Every finding on record at Arden Hospice of Southern Tennessee, LLC

Based on policy review, medical record review, observation and interview, the facility failed to ensure nursing staff updated the medication profile to reflect the current medications for 1 of 4 (Patient #1) sampled patients with home visits. The findings included: --- 1. Review of the facility policy "Medication Reconciliation" last revised 6/2019, revealed, "Hospice will reconcile patient’s medications at the time of admission and on an ongoing basis…At the time of initial assessment the RN [Registered Nurse] will create and document a complete list of medications…including dose, route, and frequency…Medications ordered while the patient is receiving care will be compared to the medication list/profile. The medication list/profile will be updated with each new or changed medication...” 2.  Medical record review for Patient #1 revealed a start of care (SOC) dated 3/22/2024 (Benefit Period 3/17/2025 – 5/15/2025), with a diagnosis of Neoplasm (mass) of Trachea (airway), and Lung.  Review of the medication profile revealed the following medications listed on the profile in the incorrect dosage: amlodipine besylate (treats high blood pressure) 5 milligrams (mg) one daily, Carvedilol (treats high blood pressure) 12.5 mg one daily, Isosorbide Mononitrate (treats chest pain) ER (Extended Release) 30 mg one daily. Observations in the home on 4/14/2025 at 1:15 PM, revealed the pharmacy pill pack documented to take amlodipine besylate 2.5 mg one daily, carvedilol 12.5 mg one twice a day, isosorbide mononitrate ER 60 mg one daily. The following medication was observed in the home and not listed on the hospice medication profile: eye vitamin one daily. In an interview on 4/14/2025 at 1:20 PM, Patient #1 confirmed her current medications and stated she was no longer taking the following medications: MiraLAX (treats constipation)17 Grams daily, calamine (treats itchiness and skin irritations) external lotion one application every 4 hours, hydrocortisone (treats skin itching redness and swelling) 1% (percent) cream 1 application three times a day, Mucinex dextromethorphan (treats cough) Maximum Strength 60-120 mg one tablet twice a day. During an interview on 4/14/2025 at 2:50 PM, the Executive Director confirmed Patient #1’s medications were not reconciled by the nurse.

Based on policy review, medical record review and interview, the facility failed to ensure the plan of care was followed for 3 of 14 (Patient #6, 7 and 9) sampled active hospice patients reviewed. The findings included: --- 1.Review of the facility policy "Physician Orders" with no origination or revision date, revealed, "Policy Nursing and other services that require a physician's order will be provided in accordance with a physician's order. Purpose to describe the requirements of physician orders...Care and services will be provided according to physician's orders. Orders are current and updates..."2. Medical record review for Patient #6 revealed a 50 year old female admitted on 3/15/2024 with the primary diagnosis of Parkinson’s Disease. Review of the plan of care dated 3/10/2025 revealed no volunteer services. Review of the interdisciplinary visits for Patient #6 revealed a volunteer visit was made on 4/2/2025.In an interview on 4/15/2025 at 9:00 AM, the Clinical Team Leader (CTL) confirmed there was no physicians order for the volunteer visit on 4/2/2025.3. Medical record review for Patient #7 revealed a 75 year old male admitted on 2/5/2025 with the primary diagnosis of Cancer of the pancreatic bile duct.  Review of the plan of care dated 2/5/2025 revealed no Volunteer services.Review of the interdisciplinary visits for Patient #7 revealed volunteer visits were made on 2/10/2025, 3/3/2025 and 3/7/2025.  Review of a Physician order dated 3/14/2025 (32 days after the volunteer services were initiated) revealed, volunteer services 1 time per week for 2 weeks and 2 times a week for 1 week to start 2/5/25 and end 3/8/2025.In an interview on 4/15/2025 at 10:00 AM, the Administrator stated there had been problems keeping up with the orders for volunteer services. The Administrator verified the volunteer visits should not have been made without a physician order.4. Medical record review for Patient #9 revealed a 93 year old male admitted on 10/26/2024 with the primary diagnosis of Alzheimer’s Disease. Review of the plan of care dated 1/4/2025 revealed no volunteer services.Review of the interdisciplinary visits for Patient #9 revealed volunteer visits were made on 3/31/2025 and 4/1/2025.  In an interview on 4/15/2025 at 9:45 AM the CTL confirmed there was no physicians order for the volunteer visit on 3/31/2025 and 4/1/2025.

Based on policy review, medical record review, and interview, the facility failed to ensure nursing staff performed a read back for verification of medication when receiving verbal or telephone orders for 1 of 14 (Patient #10) active hospice patients reviewed. The findings included: --- 1. Review of the facility policy “Medication Orders,” last revised 2/2022, revealed, “Hospice will minimize errors and misinterpretation of written or verbal orders…Verbal or telephone orders will be written down, read back for verification and confirmation received…” 2. Medical record review for Patient #10 revealed a start of care (SOC) dated 3/10/2025 (Benefit Period 3/10/2025 – 6/7/2025), with diagnoses of Heart Failure, Chronic Respiratory Failure, and Diabetes. Review of the Physician Order dated 4/3/2025 at 12:00 PM, revealed the following medication updates: Discontinued Medications: atorvastatin calcium (treats high cholesterol 80 mg (milligrams) one tablet at bedtime by mouth (start 3/10/2025, end 4/3/2025), folic acid (supplement) 1 mg tablet daily by mouth (start 3/10/2025, end 4/3/2025), magnesium oxide (treats low magnesium) 400 mg tablet daily by mouth (start 3/10/2025, end 4/3/2025), metformin (treats high blood sugar) 500 mg tablet twice a day by mouth (start 3/10/2025, end 4/3/2025). The Order Details revealed the order was not checked for “…Order Read Back and Verified…” The order was electronically signed by the nurse on 4/4/2025 at 4:25 PM and the physician on 4/4/2025 at 5:00 PM. Review of the Physician Order dated 4/7/2025 at 1:00 PM, revealed the following medication updates: New Medications: furosemide (treats fluid overload) 40 mg tablet daily by mouth (start 4/7/2025, end 4/10/2025), furosemide 20 mg tablet daily by mouth (start 4/11/2025). Discontinued Medications: Lasix (treats edema) 40 mg by mouth daily (start 3/10/2025, end 4/7/2025).  The Order Details revealed the order was not checked for “…Order Read Back and Verified…” The order was electronically signed by the nurse on 4/7/2025 at 7:18 PM, and the physician on 4/9/2025 at 5:45 PM. During an interview on 4/15/2025 at 2:55 PM, the Executive Director confirmed the order detail box was not checked to verify the order had been read back and verified by the nurse.

Based on policy review, medical record review, observation and interview, the facility failed to ensure nursing staff updated the medication profile to reflect the current medications for 2 of 3 (Patient #2 and 3) sampled patients with home visits. --- The findings included: 1. Review of the facility policy "Medications Mangement" last revised 5/1/2017, revealed, "It is the policy of the Company that nurses will review patient's medications on all routine visits..." Review of the facility policy "Medications- Profile" revealed, "...The patient's medication profile is reviewed by the IDG [Interdisciplinary Group] whenever there is a significant change, and at a minimum, every fourteen (14) days..." 2. Medical record review for Patient #2 revealed a start of care (SOC) dated 2/16/2023 with a diagnosis of End stage renal disease with discontinuation of dialysis. Review of the medication profile revealed the following medications listed on the profile in the incorrect dosage: Entresto 24 milligram (mg)- 26 mg oral tablet take one tablet daily. Observations in the home on 2/21/2023 at 10:00 AM revealed the medication bottle documented to take Entresto one tablet two (2) times daily. Further, the following medications were observed in the home and were not listed on the hospice medication profile: Metoprolol 25 mg twice daily, Sevelamer carbonate 800 mg three (3) times daily. In an interview on 2/21/2023 at 10:08 AM, Patient #2's son stated he was giving all the medications to his father, as they were listed on the medication bottles. 3. Medical record review for Patient #3 revealed a SOC date of 6/7/2022 with a diagnosis of Chronic Ischemic Heart Disease. Observations on 2/22/2023 at 9:30 AM, revealed the following medications documented on the medication profile that were not in the home: Ativan 0.5 mg take one (1) tablet every eight (8) hours as needed and Lopenamide (Loperamide) 0.5 mg tablet administer one (1) tablet every other day. In an interview on 2/22/2023 at 9:30 AM, Patient #3's wife verified the above medications were not in the home.

Based on policy review, document review, medical record review and interview, the facility failed to ensure the clinical records for discharge were documented accurately for 1 of 3 (Patient #6) discharge records reviewed. --- The findings included: 1.Review of the facility policy "Discharge" revised 1/1/2022, revealed "[name of facility] follows a consistent plan for discontinuance of services..." PROCEDURE 1. A patient may be discharged from hospice under the following circumstances: the patient moves outside the geographical area serviced by the hospice or transfers to another hospice. 3. When a patient is discharged from hospice (and not transferring to another hospice), s/he is no longer covered under the Medicare Hospice Benefit, resumes Medicare coverage of the benefits waived by the election of hospice care and may, at any time, elect to receive hospice care again in the future..." 2. Patient #6 was documented as a revocation on the hospice list of revocations for the past 6 months. 3. Medical record review for Patient #6 revealed a start of care dated 1/25/2023 with a diagnosis of Chronic obstructive pulmonary disease. A hospice revocation form was signed by an Registered Nurse, with verbal consent given by Patient #6's son to revoke the hospice benefit on 1/31/2023. Review of nursing communication notes dated 1/31/2023 revealed Patient #6's son had been designated Power of Attorney and Patient #6 would be moving to another state to live with her son and would be discharged from hospice services. There was no documentation the family wished to revoke the hospice benefit. 4. In a telephone interview on 2/22/2023 at 12:54 PM, the Administrator stated, "It would have been more appropriate to discharge her [Patient #6] and not complete a revocation.