Every finding on record at Caring Cove Hospice LLC

Upon patient record review, 3 of 19 (Patient #1,3,4) 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 Upon home visit to SNF, observed the facility MAR contained two medication orders that were not on the medication profile. Zolpidem 5mg tablet at HS and Bisacodyl EC oral tablet 5mg, take 2 tablets every 23 hours as needed for constipation. . Corrected on site Patient #3 Upon home visit to ALF, observed facility MAR contained order for Escitalopram 20mg po daily and the hospice medication profile contained an order for Escitalopram10mg, take one tablet oral daily and also an order for Lexapro 20mg take one tablet oral daily. Corrected on site Patient #4 Upon home visit, surveyor observed medications in home did not match all meds and instructions as on the medication profile as follows: Norco 5/325mg tabs label instructed "one tablet three times daily". Hospice medication profile contained that order and also an additional order for Norco 5/325mg "take one tablet every 4 hours As needed for pain". There was no evidence of the PRN instruction at the home. The following medications were on the medication profile and not found in the home: Bisacodyl Suppository, Hyoscyamine sublingual tablets, and Morphine concentrate. Corrected on site

Upon patient record review, 3 of 19 (Patient #1,3,4) 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 Upon home visit, observed the facility MAR contained two medication orders that were not on the hospice POC . Zolpidem 5mg tablet at HS and Bisacodyl EC oral tablet 5mg, take 2 tablets every 23 hours as needed for constipation. . Corrected on site Patient #3 Upon home visit, observed facility MAR contained order for Escitalopram 20mg po daily, which was not on the hospice POC. Corrected on site Patient #4 Upon home visit, surveyor observed medications in home did not match all meds and instructions in home, on the hospice POC as follows: Norco 5/325mg tabs label instructed "one tablet three times daily". Hospice POC contained that order and also an additional order for Norco 5/325mg "take one tablet every 4 hours As needed for pain". There was no evidence of the PRN instruction at the home. The following medications were on the hospice POC and not found in the home: Bisacodyl Suppository, Hyoscyamine sublingual tablets, and Morphine concentrate. Corrected on site

Upon personnel record review, 1 of 14 (Personnel #6) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Appropriate and safe techniques in personal hygiene and grooming that include- ·(B) Sponge bath ·(C) Shampoo, sink, tub, and bed Personnel #6 Competency did not include a "sponge" bath, nor did it specify shampoo, "sink, tub, and bed".

Upon client record review, 1 of 19 (Patient #18) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patient #18 Revoked benefit. The Discharge summary has a section that states: "Discharge Summary sent to Attending Physician", this is marked "no".