Every finding on record at Anova Hospice Palliative Care Services Inc.

Based on review of clinical records (CR) and staff interview (EMP), The facility failed to ensure the patient Plan of Care included a detailed statement of the scope and frequency of volunteer visits for three (3) of three (3) clinical records reviewed (CR1, CR2, CR3). --- Findings Included: Review of CR1 on 4/13/23 at approximately 11:45 am and continued 4/14/23 on site revealed: Start of care 4/26/2018. Reviewed certification period (Plan of Care) 3/16/2023 to 5/14/2023. SN (Skilled nursing) visits for period reviewed - 2 times a week, 5 PRN (as needed) (decline/symptom management), MSW (Social Worker) 2 times a month, 4 PRN (For decline in condition, changes in patients anxiety...additional emotional support...) Services accepted: RN (registered nurse), MSW, Volunteer...Services Declined: Spiritual, Aide... CR1 Plan of Care noted volunteer services were accepted but did not include documentation a detailed statement of the scope and frequency of volunteer visits. Review of CR2 on 4/14/2023 at approximately 12:05 pm on site revealed: Start of care 8/11/2018, Reviewed certification period (Plan of Care) 3/18/2023 to 5/16/2023, SN visits for period reviewed - once a week, 5 PRN...MSW 2 times a month, 4 PRN...Services accepted: RN, MSW, Volunteer...Services Declined: Spiritual, Aide... CR2 Plan of Care noted volunteer services were accepted but did not include documentation a detailed statement of the scope and frequency of volunteer visits. Review of CR3 on 4/14/23 at approximately 1:30 pm on site realed the following: Start of care 11/19/2020, Reviewed certification period 3/9/2023 to 5/7/2023, SN visits for periods reviewed – 2 times a week, 5 PRN...Services accepted: RN, Volunteer...Services Declined: Spiritual, Aide, MSW... CR3 Plan of Care noted volunteer services were accepted but did not include documentation a detailed statement of the scope and frequency of volunteer visits. An exit conference was conducted via telephone on 4/20/23 at approximately 12:05 pm with facility Vice President (EMP2). Above findings were reviewed.

Based on review of clinical records (CR), facility policy and procedure, and interview with staff (EMP), the facility failed to ensure the patient plan of care included all services necessary for the palliation and management of the terminal illness and related conditions, specifically, failed to revise/update the patient medication profile for changes to the patient medication regimen for two (2) of three (3) clinical records reviewed (CR1, CR2). --- Findings included: Facility policy review conducted on 4/20/23 revealed the following: ";Medication Profile; Policy No. 2-004...Patients receiving medications administered by the organization will have a current, accurate medication profile in the clinical record. The medication profiles will be updated for each change to reflect current medications, and new and/or discontinued medications...2. A drug regimen review will be performed...when updates to the comprehensive assessments are performed, when care is resumed after a patient has been placed on hold, and with addition of a new medication. 5. Based on the review of the medication profile as well as the written material, changes in the plan of care may be required..." Review of CR1 on 4/13/23 start at approximately 11:45 am and continued 4/14/23 on site; Further reviews were conducted off-site and completed 4/20/2023. Start of care 4/26/2018. Review of certification period 3/16/2023 to 5/14/2023 revealed current medication profile that included (but was not limited to): CR1 documented a physician order dated 11/9/2021, "...Roxanol 20mg/mL (milligrams/milliliters) oral concentrate, 10 mg (0.5mL), every 2 hours PRN (as needed), Reason for order: pt needing MS (Morphine Sulfate) for [Shortness of breath] ..." CR1 did not have the updated Roxanol medication order documented on the patient medication profile. Review of CR2 on 4/14/23 at approximately 12:05 PM on site: Start of care 8/11/2018. Review of certification period 3/18/2023 to 5/16/2023 revealed current medication profile that included (but was not limited to): CR2 documented physician order (e-script) for Roxanol dated 9/6/2022 – "...increased dosage to morphine concentrate 100mg/5mL (20mg/mL) oral solution, Take 1 ½ (one and one half) mL by mouth every hour as needed, 30 mg Every hour as needed for Shortness of breath or pain..." CR2 did not have the updated Roxanol medication order documented on the patient medication profile. An exit conference was conducted via telephone on 4/20/23 at approximately 12:05 pm with facility Vice President (EMP2). Above findings were reviewed.

Based on review of clinical records (CR), facility policy and procedure, and interview with staff (EMP), the facility failed to ensure that progress towards hospice goals were reviewed during the interdisciplinary team (IDT) meetings for one (1) of three (3) clinical records for whom a change condition or incident was identified/reported and for whom an IDT meeting was conducted after establishment of the recertification "Hospice Plan of Care" (CR1). --- Findings included: Facility policy review conducted on 4/20/23 revealed the following: ";Medication Profile; Policy No. 2-004...Patients receiving medications administered by the organization will have a current, accurate medication profile in the clinical record. The medication profiles will be updated for each change to reflect current medications, and new and/or discontinued medications...2. A drug regimen review will be performed...when updates to the comprehensive assessments are performed, when care is resumed after a patient has been placed on hold, and with addition of a new medication. 5. Based on the review of the medication profile as well as the written material, changes in the plan of care may be required..." Review of CR1 on 4/13/23 start at approximately 11:45 am and continued 4/14/23 on site; Further reviews were conducted off-site and completed 4/20/2023. Start of care 4/26/2018. Review of certification period (Plan of Care - "POC") 3/16/2023 to 5/14/2023 revealed: CR1 POC medication profile documented "Allergies: NKA (no known allergies)" and documented medication " Xanax (Alprazolam) 2 mg Tablet, oral, QHS (at hours of sleep), purpose: insomnia." Patient CR1 hospitalized 3/20/23 to 3/22/23. The hospital ";After Visit Summary" included (but was not limited to) the following: "...Instructions: Your medications have changed: ...Start taking: ...Alprazolam 2mg tablet...Take 1 tablet (2mg total) by mouth 3 times a day for 7 days...Allergies: Ambien (Zolpidem); Reactions: Not noted..." There was no documentation on the "IDT Notes" which provided evidence that the IDT reviewed/addressed CR1 patient discharge status changes related to Alprazolam medication regimen and Ambien (medication) allergy during the IDT meeting conducted 3/30/2023 (post hospitalization meeting). An exit conference was conducted via telephone on 4/20/23 at approximately 12:05 pm with facility Vice President (EMP2). Above findings were reviewed.