Every finding on record at Anodyne Palliative Services, LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over the counter (OTC) drugs, supplements, herbal remedies, other alternative treatments that could affect drug therapy. This standard was not met as evidenced by clinical record review and interview. In 3 of 14 (21%) clinical records reviewed it was revealed that the current drug profile did not contain the patient's current prescriptions and over the counter drugs or alternative treatments that could affect drug therapy. CLINICAL RECORD 3: The patient elected the benefit on 01/08/2026. A review of the comprehensive assessment dated 01/08/2026 and the plan of care dated 01/08/2026-04/07/2026 included documentation the patient was ordered Oxygen 2-4 L via nasal cannula as needed. There was no documented evidence that oxygen was on the patient’s drug profile CLINICAL RECORD 5: The patient elected the benefit on 12/16/2025. A review of the comprehensive assessment dated 12/16/2025 and the plan of care dated 12/16/2025-02/13/2025 included documentation the patient was ordered Oxygen 2-4 L via nasal cannula as needed. There was no documented evidence that oxygen was on the patient’s drug profile CLINICAL RECORD 6: The patient elected the benefit on 09/10/2025. A review of the comprehensive assessment dated 09/10/2025 and the plan of care dated 12/16/2025-02/13/2025 included documentation the patient was ordered Oxygen 2-4 L via nasal cannula as needed. There was no documented evidence that oxygen was on the patient’s drug profile Following a joint record review and discussion with the Administrator (Personnel Record 1) on 01/13/2026, she confirmed that the oxygen in those records was not on the agency's current drug profile and that is the expectation of the agency to have oxygen on the medication list.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group and written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 8 (13% ) clinical records reviewed for patients receiving hospice aide service the agency did not ensure that the hospice aides are assigned to a specific patient by a registered nurse. CLINICAL RECORD 4: The patient elected the hospice benefit on 09/06/2025 with a primary diagnosis of Myelodysplastic Syndrome and a secondary diagnosis of Unspecified Dementia. The aide care plan dated 09/06/2025 included the task of bathing: bed bath—complete and assisted bath—chair. However, the record did not specify the circumstances or schedule for each bathing method. There was no documented evidence that the RN who was a member of the Interdisciplinary Group provided clear written patient care instructions for the hospice aide. Following a joint record review and discussion with the Administrator on 01/14/2026, it was determined that two bathing types were ordered on the hospice aide plan of care. It was also confirmed that this patient was not able to make independent choices regarding bathing due to their condition.

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. This standard was not met as evidenced by a review of clinical records and interviews. In 2 of 5 (40%) applicable records reviewed, it was revealed that the hospice did not ensure oxygen was documented on the drug profile. Clinical Record 5 - The patient was admitted on 11/23/2022 with a diagnosis of Alzheimer's Disease. The plan of care included oxygen 2-4 liters per nasal cannula. The patient was receiving oxygen continuously. Oxygen was not listed on the drug profile. The patient's date of death was 12/9/2022. Clinical Record 4 - The patient was admitted on 10/5/2022 with a diagnosis of CHF. The Plan of care included oxygen 2-4 liters per nasal cannula. The patient was receiving oxygen 2 liters per nasal canula continuously. Oxygen was not listed on the drug profile. The patient chose to seek additional treatment and was discharged on 10/11/2022. During joint record review and interview with the Administrator on 1/12/2023, she validated that oxygen was not documented on the drug profile.