Every finding on record at Blooming Life Hospice

Upon patient record review, 2 of 14(Patient #4,5) did not have evidence that the patient has received effective pain management and symptom control from the hospice for conditions related to the terminal illness. Patient #4: On admission the patient had a pain score of "8" with a self identified threshold to be "2", on 3/10/25 the nurse charted a pain score of "3" and did not report it to the RN, on 03/17/25 the nurse did not record any pain assessment. There was no continuous RN assessment for the documented uncontrolled pain. Patient #5: The patient called on 03/07/25 with complaints of chest pain, nitroglycerin was ordered. There was no follow up by the nurse until the next scheduled visit on 03/14/25. In addition, on admission the patient had a pain score of "8" to the lower back with burning to bilateral extremities with a pain score of "6", the self identified threshold for both was a "2", the LVN visit on 12/25/24, 12/31/24 also documented the pain level @ an "8", this was not reported to the RN. There was no continuous RN assessment for the documented uncontrolled pain.

Upon patient record review, 3 of 14 records reviewed (Patient #1, #4, #5) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #1: The patient called on 01/21/25 and reported an elevated blood pressure, there was no RN follow up until 01/25/25. Patient #4: On admission the patient had a pain score of "8" with a self identified threshold to be "2", on 3/10/25 the nurse charted a pain score of "3" and did not report it to the RN, on 03/17/25 the nurse did not record any pain assessment. There was no continuous RN assessment for the documented uncontrolled pain. Patient #5: The patient called on 03/07/25 with complaints of chest pain, nitroglycerin was ordered. There was no follow up by the nurse until the next scheduled visit on 03/14/25. In addition, on admission the patient had a pain score of "8" to the lower back with burning to bilateral extremities with a pain score of "6", the self identified threshold for both was a "2", the LVN visit on 12/25/24, 12/31/24 also documented the pain level @ an "8", this was not reported to the RN. There was no continuous RN assessment for the documented uncontrolled pain.

Upon patient record review, 7 of 14 records reviewed (Patient #1, #4, #5, #6, #8, #9, #10) 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: The patient had a baseline BP of 214/114, there was no individualized plan of care that reflected goals and interventions for what BP readings to report and to whom. COS In addition: On admission the patient had a pain level of "5" with a goal of "3", there was no individualized plan of care that reflected goals and interventions. COS. Patient #4: The patient was a full code and had no mortuary listed on admission, there was no plan of care to reflect interventions and or patient family goals. COS. Patient #5: The patient was a full code and had no mortuary listed on admission, there was no plan of care to reflect interventions and or patient family goals. COS. Patient #6: The patient was a full code and had no mortuary listed on admission, there was no plan of care to reflect interventions and or patient family goals. COS. In addition, the patient had a pain score of "6" on admission with documentation stating the pain medication is effective per the patient, there was no plan of care to reflect interventions and or patient family goals. COS. Patient #8: The patient was a full code and had no mortuary listed on admission, there was no plan of care to reflect interventions and or patient family goals. COS. Patient #9: The patient was a full code and had no mortuary listed on admission, there was no plan of care to reflect interventions and or patient family goals. COS. Patient #10: The patient was a full code and had no mortuary listed on admission, there was no plan of care to reflect interventions and or patient family goals. COS.

Upon patient record review, 3 of 14 records reviewed (Patient #1, #4, #5) 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 equipment and supply needs. Patient #1: The patient had a cane, shower chair, wheelchair, suction and oxygen. These DME needs were not listed in the plan of care. COS. Patient #4: The patient had a nebulizer. This DME was not listed in the plan of care. COS. Patient #5: The patient had a walker with seat. This DME was not listed in the plan of care. COS.

Upon client record review, 5 of 14 records reviewed (Patient #6, #7, #8, #9, #10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #6: The social worker made a visit on 01/02/25 and 02/01/25, the chaplain made a visit on 02/24/25. There were no order frequencies for these visits. COS. Patient #7: The social worker made a visit on 02/23/25 and the chaplain made a visit on 02/18/25. There where no order frequencies for these visits. COS. Patient #8: The social worker made a visit on 01/20/25 and the chaplain made a visit on 01/14/25. There were no order frequencies for these visits. COS. Patient #9: The social worker made a visit on 12/06/24 and the chaplain made a visit on 12/02/24. There were no order frequencies for these visits. COS. Patient #10: The social worker made a visit on 12/06/24, 03/02/25 and the chaplain made a visit on 12/01/24. There were no order frequencies for these visits. COS

Upon patient record review, 1 of 14 (Patient #9) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient's life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination: • The primary terminal condition • Related diagnosis • Current subjective and objective medical findings • Current medication and treatment orders • Information about the medical management of any of the patient's conditions unrelated to the terminal illness Patient #9: The certification for period 09/05/24 to 12/03/24 did not have a narrative that included individual clinical circumstances.

Upon patient record review, 6 of 14 (Patient #1,2,3,8,9,10) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient's clinical information and provide written documentation that it is anticipated that the patient's life expectancy is 6 months or less. Patient #1: There was no narrative on the 2nd recertification for time period 03/07/25 - 06/04/25. Patient #2: There was no narrative on the 9th recertification for time period 01/23/25 - 03/23/25. Patient #3: There was no narrative on the 2nd recertification for time period 02/02/25 - 05/02/25. Patient #8: There was no narrative on the 2nd recertification for time period 01/20/25 -04/19/25. Patient #9: There was no narrative on the 3rd recertification for time period 03/04/25 - 05/02/25. Patient #10: There was no narrative on the 3rd recertification for time period 03/02/25 - 04/30/25.

Upon patient record review, 5 of 5 records (Patient #1,#2,#3,#4,#5,) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death.

Upon patient record review, 1 of 5 records (Patient #3) 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. Patient 3: The medication profile contains Magnesium Oxide 400mg, 241.3 tab oral daily. Corrected on site.

Upon patient record review, 1 of 5 records (Patient #3) 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 3: The plan of care contains an order for Magnesium Oxide 400mg, 241.3 tab oral daily. Corrected on site.

Upon patient record review, 2 of 5 records (Patient #2,#3) 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 equipment and supply needs. Patient 2: The medical record contains an RN comprehensive assessment that patient has an air mattress. There is no evidence of an air mattress listed on the plan of care. Patient 3: Upon home visit, there was evidence of patient using a walker. There was no evidence of a walker listed on the plan of care. Corrected on site.

Upon patient client record review, 1 of 5 records (Patient #5) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Patient 5: The medical record contains aide documentation for a visit completed on 1-26-22. The aide signed the visit as a single name which was not the same as her legal name.