Every finding on record at Caring Heart Hospice Inc

Upon patient record review, 7 of 14 (Patient #1, #2, #3, #4, #6, #8, #10) did not contain evidence 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: Diclofenac 1% gel did not indicate which knee(s) to be applied to. During home visit it was noted that patient had both Acetaminophen 650mg tabs 1 tab three times daily and 325mg 2 tabs two times daily. Acetaminophen 325mg tab was not listed on medication profile. During home visit it was noted that patient was using Senna 8.6mg tabs but both tablets and Senna 8.8mg/5mL syrup were listed on medication profile. Patient #2: Furosemide 20mg tab daily was listed on medication profile but was not found in the home during home visit. Senna 8.6mg tab and 8.8mg/5mL liquid on medication profile but only Senna liquid 8.8mg/5mL was in the home during home visit. Patient #3: Patient has order for oxygen 2L/NC PRN but this was not listed on medication profile. Patient #4: Patient has order for oxygen 2L/NC PRN but this was not listed on medication profile. Patient #6: 11/04/25 order date - Amoxicillin 500mg 1 tab three times daily for 10 days. There was no end date and medication was not discontinued. Patient #8: Diclofenac 1% gel did not indicate which knee(s) to be applied to. Patient #10: 10/08/25 order date - Bactrim DS 800/160mg 1 tab two times daily for 7 days. There was no end date and medication was not discontinued.

Upon patient record review, 8 of 14 (Patient #1, #2, #3, #4, #6, #7, #8, #10) did not contain 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: Initial POC and all updated POCs - Diclofenac 1% gel did not indicate which knee(s) to be applied to. During home visit it was noted that patient had both Acetaminophen 650mg tabs 1 tab three times daily and 325mg 2 tabs two times daily PRN. The 325mg tabs was not listed on POCs. During home visit it was noted that patient was using Senna 8.6mg tabs but both tablets and Senna 8.8mg/5mL syrup were listed on POC. Patient #2: Initial POC and all updated POCs - Furosemide 20mg tab daily was listed on POC but was not found in the home during home visit. Senna 8.6mg tab and 8.8mg/5mL liquid on POC but only Senna liquid 8.8mg/5mL in the home during home visit. Patient #3: Initial POC and all updated POCs - Patient has order for oxygen 2L/NC PRN but this is not listed on POC and was indicated on nurses comprehensive assessment. Patient #4: Initial POC and all updated POCs - Patient has order for oxygen 2L/NC PRN but this is not listed on POC and was indicated on nurses comprehensive assessment. Patient #6: 11/04/25 (order date) and following updated POCs - Amoxicillin 500mg 1 tab three times daily for 10 days. There was no end date and medication was not discontinued. Patient #7: Patient had 2 wounds indicated on POCs dated 07/18/25 and 11/05/25. Neither indicated who would perform wound care on days that hospice nurse was not present. Patient #8: Initial POC and all updated POCs - Diclofenac 1% gel did not indicate which knee(s) to be applied to. Patient #10: 10/08/25 (order date) and following updated POCs - Bactrim DS 800/160mg 1 tab two times daily for 7 days. There was no end date and medication was not discontinued.

Upon client record review, 7 of 14 (Patient #2, #4, #5, #7, #8, #10, #11) did not contain evidence that the IDG ensures that the care and services are provided in accordance with the plan of care: Patient #2: SN updated POC/IDG dated 09/05/25 reflected 1x/weekly visit. There were no visits made week of 10/26/25. Initial POC/IDG reflected MSW 1x/month visit and no visits were made during the month of September. Patient #4: Updated POC/IDG starting on 06/13/25 - 09/05/25 indicated SN visit frequency 2x/week. Week of 08/17/25 there was only 1 visit made. Updated POC/IDG starting on 09/06/25 - 11/14/25 indicated SN visit frequency 3x/week. Weeks of 10/19/25 and 10/26/25 there was only 2 visits made each week. MSW initial POC/IDG and all updated indicated 1x/month visit frequency. There were no visits made during September or October. Patient #5: MSW Initial POC/IDG and all updated indicated 1x/month visit frequency. There were no visits made during September. SN initial POC/IDG and all updated indicated 2x/weekly visit frequency. SN only made 1 visit week of 10/12/25. Patient #7: MSW Initial POC/IDG all updated indicated 1x/month visit frequency. There were no visit made during September. SN Initial POC/IDG and all updated indicated 2x/weekly visit frequency. There was only 1 visit made during weeks of 08/17/25 and 11/02/25. Patient #8: MSW Initial POC/IDG and all updated indicated 1x/month visit frequency. There were 2 visits made during July. There were no visits made during months of September and October. SC Initial POC/IDG and all updated indicated 1x/month visit frequency. During month of July and September there were 2 visits made. SN Initial POC/IDG and all updated indicated 2x/weekly visit frequency. Weeks of 04/27/25 and 07/20/25 there were 3 visits made. During week of 10/12/25 there was only 1 visit made. Patient #10: MSW Initial POC/IDG and all updated indicated 1x/month visit frequency. There were no visits made during September. SN IDG/POC beginning on 07/25/25 indicated visit frequency 1x/weekly. Week of 08/03/25 2 visits were made. Week of 08/17/25 there were no visits made. Week of 10/05/25 there were 3 visits made. Patient #11: MSW Initial POC/IDG and all updated indicated 1x/month visit frequency. There were no visits made following 08/26/25 visit.

Upon patient record review, 1 of 14 (Patient #1) did not contain evidence that the hospice aide POC/assignments and duties indicated 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 #1: POC/assignments included changing patient linens but did not indicate the frequency for this to be completed. Bathing/hygiene indicated shampoo and shave but did not give frequency for either. Aide stated that she shampoos and shaves on M/W/F every week.

Upon patient record review 3 of 14 (Patient #1, #8, #10) did not contain evidence of documentation that a hospice aide provides services that were included in the plan of care: Patient #1: Plan of care indicated nails to be cleaned/filed at each visit and these were not completed during home visit. Deodorant to be applied at each visit and this was not done during home visit. At every visit patient's trash/light housekeeping were to be performed and these were not done during home visit. Visit notes documented aide performed shampoo and shave although not frequency on POC, aide verbally stated these are performed every M/W/F. Patient #8: Aide Initial POC/IDG and all updated indicated visit frequency 2x/weekly. There were no visits made after 11/06/25. Patient #10: Aide IDG/POC beginning 07/10/25 indicated 2x/weekly visit frequency. Weeks of 07/20/25, 07/27/25, 08/03/25 and 08/10/25 there were 3 visits made. Week of 08/31/25 there were 4 visits made.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. 2024 cost savings report only reflected savings of 3.29%.

Upon client record review, 1 of 14 (Patient #14) did not contain 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 #14: there was no documentation providing proof that a copy of the discharge summary was provided to whomever was assuming care of patient.

Upon client record review, 1 of 14 (Patient #14) did not have evidence that the discharge summary included all required information.

Upon personnel record review, 1 of 11 (Personnel #8) did not contain evidence the hospice obtained a criminal background check on all contracted individuals who have direct patient care and access to patient records. Personnel #8: did not have criminal background checks, National sex offender, or OIG checks done.

Upon patient record review, 1 of 11 (Patient #3) 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 3: SC observed on 8/22 that the patient is in 8 out of 10 pain in the legs with no record of communication to RN and other appropriate resources.

Upon patient record review, 3 of 11 (Patient #5, #6, #8) 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 5, 6, 8: Oxygen was found in the clinical documentation but not in the medication profile. Corrected on site 11/4. Patient 5: Levofloxacin ordered on 10/24 for 5 days and remained on the medication profile at 11/3. Corrected on site 11/4.

Upon patient record review, 2 of 11 (Patient #2,#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. Patient 2 SOC 5/26/22 and the bereavement assessment was completed on 6/7/22. Patient 4 SOC 6/28/22 and the bereavement assessment was completed on 7/7/22.

Upon patient record review, 1 of 11 (Patient #6) 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. Patient 6: coccyx wound noted on clinical records but did not have problems, goals and interventions related to integumentary system. Corrected on site.

Upon patient record review, 1 of 11 (Patient #1) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient 1: Plan of Care demonstrated a discrepancy of MSW frequency as both as needed only and 1 time a month and prn.

Upon patient record review, 3 of 11 (Patient #1, #5, #6) 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: Record review indicated that foley catheter order did not include size of the balloon and frequency of change, Corrected on site. Patient 5: Record review indicated that oxygen noted in the treatment as 5L/min but did not contain frequency or delivery method. Corrected on site Patient 6: Record review indicated in RN initial assessment the presence of foley catheter but did not contain foley catheter order. Corrected on site.

Upon patient record review, 6 of 11 (Patient #2, #3, #4, #5, #6, #11) 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: Admission note indicated the use of shower bench, over bed table wheelchair and table but none of them are in the plan of care. Patient 3: Admission note indicated the presence of O2@2L/min and shower chair but not in the plan of care. Patient 4: Admission note indicated the presence wheelchair, overbed table and not in the plan of care Patient 5: Nursing record shows the use of walker, shower chair and wheel chair but not in the plan of care. Patient 6: Admission note indicated the presence of air mattress, and wheelchair but not in plan of care. Patient 11: Nursing record indicated the presence of hospital bed, over bed table and wheel chair but not in plan of care.

Upon client record review, 1 of 11 (Patient #5) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 5: SN ordered once a week but two routine visits recorded on the week of 10/25/22.

Upon patient record review 1 of 10 applicable (Patient #8) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Included in the plan of care Patient 8: On 2/3/22, the aide provided bed bath without the order in the aide plan of care and showed no evidence of RN collaboration. On 2/20/22 the aide provided sponge bath without the order in the plan of care with no evidence of RN collaboration.

Upon patient client record review, 1 of 11 (Patient #11) did not evidence that each patient record contains physician orders. Patient 11: did not have a physician order to discharge the patient.

Upon client record review, 2 of 2 applicable patients (Patient #10, #11) did not have evidence that the discharge summary includes all required information. Patients 10, 11: discharge summary did not contain all required items such as: • A summary of the patient's stay, including treatments, symptoms and pain management • The patient's current plan of care • The patient's latest physician orders (patient 11 only) • Any other documentation that will assist in post-discharge continuity of care or that is requested by the attending physician or receiving facility (no evidence present)