Every finding on record at Best in the West Hospice Inc

Upon patient record review, 3 of 14 (Patient 1, 2 & 7) 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. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient 1 medication profile includes “A&D ointment topical to affected area to buttocks as needed for skin care” with no frequency. “Calmoseptine Topical Ointment 120g apply to affected area to buttocks as needed for skin care” with no frequency. “Ca-Rezz cream 71g topical to affected area to buttocks as needed for skin care” with no frequency Patient 2 medication profile includes "A&D Ointment topically to affected areas with incontinent care as needed for skin care" with no frequency. Patient 7 medication profile includes “Diclofenac Sodium 1% gel 5gms topically apply thin layer to affected area (lower back) as needed for pain” with no frequency. “Diflorasone Diacetate 0.05% Topical Cream 5gms apply thin layer to affected area (lower back) as needed for pain” with no frequency. “Rivastigmine 4.6mg/24hr transdermal patch apply topically to clean, dry and hairless area of skin on the upper or lower back, upper arm or chest” with no frequency.

Upon patient record review, 2 of 14 (Patient #4, 11) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 4 & 11 with no evidence of end of life care preferences on plan of care. End of life preference was "undecided".

Upon patient record review, 3 of 14 (Patient 1, 2 & 7) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 1 plan of care includes “A&D ointment topical to affected area to buttocks as needed for skin care” with no frequency. “Calmoseptine Topical Ointment 120g apply to affected area to buttocks as needed for skin care” with no frequency. “Ca-Rezz cream 71g topical to affected area to buttocks as needed for skin care” with no frequency Patient 2 plan of care includes "A&D Ointment topically to affected areas with incontinent care as needed for skin care" with no frequency. Patient 7 plan of care includes “Diclofenac Sodium 1% gel 5gms topically apply thin layer to affected area (lower back) as needed for pain” with no frequency. “Diflorasone Diacetate 0.05% Topical Cream 5gms apply thin layer to affected area (lower back) as needed for pain” with no frequency. “Rivastigmine 4.6mg/24hr transdermal patch apply topically to clean, dry and hairless area of skin on the upper or lower back, upper arm or chest” with no frequency.

Upon patient client record review, 2 of 14 (Patient 2 & 11) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient 2 and 11 "Authorization form" signed by patient on admission is incomplete. The effective date of the election is blank.