Every finding on record at Ahc Home Health of Reno, LLC

Upon patient record review, 4 of 19 (Patient #5, 7, 8, 9) 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 05: The medication profile includes Benadryl Extra Strength topical cream initiated on 7/31/23, states to "apply to affected area 3-4 times daily as needed", the application site is not indicated and the qualifier for use is not indicated. (Corrected on site.) Patient 07: The medication profile includes nystatin-triamcinolone 100,000 units/g-0/1% topical cream, apply topically twice a day to affected area, it does not indicate an application site. The profile also includes hydrocortisone 1% topical cream, apply to affected area twice daily, it does not include an application site. In addition, the profile includes Miralax oral powder 17grams orally, take one capful by mouth daily for constipation, does not include a diluent. (Corrected on site.) Patient 08: The medication profile includes mometasone 0.1% topical cream, apply thin layer twice a day as needed to skin lesion, the site of the skin lesion is not indicated. (Corrected on site) Patient 09: The medication profile includes nystatin 100,000 units/g topical powder apply 3 times a day to affected area for fungal rash, this does not include an application site. (Corrected on site.)

Upon patient record review, 2 of 14 (Patient #9, 13) 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 09: The patient was admitted on 7/10/23 with a diagnosis of symptomatic heart failure, his records indicate that he has a defibrillator. The plan of care does not include interventions or goals in relation to the active defibrillator. (Added to current plan of care.) Patient 13: The patient was admitted on 6/1/22 with a diagnosis of heart failure, including a pacemaker. The patient takes Eliquis 2.5mg po BID. The plan of care does not include interventions or goals for bleeding precautions.

Upon patient record review, 4 of 19 (Patient #5, 7, 8, 9) 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 05: The medication order for Benadryl Extra Strength topical cream initiated on 7/31/23, states to "apply to affected area 3-4 times daily as needed", the application site is not indicated and the qualifier for use is not indicated. (Corrected on site.) Patient 07: The medication order on 8/31/23 for nystatin-triamcinolone 100,000 units/g-0/1% topical cream, apply topically twice a day to affected area, does not indicate an application site. The order on 8/2/23 for hydrocortisone 1% topical cream, apply to affected area twice daily, does not include an application site. (Corrected on site.) Patient 08: The orders on 7/3/23 for mometasone 0.1% topical cream, apply thin layer twice a day as needed to skin lesion, does not indicate the site of the skin lesion. (Corrected on site.) Patient 09: The medication orders on 7/10/23 for nystatin 100,000 units/g topical powder apply 3 times a day to affected area for fungal rash, does not include an application site. (Corrected on site.)

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. #1: During the home visit it was observed that the RN placed her clean nursing tools (blood pressure cuff, thermometer, stethoscope) onto a dresser surface with no barrier, she then moved the tools to the patients bed also without a barrier. The nurse utilized her tools for the patient assessment, placing them back onto the bed, then to the dresser. The RN cleaned her assessment tools and placed them directly into her nursing bag without allowing for proper drying time. During patient care, the RN donned a pair of non-sterile gloves while performing a skin assessment to the patients bilateral legs touching both legs and feet checking for pedal pulses. Continuing her care, the RN used the same gloves to retrieve wound care supplies, remove a soiled dressing, applied collagen powder (using one finger) to the wound, and applied a clean dressing to the wound using the same pair of gloves for the entire visit.

Upon patient record review, 1 of 14 (Patient #5) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • 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 05: The order for hospice aide is indicated as 2x week x 11 weeks starting on 7/24/23. The aide has documented missed visits for 9 out of 13 visit related to patient refused, patient did not answer the door, or patient did not answer the phone. The patient did not receive aide services on 7/26/23, 7/28/23, 8/3/23, 8/4/23, 8/9/23, 8/11/23, 8/18/23, 8/22/23 or 8/31/23. The aide communicated these updates to the nurse and the aide plan of care was not revised to meet the needs of the patient.