraph (d)(2) of CFR 418.78

Upon patient client record review, 1 of 14 (Patient #3) 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 3: The medical record contained nursing documentation 4/18/23 with a completion of aide supervisory visit. The patient was not receiving aide services.