Every finding on record at Akeso Home Hospice, Inc

Upon patient record review, 2 of 19 (Patient #2,5) did not have evidence that the patient has received effective pain management and symptom control from the hospice for conditions related to the terminal illness. Patient 2: During a home visit the RN documented "Patient continues with pain in neck and arms at time, Dilaudid 2mg Q6H straight and Dilaudid 2mg every 3 hours as need in place for breakthrough pain, there is no evidence that the patient received effective pain management. Patient 5: 3/25/25 RN documented, "gave Ativan to patient, due to restlessness" there was no evidence of symptom control. f

Upon patient record review, 5 of 19 (Patient #1,2,3,4,6) 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: On the SNF medication profile there are medications "Chloraseptic Mouth/Throat lozenge 6-10mg Benzocaine-menthol, mouth throat give one tablet by mouth every 4 hours for throat pain, Loperamide HCL tablet 2mg tablet Give, 1 tablet by mouth as needed for loose stools, Guaifenesin Oral Syrup 100mg/5ml, give 5ml by mouth every 4 hours as needed for cough". There is no evidence that these medications are on the hospice medication profile. Corrected on site. Patient 2: On the medication profile, 5/9/24 "Polyethylene Glycol 17g Powder" there is no diluent for mixture for the medication. On the SNF medication profile there are medications " Bio freeze External Gel 4% Apply to Rt shoulder topically every 8 hours as needed for pain, Hydromorphone HCL Oral Liquid 1mg/ml, Give 1ml sublingually every 2 hours as needed for increased pain". There is no evidence that these medications are on the hospice medication profile. Corrected on site. Patient 3: On the hospice medication profile there is “ Acetaminophen 325mg 2 tablets, give 2 tablets every 6 hours as needed mild to moderate pain 1-6 level. Systane solution 0.4-0.3% 1 drop into both eyes 4xs a day for dry eyes". There is no evidence that these medications are on the SNF medication profile. Corrected on site. Patient 4: On the medication profile 4/1/24 " Miralax Polyethylene Glycol 3350 /17000mg Powder", there is no evidence of a diluent for mixture with the medication. Corrected on site Patient 6: On 11/20/24 the patient medication profile there is "Menthol 100mg/ml I inch topical cream q 8 hrs topical" the order does not say where to apply cream. "Benzocaine 200mg/ml menthol 5mg/ml topical spray, one spray every 6 hrs prn", the order does not say where to apply or spray the medication. On 5/27/25 there is an order "Petrolatum Aquaphor 1 inch topical ointment daily and prn Barrier protection to wound was ordered", the order does not say where to apply barrier protection or where the wound is. Corrected on site.

Upon patient record review, 3 of 19 (Patient #2,8,14) 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: On the RN assessment there is a need for a hoyer lift and a risk for falls and skin breakdown. On the plan there is not a risk for falls or risk for skin breakdown with goals and interventions. Corrected on site. Patient 8: On the RN comprehensive assessment the nurse documents "patient is in bed and chair with contractures, Pt. is incontinent of urine and bowel and bed/chair bound". There is no evidence of risk of falls or risk of skin break down on the POC with goals and interventions. Corrected on site. Patient 14: On 8/6/24 in the RN assessment there is evidence that the patient is at risk for falls. There is no risk for falls on the POC with goals and interventions. Corrected on site.

Upon patient record review, 5 of 19 (Patient #1,2,3,4,6) 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: On the SNF POC there are medications "Chloraseptic Mouth/Throat lozenge 6-10mg Benzocaine-menthol, mouth throat give one tablet by mouth every 4 hours for throat pain, Loperamide HCL tablet 2mg tablet Give, 1 tablet by mouth as needed for loose stools, Guaifenesin Oral Syrup 100mg/5ml, give 5ml by mouth every 4 hours as needed for cough". There is no evidence that these medications are on the hospice POC. Corrected on site. Patient 2: On the hospice POC, 5/9/24 "Polyethylene Glycol 17g Powder" there is no diluent for mixture for the medication. On the SNF POC there are medications " Bio freeze External Gel 4% Apply to Rt shoulder topically every 8 hours as needed for pain, Hydromorphone HCL Oral Liquid 1mg/ml, Give 1ml sublingually every 2 hours as needed for increased pain". There is no evidence that these medications are on the hospice POC. Corrected on site. Patient 3: On the hospice POC there is “ Acetaminophen 325mg 2 tablets, give 2 tablets every 6 hours as needed mild to moderate pain 1-6 level. Systane solution 0.4-0.3% 1 drop into both eyes 4xs a day for dry eyes". There is no evidence that these medications are on the SNF POC. Corrected on site. Patient 4: On the POC 4/1/24 " Miralax Polyethylene Glycol 3350 /17000mg Powder", there is no evidence of a diluent for mixture with the medication. Corrected on site Patient 6: On 11/20/24 POC there is "Menthol 100mg/ml I inch topical cream q 8 hrs topical" the order does not say where to apply cream. "Benzocaine 200mg/ml menthol 5mg/ml topical spray, one spray every 6 hrs prn", the order does not say where to apply or spray the medication. On POC 5/27/25 there is an order "Petrolatum Aquaphor 1 inch topical ointment daily and prn Barrier protection to wound was ordered", the order does not say where to apply barrier protection or where the wound is. Corrected on site.

Upon patient record review 1 of 19 (Patient #4) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient 4: 2/18/2025 the RN documented, "There is also concern for caregiver exhaustion. Patient’s primary caregiver is his wife. Patient requires constant observation due to his poor safety awareness, which can become exhausting. Caregiver has a very small support group often feels isolated and anxious, and has health conditions of her own. On 4/29/2025 patient's wife continues to struggle with caregiver exhaustion due to 24/7 care. ". There is no evidence that there is sharing of information between all disciplines providing care and services in all settings, or documentation of follow up on caregiver fatigue.

Upon patient client record review, 2 of 19 (Patient #2,5) did not have evidence that each patient record contains responses to medications, symptom management, treatments, and services. Patient 2: During a home visit the RN documented "Patient continues with pain in neck and arms at time, Dilaudid 2mg Q6H straight and Dilaudid 2mg every 3 hours as need in place for breakthrough pain", there is no evidence of follow up on the pain for responses to medication. Patient 5: 3/25/25 RN documented, "gave Ativan to patient, due to restlessness" there was no evidence of a follow up on the restlessness after the medication was given.

Upon patient client record review, 1 of 19 (Patient #2) 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 2: On the POC 5/9/24 “Prednisone 2.5mg I tablet oral by mouth /give 1 tablet faily” the meaning of faily isn’t clear.

Upon patient record review, 1 of 11 (Patient #11) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #11: Missing evidence that the patient elected an attending physician. This area of the election form was blank.

Upon patient client record review, 1 of 11 (Patient #11) did not have evidence that each patient record contains a signed election statement in accordance with 418.24. Patient #11: The Election of Benefit page was not complete. The effective date and attending physician name were missing on the form. These spaces were not written/typed in the spaces provided on form.

Upon patient client record review, 1 of 11 (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. Patient 11: The CTI dates for 1st benefit period were greater than 90 days. The dates indicated on CTI form were 11-4-21 to 2-1-22. These dates did not meet 90 day benefit period requirement.