Every finding on record at Amari Hospice Care Inc.

Observed in Record Review. In 8 of 10 active patient records reviewed, the agency failed to document the recognition and resolution of duplicate drug therapy. On review of RRHV #1, it was noted that the patient had 3 PRN medications for constipation for Senna, Bisacodyl and Milk of Magnesium, while there were instructions for the Bisacodyl there were no clear indication when to use the other two duplicate therapies. On review of RRHV #2 and RRNHV #3, it was noted that patient had PRN Tylenol and PRN Morphine for pain with no clear indication when to use each on for pain. On review of RRHV #3 it was noted that there were no clear indications for the use of duplicate therapies of Hydromorphone and Tylenol for Pain. On review of RRNHV #2, RRNHV #4, RRNHV #5 patient had duplicate PRN medications for constipation that had no indication for when to use each duplicate therapy. On review of RRNHV #7, it was noted patient had multiple PRN medications for Pain with no indication for use for each pain medication. This finding was reviewed with the DCPS.

Observed in Record Review. In 2 out of 14 patient records reviewed, the organization failed to maintain complete and accurate records. On review of RRHV #1, it was observed by the nurse surveyor during the home visit that the aide performed a full assist transfer to wheelchair and then transferred patient with full assist from wheelchair to shower bench for shower, however the documentation states patient used walker. In addition, it was observed during the care that patient did not have hair blow dried or lotion applied to patient but it is documented that this was performed on the visit record. On review of RRHV #3, it was observed by the nurse on the home visit that the LVN took vital signs. The LVN took the vital signs and then stated what the numbers were for me and the caregiver. She stated the temp was 97.4 and the respirations were 20, however the medical record for the visit states a temp of 97.9 and resp of 24. It was also observed that the LVN did not write down or document those vital signs after she took them. In addition, it was noted that on arrival to the home the family/caregivers reported that patient had tried to stand up and had a fall, the LVN assessed the patient but had documented in the visit note that there were no falls to report today. This observation was reviewed with the DPCS.

Observed in Record Review. In 2 of 10 active patient records reviewed, the organization did not have orders for all care needs of the patient. On RRNHV #1, it was noted that the patient had a coccyx wound and wound care was being provided without a physician order. On RRNHV #2, it was noted in the nursing notes that patient had a Right Leg wound that nurse was performing wound care on during the visit and there was no physician order for the wound care. This finding was reviewed with DPCS.

Observed in Record Review. In 4 of 10 active patient records reviewed, plan of care had not been updated with goals that reflect changes to the patient's assessment. On review of RRHV #2, patient had need for Hoyer lift while on service, while their is documentation that the Hoyer lift was ordered and on the nursing visit the check box on the assessment for DME taught was checked, there was no updated to the plan of care to reflect goals and care needs for this change in care. On review of RRHV #3, it was noted that the patient had antibiotic therapy 3 months ago and the goals for the teaching of the medication that is not finished has not been updated in the goals on the plan of care. On review of RRNHV #1, it was noted in the record that pain medications had been increased in the frequency of delivery and care plan was not updated to reflect this change in care. On review of RRNHV #3, the patient got a right leg wound and the plan of care was not updated to reflect the patients assessed change. This finding reviewed with the DCPS.

Observed in Patient Home. In 1 of 3 home visits conducted, the patient's individualized emergency management plan was incomplete. During RRHV #2, it was noted that the individualized emergency plan was not completed and that the form was blank in the patient's home packet. This was discussed with the administrator who was present during the visit.

Observed in Record Review. In 1 out of 5 patient records reviewed with ordered aide services, the Aide Care Plan did not have specific instructions for the aide. During record review of RRHV#1, the assigned tasks had not been updated to include the change of care needs for the patient since a fall two weeks ago and the patient is no longer able to ambulate with walker to shower. This finding was reviewed and validated with the DCPS.

Observed in Patient Home. In 1 of 1 home visits conducted with the aide, the aide failed to provide care that was ordered. On RRHV #1, the aide failed to provide lotion and blow drying that was ordered every visit on the POC. This finding was reviewed with the DPCS.

Observed in Tracer Activities. During the Volunteer Program session with the Coordinator and DCPS, the hospice did not document its efforts to recruit and retain volunteers. For example, there was no evidence documented of recruitment or retention efforts for 2023 or 2024, the coordinator stated she just has that information in her head. This was validated by the Coordinator and DCPS.

Observed in Tracer Activities. During the review of the Volunteer Program, the organization did not provide volunteers for at least 5% of the total patient care hours of all paid hospice employees and contract staff in 2023 and YTD for 2024. Agency only had 4.4% since the public health emergency ended in 2023. And YTD for 2024 the agency is at 3.3%. The Agency does not have an active performance improvement plan in place related to recruitment of volunteers but state they are actively recruiting volunteers. This was reviewed and validated with the DPCS.

Observed in Record Review. In 2 of 10 active patient records, the hospice nurse surveyor noted that the medical record did not contain medical equipment used by the patient in the home. On review of RRHV #1, it was noted during the home visit that patient had a bedside commode in her room and that she was using a shower bench for her showers an these DME items were not documented in the patient's medical record. On review of RRHV #2, it was noted during the home visit that patient was using a hospital bed with overlay mattress and had a bedside commode, these DME supplies were not document in the patient's medial record.

Observed in Record Review. In 2 of 2 discharged patient records reviewed where patient was discharged from service, a discharge summary for care and treatment was not sent to the provider or a notification given that it was available. On review of RRDC #1 and RRDC #2, the discharge summary was created by the clinician but not sent but it was not sent to physician or notification of it's availability. This was reviewed and validated with the DPCS.