Every finding on record at Amedisys Hospice, L.L.C.

Upon patient record review, 1 of 19 (Patient #2) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments: Patient #2: The POC dated 12/11/2024 included, "SN to insert Foley Q 30 days, or as needed", without an indication for such as needed intervention.

Upon patient record review, 2 of 19 (Patients #1 and 2) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs: Patient #1: During Surveyor-attended home visit on 01/21/25 it was noted that the patient had the following DME: 1) commode; 2) walker; and 3) wheelchair. These DME were not on the Hospice POC. Patient #2: During Surveyor-attended home visit on 01/21/25 it was noted that the patient had the following DME: wheelchair. This DME was not on the Hospice POC.

Upon patient record review, 1 of 19 (Patient #3) did not contain evidence that the revised Plan of Care included information from the patient's updated comprehensive assessment(s): Patient #3: Had numerous changing and repeat wound locations/assigned numbers. The 12/20/24-02/17/25 Plan of Care continued to include treatments for inactivated wounds: 1) Wound #30 - inactivated 11/26/24; 2) Wound #31 - inactivated 12/10/24; 3) Wound #33 - inactivated 09/10/24; 4) Wound #35 - inactivated 11/19/24; and 5) Wound #36 - inactivated 08/06/24.

Upon patient record review, 10 of 19 (Patients #3, 5, 7, 8, 9, 10, 11, 12, 13, and 14) did not contain evidence that the IDG had ensured that care and services were provided in accordance with the Plan of Care: Patient #3: There were no SW visits made/documented between 10/03/24 and 12/19/24. There were no interim verbal orders located between 10/03 and 12/19/24 that addressed the intended SW visit frequency. All IDG POC's included the following statement, "SW to continue to visit at least bi-monthly." Missed visit reports were located for 10/20/24, 11/29/24, and 12/19/24 stating, "Rescheduled for next Medicare week." No visits were re-scheduled. Patient #5: There were no SW visits made/documented between 11/18/24 and 01/20/25. There were no interim verbal orders located that addressed the intended SW visit frequency. All IDG POC's included the following statement, "SW to continue to visit at least bi-monthly." Missed visit reports were located for 11/28/24, and 12/06/24 stating, "Rescheduled for next Medicare week." No visits were re-scheduled. Patient #7: A verbal order was obtained on 10/28/24 for, "Effective 10/14/24 SW 1x per month x3 months". No further SW visits had been made/documented. All IDG POC's included the following statement, "SW to continue to visit at least bi-monthly." Missed visit reports were located for 11/29/24, and 12/31/24, without a clear reason of why. Patient #8: SW visits were made on 11/12/24, 12/05/24, and 01/08/25. There was a verbal order obtained, "Effective 11/09/24, SW 1x per month x4". However, all IDG POCs included the following statement, "SW to continue to visit at least bi-monthly." Patient #9: SW visits were made on 12/17/24, 01/07/25. There was a verbal order obtained, "Effective 12/13/24, SW 1x per month x3". However, all IDG POCs included the following statement, "SW to continue to visit at least bi-monthly." Patient #10:There were no SW visits made/documented between 11/22/24 and 01/20/25. All IDG POCs included, "SW to continue to visit at least bi-monthly." Patient #11: SW visits were made on 11/12/24 and 12/13/24. All IDG POCs included, "SW to continue to visit at least bi-monthly." Patient #12: SW visits were made on 12/05/24 and 01/17/25. All IDG POCs included, "SW to continue to visit at least bi-monthly." Patient #13: A Chaplain visit was made on 11/23/24. A verbal order was obtained for, "Effective 11/07/24 Chaplain 1x per month x3 months". There was no December visit. On 12/31/24, there was a missed visit note, "Re-schedule to next Medicare week", without a clear reason of why. Patient #14: SW visits were made on 11/18/24 and 12/19/24. All IDG POCs included, "SW to continue to visit at least bi-monthly."

Upon patient record review 1 of 19 (Patient #6) did not contain evidence that a Hospice Aide provided services that were: • Ordered by the Interdisciplinary Group • Included in the Plan of Care Patient #6: Aide visits were ordered at a frequency of "3x per week effective 12/22/24". Only (1) visit was made the weeks of December 22-28, 2024 and December 29-January 4, 2025. No Aide visits were made January 5-11, 2025. There was one missed visit report during that week stating, "In-climate weather". However it did not indicate whether this was per patient request, nor evidence of attempt to re-schedule. No Aide visits were made January 12-17, 2025. Two days this week there was a note,"Caregiver provided care". No evidence that patient had refused the Aide visit.

Upon observation, there was not evidence that the annual report documented 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 Hospices calendar-year for this requirement was 0.89% throughout 2024.

Upon patient record review, 1 of 19 (Patient #5) did not contain evidence that all entries were clear/complete: Patient #5: The Aide Plan of Care assigned, "Report pain > 5 out of 10." On the Aide home visit report(s), the assigned Aide(s) entered a response of "Yes". The Aide's were not documenting the result of each patient's pain assessment in their individual home visit reports. It is unclear as to whether the Aides were assessing the pain and the results of such, in order to ascertain whether the Aide(s) needed to report to the RN or not.

Based on review of clinical records, it was determined the hospice Registered Nurse (RN) failed to ensure initial comprehensive assessments was completed within 48 hours after the election of hospice care for six (6) of sixteen (16) patients (P) (P#1, P#7, P#10, P#11, P#12 and P#15). The findings include: 1. Review of the clinical record for (P#1), who was admitted on 10/23/20, with a diagnosis of heart failure, pulmonary collapse, chronic respiratory failure with hypoxia and pleural effusion, revealed that the referral was sent on 10/19/20, but the initial skilled nurse assessment was completed on 10/23/22, (four days) after the election of hospice care. The clinical record lacked documentation regarding the staff's delay in completing the assessments. 2. Review of the clinical record for (P#7), who was admitted on 12/21/21, with a diagnosis of malignant neoplasm unspecified of bronchus or lung, bone cancer, diverticulitis of large intestine without perforation, generalized anxiety disorder, type 2 diabetes, Crohn's disease of small intestine, nausea and vomiting, and melena, revealed the referral was sent on 12/13/21, the initial skilled nurse assessment was completed on 12/21/21, (eight days) after the election of hospice care. The clinical record lacked documentation regarding the staff's delay in completing the assessments. 3. Review of the clinical record for (P#10), who was admitted on 8/10/21, with a diagnosis of senile degeneration of brain, atrial fibrillation, and adult failure to thrive, revealed the referral was sent on 8/4/21, the initial skilled nurse assessment was completed on 8/10/21, (six days) after the election of hospice care. The clinical record lacked documentation regarding the staff's delay in completing the assessments. 4. Review of the clinical record for (P#11), who was admitted on 10/18/21, with a diagnosis of chronic obstructive pulmonary disease, hypertension, and hyperlipidemia, revealed the referral was sent on 9/28/21, the initial skilled nurse assessment was completed on 10/18/21, (nineteen days) after the election of hospice care. The clinical record lacked documentation regarding the staff's delay in completing the assessments. 5. Review of the clinical record for (P#12), who was admitted on 9/27/21, with a diagnosis of Parkinson's disease, hypertension, and type 2 diabetes, gastro esophageal reflux disease, and hypothyroidism, revealed the referral was sent on 9/20/21, the initial skilled nurse assessment was completed on 9/27/21, (seven days) after the election of hospice care. The clinical record lacked documentation regarding the staff's delay in completing the assessments. 6. Review of the clinical record for (P#15), who was admitted on 9/16/21, with a diagnosis of senile degeneration of brain, chronic pain, spinal stenosis lumbar region without neurogenic Claud, dizziness and giddiness, mononeuropathy, constipation, repeated falls, and mixed incontinence, revealed the referral was sent on 9/13/21, the initial skilled nurse assessment was completed on 9/16/21, three days (72 hours) after the election of hospice care. The clinical record lacked documentation regarding the staff's delay in completing the assessments. During interview on 3/25/22, at 1:35 p.m., the Administrator said they had shortage of nurses. The Administrator also confirmed the surveyor had been provided with all available documentation for the patients' record.

Based on review of clinical records, it was determined the interdisciplinary group failed to ensure the comprehensive assessment was completed within 5 days of admission for one of (16) patients (P) (P#14). The findings include: Review of the clinical record for Patient#14 admitted on 12/22/21, with a diagnosis of senile degeneration of brain disease, Parkinson's disease and dementia. The initial psychosocial assessment was completed on 12/30/21, eight days after the patient's admission. The clinical record lacked documentation regarding the staff's delay in completing the assessments. In an interview on 3/25/22, at 11:55 a.m., the Administrator said they had two social workers, both of whom were on medical leave. The Administrator confirmed that the surveyor had been provided with all available documentation for the patients' record.

Based on observation, clinical record review, and staff interviews, it was determined that the agency failed to dispose expired Morphine for one (1) of sixteen (16) patients (P) (P#2). The findings include: 1. During a home visit observation conducted on 3/23/22, at approximately 11:30 a.m., with Registered Nurse (RN) AA, for P#2, it was revealed P#2 was admitted on 2/23/22, with a diagnosis of senile degeneration of brain, hyperlipidemia, hemiplegia, longterm and current use of insulin, and hypertension. The surveyor compared P#2's current medication list at home to the hospice agency's medication profile. It was revealed that Morphine concentrate 100mg/5ml (20mg/ml) oral solution give 0.25ml every hour for pain or shortness of breath filled on 2/23/21, expired 2/23/22. The above-listed medication was administered to P#2 on 3/23/22, one month after the expiration date as confirmed by P#2's caregiver. On 3/23/22, at 12:00 p.m., an interview was conducted with RNAA, who stated she was an agency nurse 3/23/22 and it was the first time she would visit P#2. RNAA confirmed she did not check the medication containers and was not aware the morphine liquid had expired.

Based on observation, clinical record review, and staff interviews, it was determined that the agency failed to dispose expired Morphine and order a new Morphine for one (1) of sixteen (16) patients (P) (P#2). The findings include: 1. During a home visit observation conducted on 3/23/22, at approximately 11:30 a.m., with Registered Nurse (RN) AA, for P#2, it was revealed P#2 was admitted on 2/23/22, with a diagnosis of senile degeneration of brain, hyperlipidemia, hemiplegia, longterm and current use of insulin, and hypertension. The surveyor compared P#2's current medication list at home to the hospice agency's medication profile. It was revealed that Morphine concentrate 100mg/5ml (20mg/ml) oral solution give 0.25ml every hour for pain or shortness of breath filled on 2/23/21, expired 2/23/22. The above-listed medication was administered to P#2 on 3/23/22, one month after the expiration date as confirmed by P#2's caregiver. On 3/23/22 at 12:00 p.m., an interview was conducted with RNAA, who stated that she was an agency nurse and that day (3/23/22), was the first time she would visit P#2. RNAA confirmed she did not check the medication containers and was not aware the morphine liquid had expired.

Based on record review and staff interview, it was determined that the agency failed to provide drugs and biologicals related to the management and palliation of the terminal illness and related conditions identified on patients' hospice plan of care. The agency failed to provide the needed medications related to the co morbidities in eight (8) of sixteen (16) patients (P) (P#4, P#5, P#6, P#7, P#11, P#12, P#15, and P#16). The findings include: 1. Clinical records for P#4 was reviewed for certification date 1/4/22 to 4/3/22. Per P#4's plan of care, the patient was admitted to hospice services on 1/4/22, with a primary diagnosis of hypertensive heart disease with heart failure, with the following co morbidities: dementia, dysphagia following cerebral infarction, hyperlipidemia, acute pulmonary edema, and atrial fibrillation. The record showed the agency was not providing coverage for payment for the following medications used to manage the co morbidities: Lovastatin 20milligrams (MG) one tablet oral daily for elevated cholesterol, and Montelukast 10mg one tablet oral daily at bedtime for cardio obstructive pulmonary disease. P#4 expired on 1/28/22. 2. Clinical records for P#5 were reviewed for certification date 3/16/22 to 5/14/22. Per P#5's plan of care, the patient was admitted to hospice services on 9/17/21 with a primary diagnosis of severe protein calorie malnutrition, hemiplegia following cerebral infarction affecting left side, essential hypertension and chronic pain. The record showed the agency was not providing coverage for payment for the following medications used to manage the co morbidities: Plavix 75mg give one tablet oral daily for anticoagulant; and Protonix 20mg give one tablet oral daily for reflux. 3. Clinical records for P#6 were reviewed for certification date 2/7/22 to 3/13/22. Per the P#6's plan of care, the patient was admitted to hospice services on 4/13/21, with a primary diagnosis of Parkinson's disease, atrial fibrillation, type 2 diabetes, and essential hypertension. The record showed the agency was not providing coverage for payment for the following medications used to manage the co morbidities: Eliquis 5mg give one tablet twice daily for blood thinner. P#6 expired on 3/13/22. 4. Clinical records for P#7 were reviewed for certification date 12/21/21 to 3/20/22. Per P#7's plan of care, the patient was admitted to hospice services on 12/21/21, with a primary diagnosis of malignant neoplasm unspecified of bronchus or lung, bone cancer, diverticulitis of large intestine without perforation, generalized anxiety disorder, type 2 diabetes, Crohn's disease of small intestine, nausea and vomiting, and melena. The record showed the agency was not providing coverage for payment for the following medications used to manage the co morbidities: Glipizide 5mg give one tablet daily oral for diabetes; and Simvastatin 10mg give one tablet daily oral for hyperlipidemia. 5. Clinical records for P#11 were reviewed for certification date 1/16/21 to 4/15/22. Per P#11's plan of care the patient was admitted to hospice services on 10/18/21, with a primary diagnosis of chronic obstructive pulmonary disease, essential hypertension, and hyperlipidemia. The record showed the agency was not providing coverage for payment for the following medications used to manage the co morbidities: Carvedilol 12.5mg give one tablet oral twice daily for hypertension; and Flonase allergy relief 50micrograms (MCG), give one spray nasal twice daily for congestion. 6. Clinical records for P#12 were reviewed for certification date 12/26/21 to 3/25/22. Per #12's plan of care, the patient was admitted to hospice services on 9/27/21, with a primary diagnosis of Parkinson's disease, hypertension, and type 2 diabetes, gastro esophageal reflux disease, and hypothyroidism. The record showed the agency was not providing coverage for payment for the following medications used to manage the co morbidities: Lisinopril 40mg give one tablet oral daily for blood pressure; omeprazole 40mg give one capsule oral daily for epigastric pain; Linzess 145mcg give one capsule oral daily for aide in digestion; Levothyroxine 137mcg give one tablet oral daily for thyroid; Ranolazine extended release 1,000 mg give one tablet oral twice daily for heart; and Atorvastatin 20mg give one tablet daily oral for cholesterol. 7. Clinical records for P#15 were reviewed for certification date 3/15/22 to 5/13/22. Per P#15's plan of care, the patient was admitted to hospice services on 9/16/21, with a primary diagnosis of senile degeneration of brain, chronic pain, spinal stenosis lumbar region without neurogenic Claud, dizziness and giddiness, mononeuropathy, constipation, repeated falls, and mixed incontinence. The record showed the agency was not providing coverage for payment for the following medications used to manage the co morbidities: Escitalopram 10mg give one tablet oral daily for depression; and Famotidine 40mg give one tablet oral daily for reflux. 8. Clinical records for P#16 were reviewed for certification date 2/14/22 to 4/14/22. Per P#16'splan of care, the patient was admitted to hospice services on 6/19/21, with a primary diagnosis of malignant neoplasm of right kidney, thrombocytopenia, weakness, chronic atrial fibrillation, hypertension, and diarrhea. The record showed the agency was not providing coverage for payment for the following medications used to manage the co morbidities: Saccharomyces Boulardll 250mg give one capsule oral twice daily for diarrhea. In an interview at the agency's office on 3/23/22, at 2:00 p.m., Administrator and Vice President of Clinical Operation, both stated they were unaware it was a requirement that the hospice pay for medications related to listed co morbidities on the patients' plan of care.