Every finding on record at Amara Hospice LLC

Upon patient record review, 2 of 19 (Patient #3, 14) 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 Patient 3: The medication list indicates the patient utilizes D'Mannose 2g po daily for management of symptoms; however, there was no evidence of instructions for reconstitution of this powdered medication. (corrected onsite) Patient 14: The medication list indicates the patient utilizes Miralax 17g po daily for management of symptoms; however, there was no evidence of instructions for reconstitution of this powdered medication. (corrected onsite)

Upon patient record review, 1 of 19 (Patient #4) 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 4: The patient's plan of care for management of the Foley catheter included instructions to change catheter PRN, with no evidence of an indicator for the PRN order. (corrected onsite)

Upon client record review, 2 of 19 (Patient #10, 13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 10: On 08.04.2023, the RN received an order to obtain lab draws on the patient to evaluate BMP & albumin levels; there is no evidence of follow-up to determine if the lab draws were performed, or if the results were reported back to the ordering physician. Patient 13: On 08.28.2023, the RN received an order to obtain lab draws on the patient to evaluate albumin levels; there is no evidence of follow-up to determine if the lab draws were performed, or if the results were reported back to the ordering physician.

Upon patient record review, 1 of 19 (Patient #17) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient 17: The patient died on 02.16.2023; there was no evidence that the bereavement care plan was updated at that time or at any time thereafter.

Upon patient record review, 2 of 19 (Patient #7, 11) 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 7: The hospice aide care plan, dated 08.04.2023, indicated the HA should turn & position PRN, transfer bed to chair PRN, and change linens PRN. (corrected onsite) Patient 11: The hospice aide care plan, dated 08.02.2023, indicated the HA should transfer bed to chair PRN and shave PRN. (corrected onsite)