Every finding on record at Billet Hospice Inc - Las Vegas

Upon patient record review 1 of 11 (Patient #4) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #4: There is evidence patient was admitted on 5/8/25. The psychosocial assessment was conducted on 5/30/25

Upon patient record review, 1 of 11 (Patient #3) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient #3: There is no evidence in the medical record the nursing comprehensive assessment took into consideration the imminence of death.

Upon patient record review, 1 of 11 (Patient #2) 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 #2: Upon observation of the home visit the medication flonase allergy relief suspension 50 mcg/act 1 ml BID was on the patients medication list, however it was not on the hospice medication list.

Upon patient record review, 1 of 11 (Patient #4) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #4: There is evidence in the medical record, the patient was admitted on 5/8/25. The bereavement assessment was conducted on 5/30/25.

Upon patient record review, 1 of 11 (Patient #1) 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 #1: There is evidence on the initial nursing assessment "appetite decreased, weight loss more than 10 lbs. in last month. There is no plan of care with problem/interventions/goals for nutrition. Additionally the patient was admitted with lung cancer, his pulse ox was 88% on admission and he is on oxygen as needed. There is no plan of care with problem/interventions/goals for respiratory.

Upon patient record review, 1 of 11 (Patient #1) 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: There is evidence on the initial nursing assessment that the patient has a colostomy. The aide plan of care indicates to empty colostomy every visit. There is no order for colostomy care.

Upon patient record review, 1 of 11 (Patient #2) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2: There is evidence on the plan of care for chaplain frequency 1xweek. The chaplain is visiting once monthly.

Upon patient record review, 1 of 11 (Patient #2) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #2: There is evidence on the nursing recertification assessment that the nurse "educated the patient on aspiration precautions", also the physician F2F noted "difficulty swallowing some foods". The aide plan of care did not have aspiration precautions.

There is no evidence that all patient records are retained for a minimum of six years from the date of the most recent discharge or the death of the patient, unless state law stipulates a longer period of time. Three patient records from 2022 are missing.

Upon patient record review, 1 of 11 (Patient #11) did not have evidence that the hospice forwarded a summary and a copy of the patient record, if requested, to a facility when transferring the patient to that facility. Patient #11: There is evidence on 1/17/24 the patient was transferred to another Medicare facility. There is not evidence of a transfer summary.

Upon observation and personnel record review, 4 of 13 (Personnel 8,11,12,13) there is no evidence the hospice conducted a fingerprint-based criminal history background check based on Nevada Revised Statutes (NRS) 449.176 through NRS 449.188 on each employee and each independent contractor. Under NRS 449, you must conduct a fingerprint-based criminal history background check on each employee and each independent contractor if you are the administrator of, or you are licensed to operate, any of the following: •Agency to provide nursing in the home. Personnel #8,11,12,13: There was no evidence the contractors had a fingerprint based criminal history background check.

Upon observation and personnel record review, 9 of 13 (Personnel 1,2,3,4,5,6,7,9,10) there is no evidence the hospice conducted a fingerprint-based criminal history background check based on Nevada Revised Statutes (NRS) 449.176 through NRS 449.188 on each employee and each independent contractor. Under NRS 449, you must conduct a fingerprint-based criminal history background check on each employee and each independent contractor if you are the administrator of, or you are licensed to operate, any of the following: •Agency to provide nursing in the home. Personnel #1,2,3,4,5,6,7,9,10: There was no evidence any of the agency employees had a fingerprint based criminal history background check.