Every finding on record at Ahc Home Health of Las Vegas LLC

Upon observation, there was no evidence the agency has conducted exercises to test the emergency plan every two years. The agency had no evidence of performing emergency drills in 2024. They had evidence of Great Nevada Shake Out in 2023.

Upon patient record review, 1 of 19 (Patient #13) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient 13: The patient's son had signed the NOE on admission accepting the hospice medical director as the attending. The agency had a change in their medical director and had the patient sign the change of attending form. This patient has a diagnosis of Senile dementia of the brain. The signature was a scribble and not on the correct line of the form with an arrow drawn to the patient signature line. It was not the signature of the son which was on all consents that were legible.

Upon patient record review, 3 of 19 (Patient #1,2,5) 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: Patient 1: The POC 2/16/25 contains an order to add thickener to patient's beverages. It does not state how much thickener to add to get desired thickness. Thickener was not included on the medication profile. The facility has an order on their MAR for Aspercreme. The Hospice medication profile does not have this medication ordered. The Hospice medication profile contains orders for Dulcolax suppository started 12/2/24, lidocaine topical film started 8/19/24, Vitamin D3 8/19/24, refresh opthalmic 8/19/24. The AL facility did not have these medications on their MAR. Corrected on site. Patient 2: The POC 1/29/25 contains an order for "Oxygen via device 2 liters as needed for shortness of breath". There is no route. Corrected on site. Patient 5: The POC 12/31/24 contains Nystatin powder applied topically twice daily for rash. It does not state where. Corrected on site.

Upon patient record review, 3 of 19 (Patient #2,4,11) 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 2: The POC 1/29/25 contains orders for ASA and Eliquis. There was no at risk for bleeding care plan initiated with goals and interventions. Corrected on site. Patient 4: The POC 2/19/25 has an order for nectar thickened liquids. There was no at risk for aspiration care plan initiated with goals and interventions. Corrected on site. Patient 11: The pt has a diagnosis of dysphagia on initial comprehensive assessment. There was not risk for aspiration care plan initiated with goals and interventions. Corrected on site.

Upon patient record review, 4 of 19 (Patient #1,2,5,14) 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 medications and treatments. Patient 1: The POC 2/16/25 contains an order to add thickener to patient's beverages. It does not state how much thickener to add to get desired thickness. The facility has an order on their MAR for Aspercreme. The Hospice POC does not have this medication ordered. The Hospice POC contains orders for Dulcolax suppository started 12/2/24, lidocaine topical film started 8/19/24, Vitamin D3 8/19/24, refresh opthalmic 8/19/24. The AL facility did not have these medications on their MAR. Corrected on site. Patient 2: The POC 1/29/25 contains an order for "Oxygen via device 2 liters as needed for shortness of breath". There is no route. Corrected on site. Patient 5: The POC 12/31/24 contains Nystatin powder applied topically twice daily for rash. It does not state where. Corrected on site. Patient 14: The POC 1/8/25 contains an order "Insert foley as ordered". There is not a size, frequency, nor who is to perform. Corrected on site.

Upon patient record review, 1 of 19 (Patient #2) 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 2: Upon home visit finding pt has a specialty mattress that was not included on the POC. Corrected on site.

Upon patient record review, 3 of 14 (Patient #1,8,14) 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 1: The updated POC contains an order to add thickener to patient's beverages effective 12/30/24. A risk for aspiration care plan was not added with goals and interventions. Corrected on site. Patient 8: The Physician documented on the CTI 1/18/25 "pt is a high fall risk". There was no at risk for falls added to the POC with goals and interventions. Corrected on site. Patient 14: The SN documented on 3/4/25 "The patient is at risk for aspiration". There was no risk for aspiration care plan initiated with goals and interventions. Corrected on site.

Upon client record review, 4 of 19 (Patient #3,5,9,10) 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 POC 2/4/25 contains an order for Chaplain once per month. The chaplain did not make a visit the month of February 2025. There was no missed visit documentation or evidence of refusal. Corrected on site missed visit added. Patient 5: The POC 12/31/24 contains an order for SC once per month. There were no SC visit completed 12/31/24-2/28/24. There was no evidence of refusal or missed visit documentation. Corrected on site, missed visit documentation added. Patient 9: The SN documented on 2/27/25 in the area for performing wound care "wound care per care plan". There is no order for wound care on the POC. Wound care order added for a stage I pressure ulcer to correct on site. Patient 10: The POC 1/5/25 contains an order for: cleanse sacral coccyx wound with dermal cleanser,pat dry, cover with border foam twice weekly. The SN documented on 2/20/25 "4x4 foam dressing applied to coccyx" and on 2/24/25 "4x4 foam dressing changed skin intact". The nurse did not follow the POC and there is no new order to cover just the coccyx with foam dressing with out cleansing. Corrected on site.

Upon observation, there was no evidence the hospice investigates all adverse events, incidents, accidents, variances or unusual occurrences that involve patient care and develops a plan of correction to prevent the same or similar event from occurring again. Patient 13: The SN documented pt had a fall on 2/23/24, there was no incident report completed.

Upon patient record review, 2 of 19 (Patient #6,13) did not have evidence in the patient record that hospice aide assignments and duties are: Patient 6: The aide POC 3/5/25 contains orders for electric shave only if patient wants to be shaved. This pt is not alert and oriented and is not cognitively able to make decisions as per RN comprehensive assessments. Corrected on site. Patient 13: the aide POC 1/29/25 contains an order for shave with safety razor with no frequency. Corrected on site.

Upon patient record review 3 of 19 (Patient #4,6,11) did not have evidence documentation in the patient record that a hospice aide provides services that are: Patient 4: The aide made visits on 2/24/25 and 2/26/25. The aide POC has orders for make bed, change linens, assist with dressing, and oral care all to be performed every visit. The aide documented "Not Due" after each of these interventions. There was no evidence the aide called the RN to get orders to not complete these tasks. Patient 6: The aide POC 3/5/25 contains an order for shampoo once per week. The aide documented shampoo on 2/12/25 and 2/16/25 with no evidence of calling the RN for the extra shampoo that week. Patient 11: The aide POC contains an order for shampoo once a week. The aide documented shampoo on 2/24/25 and 2/28/25. There was no evidence the aide called the RN for orders to perform the second shampoo that week.

Upon patient record review 2 of 19 (Patient #2,9) 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 2: The POC 1/29/25 contains orders for aides 5 days a week. The last supervisory visit was completed 2/6/25. Patient 9: The medical record does not contain evidence that the RN has made an aide supervisory visit since 1/24/25. The aide is seeing the patient 4 times per week.

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 2024 volunteer total hours were 4.90%.

Upon patient client record review, 3 of 19 (Patient #8,12,13) did not have evidence that each patient record contains: Patient 8,12: The caregiver indicated on the consents that they wanted a copy Notice of noncovered items and there is not evidence this was received by the caregiver. Patient 13: The caregiver indicated on the consents they wanted a copy of the list of non covered items,services and/or drugs and there was no evidence that the addendum was given to the caregiver. The patient's son had signed the NOE on admission accepting the hospice medical director as the attending. The agency had a change in their medical director and had the patient sign the change of attending form. This patient has a diagnosis of Senile dementia of the brain. The signature was a scribble and not on the correct line of the form with an arrow drawn to the patient signature line. It was not the signature of the son which on all consents was legible.

Upon patient client record review, 2 of 19 (Patient #7,11) did not have evidence that each patient record contains Advance Directives. Patient 7: The current POC has an order for DNRCC, there is not copy of this in the medical record. Patient 11: The POC 12/17/24 contains an order of DNRCC and there is no copy in the clinical record. Corrected on site.

Upon patient client record review, 7 of 19 (Patient #1,5,6,8,9,11,12) 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 1: The SN documented the following abbreviations: GH, CG. These are not approved abbreviations. Patient 5: The SN documented the following abbreviations on 1/28/25: pta and 6li. These are not approved abbreviations. Patient 6: On 2/7/25 the aide documented a missed visit but also documented "patient refused transfer". Patient 8: The aide documented a missed visit on 2/28/25 pt declined the visit. The aide also documented "assist with positioning not due". Patient 9: The SN documented an LVN supervisory visit on 2/4/25, there was no LVN seeing the patient at that time. Patient 11: The aide documented a missed visit on 2/17/20 and also documented each task as refused. Patient 12: The SN documented on 2/21/25 and 2/27/25 "wound care done per POC". There is no evidence the POC was followed.

Upon client record review, 1 of 19 (Patient #15) 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: Patient 15: There is no evidence the discharge summary was sent to the attending physician.

Upon client record review, 1 of 19 (Patient #15) did not have evidence that the discharge summary includes all required information. Patient 15: The discharge summary did not contain a summary of the patient's stay, including treatments, symptoms and pain management, the patient's current plan of care, the patient's latest physician orders.

Upon patient record review, 2 of 13 (Patient #1, 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, 8 - patient on oxygen but not on medication profile.

Upon patient record review, 4 of 13 (Patient #1, 7, 9, and 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 #1 - POC dated 03/03/2022 did not include oxygen. POC dated 03/03/2022 "perform digital exam stimulation as indicated and remove fecal impaction manually" did not include modifier for as indicated. Patient #7 - POC dated 12/10/2021 contained "perform pressure ulcer care" wound care not specific. Patient #9 - POC dated 01/23/2022 did not include oxygen. Patient #11 - POC dated 01/27/2022 wound care to coccyx wound did not include frequency.

Upon patient record review, 2 of 13 (Patient #2, 6) did not have evidence in the patient record that hospice aide assignments and duties are: • 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 #2 - Aide POC effective 02/18/2022 contained "bath- shower chair each visit unless patient refuses - okay to give bed bath if patient request" documentation did not include that the patient was cognitively and functionally able to make decision. Patient #6 - Aide POC effective 01/19/2022 did not include frequency for task: dressing, bed bath or shampoo.

Upon patient client record review, 1 of 13 (Patient #11) 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 #11 - Visit note 01/28/2022 wound care to coccyx and skin tear per care plan - did not document what specific care was completed.