Every finding on record at Azelea Hospice, LLC

Based on observation, clinical record review and staff interview it was determined that the agency failed to ensure that patient medication profiles were updated to reflect current medications at the time of the comprehensive assessment for two of seven patients (P) (P#1 and P#2). The findings include: 1. A home visit was conducted on 10/5/21, at approximately 8:15 a.m. at the residence of P#1 with Registered Nurse (RN) #CC. The patient was admitted to hospice on 4/27/21, with the hospice diagnosis of Alzheimer's disease. The surveyor compared P#1's current medication list in the agency's electronic medical record (EMR) to the medications in P#1's record at the personal care home (PCH) in which P#1 resides. P#1 had the following medications listed on the agency's EMR, but the medications were not listed on P#1's record at the PCH: a. Bisacodyl Rectal Suppository 10 mg (milligrams) which is used to manage constipation. b. Hyoscyamine Sulfate Oral Tablet 0.125 mg which is used to manage secretions. c. Lorazepam Oral Tablet 1 mg which is used to manage anxiety, agitation, or shortness of breath. d. Promethazine HCl (hydrogen chloride) Oral Tablet 25 mg which is used to manage nausea or vomiting. e. Acetaminophen Rectal Suppository 650 mg which is used to manage fever. f. Morphine Sulfate Concentrate Oral Solution 20 mg/ml which is used to manage shortness of breath or pain. g. Senna S Oral Tablet 8.6-50 mg which is used to manage constipation. The following medications were listed on P#1's record at the PCH but were not listed in the agency's EMR: a. Aspirin EC (enteric coated) 325 mg which is used as an anticoagulant. b. Rosuvastatin 5 mg which is used to manage hyperlipidemia. 2. A home visit was conducted on 10/5/21, at approximately 9:00 a.m., at the residence of P#2 with RN #CC. The patient was admitted to hospice on 4/30/21, with the hospice diagnosis of Alzheimer's disease. The surveyor compared P#2's current medication list in the agency's EMR to the medications in P#2's record at the PCH in which P#2 resides. P#2 had the following medications listed on the agency's EMR, but the medications were not listed on P#2's record at the PCH: a. Bisacodyl Rectal Suppository 10 mg which is used to manage constipation b. Haloperidol Oral Tablet 1 mg which is used to manage agitation. c. Hyoscyamine Sulfate Oral Tablet 0.125 mg which is used to manage secretions. d. Promethazine HCl (hydrogen chloride) Oral Tablet 25 mg which is used to manage nausea or vomiting. e. Acetaminophen Rectal Suppository 650 mg which is used to manage fever. f. Morphine Sulfate Concentrate Oral Solution 20mg/ml which is used to manage shortness of breath or pain. g. Lorazepam Oral Tablet 1 mg which is used to manage anxiety, agitation, or shortness of breath. h. Colace Oral Capsule 100 mg which is used to manage constipation. It was noted P#2's record at the PCH contained the medication Potassium Chloride 20 meq (milliequivalents), which is used as a potassium supplement. However, it was not listed in the agency's EMR: During interview with RN #CC at the residence of P #1 and P#2 at approximately 9:00 a.m., on 10/5/21, RN #CC acknowledged that the medications in the agency's EMR did not match the medications on record at the residence of P#1 and P#2. In an interview at the agency at 11:30 a.m. on 10/6/21, the agency Administrator was made aware of these findings.

Based on clinical record review, it was determined that the hospice failed to ensure that the plan of care failed to include a complete physician's order for three of seven patients (P) (P#3, P#6 and P#7). The findings include: 1. Patient #3 was admitted to hospice on 6/9/21, with the hospice diagnosis of heart failure. P#3's clinical record was reviewed for the certification period 10/3/21 to 12/1/21. On 8/4/21, the following incomplete physician's orders were entered into P#3's clinical record: a. Hydralazine hydrogen chloride oral tablet 50 mg (milligrams), a medication used to manage hypertension, was ordered for the patient but lacked route of administration in the instructions. b. Mylanta Oral Suspension 200-200-20 mg/ml, a medication used to manage indigestion, was ordered for the patient but lacked a route of administration in the instructions. c. Lisinopril Oral Tablet 20 mg, a medication used to manage hypertension, was ordered for the patient but lacked a route of administration in the instructions. d. Amlodipine Besylate Oral tablet 5 mg, a medication used to manage hypertension, was ordered for the patient but lacked a route of administration in the instructions. e. Tramadol hydrogen chloride oral tablet 50 mg, a medication used to manage pain, was ordered for the patient but lacked a route of administration in the instructions. f. Sertraline hydrogen chloride oral tablet 50 mg, a medication used to manage depression, was ordered for the patient but lacked a route of administration in the instructions. g. Potassium Chloride oral tablet extended release 20 meq (milliequivalents), a medication used to manage low potassium, was ordered for the patient but lacked a route of administration in the instructions. h. Colace oral capsule 100 mg, a medication used to manage constipation, was ordered for the patient but lacked a route of administration in the instructions. i. Aspirin oral tablet delayed release 325 mg, a medication used to manage blood clotting, was ordered for the patient but lacked a route of administration in the instructions. j. Dextromethorphan-guaifenesin oral liquid 20-200 mg/ml, a medication used to manage cough was ordered for the patient but lacked a route of administration in the instructions. k. Furosemide oral tablet 20 mg, a medication used to manage swelling, was ordered for the patient but lacked a route of administration in the instructions. 2. Patient #6 was admitted to hospice on 6/4/21, with the hospice diagnosis of Alzheimer's disease. P#6's clinical record was reviewed for the certification period 6/4/21 to 9/1/21. On 6/4/21 the following incomplete physician's orders were entered into P#6's clinical record: a. Acetaminophen rectal suppository 650 mg, a medication used to manage fever, was ordered for the patient but lacked a route of administration in the instructions. b. Hyoscyamine sulfate oral tablet 0.125 mg, a medication used to manage secretions, was ordered for the patient but lacked a route of administration in the instructions c. Dulcolax rectal suppository 10 mg, a medication used to manage constipation, was ordered for the patient but lacked a route of administration in the instructions. d. Lorazepam oral tablet 1 mg, a medication used to manage shortness of breath, anxiety or pain, was ordered for the patient but lacked a route of administration in the instructions. e. Morphine sulfate concentrate oral solution 20 mg/ml, a medication used to manage shortness of breath or pain, was ordered for the patient but lacked a route of administration in the instructions. 3. Patient #7 was admitted to hospice on 4/28/21, with the hospice diagnosis of chronic obstructive pulmonary disease. P#7's clinical record was reviewed for the certification period 5/9/21 to 7/7/21. On 4/28/21, the following incomplete physician's orders were entered into P#7's clinical record: a. Lorazepam oral tablet 1 mg, a medication used to manage shortness of breath, anxiety or pain, was ordered for the patient but lacked a route of administration in the instructions. b. Acetaminophen rectal suppository 650 mg, a medication used to manage fever, was ordered but lacked a route of administration in the instructions. During interview on 10/6/21, at 11:30 a.m. at the agency, the Administrator was made aware of the lack of complete physician's order for three of seven patients sampled.

Based on review of clinical documents, it was determined that the hospice failed to ensure that the plan of care contained specific individualized frequencies of tasks to be performed by the hospice aide for five of seven patients (P) (P#1, P#2, P#5, P#6 and P#7). The findings include: 1. The clinical record for patient #1 was reviewed for certification period 9/1/21 to 10/30/21. P#1 was admitted to hospice on 4/27/21, with a diagnosis of Alzheimer's disease. Upon review of the record, it was revealed that P#1 had an order for a hospice aide to visit three times per week. However, the plan of care signed by the IDT (Interdisciplinary team) for P#1 did not have goals or interventions listed for the services the hospice aide was to provide to P#1. 2.The clinical record for patient #2 was reviewed for certification period 8/26/21 to 10/24/21. P#2 was admitted to hospice on 4/30/31, with the diagnosis of Alzheimer's disease. Upon review of the record, it was revealed that P#2 had an order for a hospice aide to visit three times per week. However, the care plan signed by the IDT for P#2 did not have goals or interventions listed for the hospice aid to provide to P#2. 3. The clinical record for patient #5 was reviewed for certification period 6/9/21 to 9/6/21. P#5 was admitted to hospice on 6/9/21, with the diagnosis of cirrhosis of the liver. Upon review of the record, it was revealed that P#5 had an order for a hospice aide to visit three times per week. However, the care plan signed by the IDT for P#5 did not have goals or interventions listed for the hospice aid to provide to P#5. 4. The clinical record for patient #6 was reviewed for certification period 6/4/21 to 9/1/21. P#6 was admitted to hospice on 6/4/21, with the diagnosis of Alzheimer's disease. Upon review of the record, it was revealed that P#6 had an order for a hospice aide to visit three times per week. However, the care plan signed by the IDT for P#6 did not have goals or interventions listed for the hospice aid to provide to P#6. 5. The clinical record for patient #7 was reviewed for certification period 5/9/21 to 7/7/21. P#7 was admitted to hospice on 4/28/21, with the diagnosis of chronic obstructive pulmonary disease. Upon review of the record, it was revealed that P#7 had an order for a hospice aide to visit three times per week. However, the care plan signed by the IDT for P#7 did not have goals or interventions listed for the hospice aid to provide to P#7. In an interview at 11:30 a.m. on 10/6/21 at the agency, the Administrator was informed that plan of care for five of seven hospice patients (P#1, P#2, P#5, P#6 and 7) reviewed did not reflect the specific individualized frequencies of individual tasks to be performed by the hospice aide.

Based on clinical record review, it was determined that the hospice failed to ensure a coordinated plan of care that specifically identified the provider responsible for each intervention included in the plan of care for four of seven sampled patients (#1, #2, #3 and #7). The findings include: 1. Patient #1 was admitted to hospice on 4/27/21. with the diagnosis of Alzheimer's disease. The clinical record for P#1 was reviewed for certification period 9/1/21 to 10/30/21. P# 1's clinical record revealed that the patient resided at a Personal Care Home (PCH). The hospice plan of care did not identify the specific provider and discipline at both the hospice and the PCH that would be responsible and accountable for each intervention, task, and function related to P#1's care and service. 2. Patient #2 was admitted to hospice on 4/30/21, with the diagnosis of Alzheimer's disease. The clinical record for P#2 was reviewed for certification period 9/26/21 to 10/24/21. P#2's clinical record revealed that the patient resided a PCH. The hospice plan of care did not identify the specific provider and discipline at both the hospice and the PCH that would be responsible and accountable for each intervention, task, and function related to P#2's care and service. 3. Patient #3 was admitted to hospice on 8/4/21, with the diagnosis of heart failure. The clinical record for P#3 was reviewed for certification period 10/3/21 to 12/1/21. P#3's clinical record revealed that the patient resided at an Assisted Living Facility (ALF). The hospice plan of care did not identify the specific provider and discipline at both the hospice and the ALF that would be responsible and accountable for each intervention, task, and function related to P#3's care and service. 4. Patient #7 was admitted to hospice on 4/28/21, with the diagnosis of chronic obstructive pulmonary disease. The clinical record for P#7 was reviewed for certification period 5/9/21 to 7/7/21. P#7's clinical record revealed that the patient resided PCH. The hospice plan of care did not identify the specific provider and discipline at both the hospice and the PCH that would be responsible and accountable for each intervention, task, and function related to P#7's care and service. During interview on 10/5/21, at 11:30 a.m. at the agency, the Administrator was made aware that the plans of care for four of seven patients (P#1, P#2, MP3# and P#7) did not identify the provider responsible for each intervention included in the plans of care.