Every finding on record at Amedisys Hospice, LLC

Upon patient record review, 7 of 14 (Patient #1, #2, #3, #4, #5, #6, #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. Patient #1-The medication profile includes Valium 5mg 1 suppository three times daily as needed for seizures. The profile includes may repeatX1 if needed. The time interval/indications for repeat dosing is not specified on the profile. (corrected on site) Patient #2-The medication profile includes Morphine 10 mg every three hours prn breakthrough pain. The dosage of 10 mg should have been discontinued when Morphine was increased on 07/06/23 to 15 mg every 3 hours prn for breakthrough pain. Both doses of Morphine are listed as active medications on the profile. On 07/17/23 the nurse documented Fentanyl was increased to 50 mcg/hr 1 patch topically every 3rd day. The medication profile does not include Fentanyl. (corrected on site) Patient #3- Polyethylene Glycol 17 gm oral packet powder is ordered as needed for constipation. The profile does not include a diluent or frequency. (corrected on site) Patient #4-The medication profile includes duplicate/unclear doses for Sertraline. Effective 03/06/23 the profile includes Sertraline 100 mg tab 1 tab daily for depression. The profile also includes Sertraline 25 mg 1 tab daily for depression. (corrected on site) Patient #5-On 05/26/23 Zofran is ordered to be administered 4mg every 6 hours prn mild nausea/vomiting. Zofran 8 mg is ordered every 6 hours prn moderate nausea/vomiting. The parameters for dosing differentiation are not included in the medication profile. The medication profile includes 06/13/23 Methadone 10 mg 1 tab three times daily. The dosage of 10 mg should have been discontinued when Methadone was increased on 06/29/23 to 10 mg 2 tabs every 8 hours. Both doses of Methadone are listed as active medications on the profile. The medication profile includes 05/04/23 Morphine 100 mg/5ml .5 ml hourly prn pain. The dosage of .5ml should have been discontinued when Morphine was increased on 06/29/23 to 100 mg/5ml 1ml hourly prn pain. Both doses of Morphine are listed as active medications on the profile. (corrected on site) Patient #6- The medication profile includes discrepancies in the frequency for administration of Celexa. Celexa is listed on the profile as 20 mg 1 tablet twice weekly and also instructions to take 1 tab daily. (corrected on site) Patient #9-The medication profile includes Hydroxyzine 25 mg 1 tab q4h allergies (scheduled). This was to be on an as needed basis for allergies.

Upon patient record review, 5 of 14 (Patient #3, #4, #7, #9, #10) did not evidence that the comprehensive assessment includes an initial bereavement assessment completed within the 5 days. Patient #3-The patient was admitted 11/02/22 and the Bereavement risk assessment was performed 11/12/22. Patient #4-The patient was admitted 03/06/23 and the Bereavement risk assessment was performed 03/21/23. Patient #7, #9, #10-Bereavement risk assessments are not on record. (corrected on site)

Upon patient record review, 7 of 14 (Patient #1, #2, #3, #4, #5, #7, #9) did not have evidence the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including specific orders for all medications and treatments. Patient #1- On admission referral orders were received to remove staples from the patient's scalp. The orders were not included in the plan of care. The 07/17/23 plan of care includes orders for the nurse to instruct the patient regarding management of Foley Catheter. The orders are not specific for Foley size/balloon size and frequency/indications for catheter changes. The patient was admitted with a surgical wound on the scalp. The plan of care does not address management of the scalp wound. On 07/19/23 orders were written to update the plan of care for Valium as follows: Valium 5mg1 suppository three times daily as needed for seizures. The orders state may repeat X 1 if needed. The time interval/indications for repeat dosing is not specified in the orders.(corrected on site) Patient #2-The plan of care includes Morphine 10 mg every three hours prn breakthrough pain. The dosage of 10 mg should have been discontinued when Morphine was increased on 07/06/23 to 15 mg every 3 hours prn for breakthrough pain. Both doses of Morphine are listed as active medications on the plan of care. On 07/17/23 the nurse documented Fentanyl was increased to 50 mcg/hr 1 patch topically every 3rd day. The plan of care was not updated with orders to increase Fentanyl. (corrected on site) Patient #3- Polyethylene Glycol 17 gm oral packet powder is ordered as needed for constipation. The plan of care does not include a diluent or frequency.(corrected on site) Patient #4-The plan of care includes duplicate/unclear doses for Sertraline. Effective 03/06/23 the plan of care includes Sertraline 100 mg tab 1 tab daily for depression. The plan of care also includes Sertraline 25 mg 1 tab daily for depression. Discharge orders on record from an ER visit were for the nurse to remove sutures from the patients left ear on 06/25/23. Orders for suture removal were not written to update the plan of care. Patient #5-The plan of care includes 06/13/23 Methadone 10 mg 1 tab three times daily. The dosage of 10 mg should have been discontinued when Methadone was increased on 06/29/23 to 10 mg 2 tabs every 8 hours. Both doses of Methadone are listed as active medications on the plan of care. The plan of care includes 05/04/23 Morphine 100 mg/5ml .5 ml hourly prn pain. The dosage of .5ml should have been discontinued when Morphine was increased on 06/29/23 to 100 mg/5ml 1ml hourly prn pain. Both doses of Morphine are listed as active medications on the plan of care. (corrected on site) Patient #7-The 07/14/23 plan of care includes orders to teach the patient management of gastrostomy. The orders do not specify dressing changes or flushes to be administered. (corrected on site) Patient #9-The plan of care includes Hydroxyzine 25 mg 1 tab q4h allergies (scheduled). This was ordered as needed basis for allergies. (corrected on site)

Upon patient record review, 5 of 14 (Patient #1, #2, #3, #9, #10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1- On 07/29/23 on call received a call that the patient complained of insomnia. The nurse documented instructing the patient to administer one dose of Lorazepam and if not effective may administer a second dose in 1 hour. The orders on record were for Lorazepam 1 mg every 4 hours prn anxiety. There are no orders on record to repeat dosing in 1 hour if not effective. (corrected on site) Patient #2- On 07/01/23 Spiritual care is ordered three times monthly for 1 month. The patient was visited twice in July on 07/15/23 and 07/27/23. There is no documentation regarding the missed spiritual care visit. (corrected on site) Patient #3-The 06/30/23 plan of care includes orders for the nurse to perform wound care to the patients right and left heel twice weekly. The nurse performed wound care once weekly between 07/07/23 and 07/26/23. There are no documented reasons for missed visits on record. On 07/01/23 Spiritual Care is ordered to be provided three times monthly for one month. The Chaplain visited once in July on 07/03/23. There is no documentation regarding the missed visits. (corrected on site) Patient #9-On 06/06/23 the social worker was ordered to visit the patient three times monthly for three months. Visits were made once monthly on 06/08/23 and 07/26/23. On 06/08/23 the Spiritual Care Provider was ordered to visit the patient four times monthly for 3 months. The patient was visited twice monthly on 06/08/23, 06/19/23, 07/13/23 and 07/26/23. (corrected on site) Patient #10-On 06/12/23 the social worker was ordered to visit the patient three times monthly for three months. There is one documented missed visit in July; however there is no documentation regarding the other two missed visits. On 07/01/23 the Spiritual Care Provider was ordered to visit the patient three times monthly for 3 months. The patient was visited once in July on 07/25/23. There is no documentation regarding the missed visits. (corrected on site)

Upon patient record review, 3 of 14 (Patient #1, #4, #8) did not have evidence in the patient record that hospice aide assignments and duties are: • Complete written patient care instructions for a hospice aide Patient #1-The Aide care plan does not include the following precautions that are applicable to the patients care: 02 precautions, seizure precautions, amputation precautions, fall precautions and Foley cath precautions. (corrected on site) Patient #4-The record documents the patient had three falls between 06/07/23 and 07/15/23. The Aide care plan does not include fall precautions. (corrected on site) Patient #8- The Aide care plan does not include fall precautions and dementia precautions which were identified safety precautions.

Upon patient record review 1 of 14 (Patient # 1) did not evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group and included in the plan of care. Patient #1-The Aide was assigned to check vital signs each visit and report findings outside of established parameters. On 07/27/23 the Aide documented the task was not completed. On 08/01/23, 08/03/23 and 08/08/23 the Aide documented the tasks had already been performed. The documentation did not specify who performed the tasks and/or results. Vital signs were not performed on these dates.

Upon personnel record review, 1 of 13 (Personnel #6) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel #6-A skills competency assessment is not on record.

Upon patient record review, 1 of 14 (Patient # 11) did not have evidence that the discharge summary includes all required information. Patient #11- Patient revoked services on 07/18/23. The discharge summary does not include a summary of the patient's stay, including treatments, symptoms and pain management. The summary only documents the patient discharged to seek aggressive treatment .

Based on record review and interview, the hospice failed to ensure imminence of death was assessed during the comprehensive assessment for seven (Patients #6, 8, 9, 11, 12, 13 and 14) of 14 patients. --- Patient #6 A review of the Initial Assessment dated 12/08/22 showed no assessment of imminence of death. Patient #8 A review of the Initial Assessment dated 05/03/23 showed no assessment of imminence of death. Patient #9 A review of the Initial Assessment dated 05/04/23 showed no assessment of imminence of death. Patient #11 A review of the Initial Assessment dated 10/26/22 showed no assessment of imminence of death. Patient #12 A review of the Initial Assessment dated 05/02/23 showed no assessment of imminence of death. Patient #13 A review of the Initial Assessment dated 06/28/22 showed no assessment of imminence of death. Patient #14 A review of the Initial Assessment dated 10/16/22 showed no assessment of imminence of death. On 05/17/23 at 2:25 pm, Staff B stated imminence of death was not assessed on the comprehensive assessment for Patients #6, 8, 9, 11, 12, 13, and 14.

Based on record review and interview, the hospice failed to ensure the plan of care was fully developed to include all services necessary for the palliation and management of the terminal illness for twelve (Patients #1, 2, 3, 5, 6, 7, 8, 9, 10, 11,12 and 13) of 14 patients reviewed. --- Patient #1 A review of the plan of care dated 03/12/23 to 05/10/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #2 A review of the plan of care dated12/28/22 to 03/27/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #3 A review of the plan of care dated 02/07/23 to 04/07/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #5 A plan of care dated 02/17/23 to 04/17/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #6 A plan of care dated 03/12/23 to 05/10/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #7 A review of the plan of care dated 02/05/23 to 04/05/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #8 A review of the plan of care dated 05/03/23 to 07/31/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #9 A plan of care dated 05/04/23 to08/01/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #10 A plan of care dated 03/01/23 to 04/29/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #11 A plan of care dated 10/26/22 to 01/23/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #12 A plan of care dated 05/02/23 to 06/30/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #13 A plan of care dated 06/28/22 to 09/25/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. On 05/17/22 at 1:20 pm, Staff B stated the plans of care for Patients #1, 2, 3, 5, 6, 7, 8, 9, 10, 11, 12 and 13 failed to include services necessary for the palliation and management of the terminal illness.

Based on record review and interview, the hospice failed to ensure the plan of care was revised to reflect the presence of pressure ulcers for two (Patient #1 and 3) of 14 patients. --- Patient #1 A review of the plan of care dated 03/12/23 to 05/10/23 with plan of care updates dated 03/22/23 and 04/05/23 documented a primary diagnosis of Alzheimer's and showed a skilled nurse frequency of two visits per week for eight weeks. A physician's order dated 03/15/23 documented a wound care to cleanse the wound with wound cleanser twice weekly. A skilled nurse assessment dated 03/16/23 documented the presence of a Stage II pressure ulcer to the mid sacrum. A skilled nurse assessment dated 03/21/23 documented the presence of a Stage II pressure ulcer to the mid sacrum. A skilled nurse assessment dated 03/23/23 documented the presence of a Stage II pressure ulcer to the mid sacrum. A skilled nurse assessment dated 03/29/23 documented the presence of a Stage II pressure ulcer to the mid sacrum. Patient #3 A review of the plan of care dated 02/07/23 to 04/07/23 with plan of care updates dated 02/08/23, 02/22/23 and 03/08/23 documented a primary diagnosis of cerebral atherosclerosis and showed a skilled nurse frequency of one visit per week for nine weeks. A physician's order dated 02/17/23 documented a wound care order to apply Betadine to the 3rd toe of the left foot. A skilled nurse assessment dated 02/17/23 documented the presence of an open wound to third toe to the left foot. A physician's order dated 02/22/23 documented a wound care order to apply Neosporin to the 3rd toe of the left foot. A skilled nurse assessment dated 02/22/23 documented the presence of an open wound to third toe to the left foot. On 05/17/23 at 3:45 pm, Staff B stated the plan of care for Patients #1 and 3 should have been updated to reflect the presence and services provided for the treatment of wounds.

Based on record review and interview the hospice failed to ensure the hospice aide notified the supervising nurse of refusal of visits for two (Patients #5 and 7) of 14 patients. --- Patient #5 A review of the plan of care dated 02/17/23 to 04/17/23 showed a hospice aide frequency of two visits per week for eight weeks. A review of the clinical record showed the following: A hospice aide missed visit note dated 03/20/23 for the week of 03/19/23 to 03/25/23 showed no notification to the supervising nurse. Patient #7 A review of the plan of care dated 02/05/23 to 04/05/23 showed a hospice aide frequency of two visits per week for eight weeks. A review of the clinical record showed the following: A hospice aide missed visit noted dated 03/30/23 for the week of 03/26/23 to 04/01/23 showed no notification to the supervising nurse. On 05/17/23 at 3:25 am, Staff B stated there was no documentation of the hospice aide notifying the supervising nurse of missed visits for Patients #5 and 7.

Based on record review and interview, the agency failed to ensure a coordinated plan of care was developed with long term care facilities for three (Patients #1, 7 and 8) of 14 patients. --- Patient #1 A review of the clinical record and review of long-term care records showed no coordinated plan of care between the agency and the long-term care facility for the services necessary for the palliation and management of the terminal illness. Patient #7 A review of the clinical record and review of long-term care records showed no coordinated plan of care between the agency and the long-term care facility for the services necessary for the palliation and management of the terminal illness. Patient #8 A review of the clinical record and review of long-term care records showed no coordinated plan of care between the agency and the long-term care facility for the services necessary for the palliation and management of the terminal illness. On 05/17/23 at 3:35 pm, Staff B stated there was no coordinated plan of care with long term care facilities for Patients #1, 7 and 8.