Every finding on record at Caris Healthcare

Based on agency policy, medical record review, and interview the agency failed to update the medication profile with new medications for 3 patients (#1, #2, and #3) of 3 patients reviewed with home visits. --- The findings include:Review of the agency policy titled, “Medication-Management,” dated 3/26/2024 revealed A Medication Profile is maintained for every patient and includes a listing of the current medication orders for each patient...The hospice monitors the medications dispensed to and used by the patient...Review of the agency's policy titled, "Medication-Orders" revised 3/26/2024 revealed, "...Orders for medications are documented in the patient’s current medication profile...”Medical record review revealed Patient #1 was admitted to the agency on 5/17/2024 with Senile Degeneration of Brain and resided in a long-term care (LTC) facility.Medical record review of Patient #1's current LTC facility Medication Administration Record (MAR) revealed Gabapentin (medication used for nerve pain) 300 milligram (mg) capsule once daily with a start date of 10/15/2024 and Lorazepam (anti-anxiety medication) 0.5mg once daily with a start date of 3/13/2025.Review of the Patient #1's agency medication profile dated 3/31/2025 showed the Gabapentin and Lorazepam had not been updated to reflect Patient #1's current medications.Medical record review revealed Patient #2 was admitted to the agency on 2/20/2025 with Alzheimer’s Disease and resided in a LTC facility.Medical record review of Patient #2's LTC facility current Medication Administration Record (MAR) revealed Bisacodyl (medication used to treat constipation) 10 mg daily as needed with a start date of 12/2/2024, Depakote (medication used to treat seizures) 125mg twice daily with a start date of 3/12/2025, Fleet Enema 19-7 gram/118 milliliter (mL) once daily with a start date of 12/2/2024, Melatonin (a medication used for sleep) 3mg at bedtime with a start date of 3/6/2025, Sertraline (a medication used for depression) 200mg with a start date of 12/2/2024.Review of the Patient #2's agency medication profile dated 3/31/2025 showed the Bisacodyl, Depakote, Fleet Enema, Melatonin, and Sertraline had not been updated to reflect Patient #1's current medications.Medical record review revealed Patient #3 was admitted to the agency on 3/14/2024 with Cerebral Infarction and resided in a LTC facility.Medical record review of Patient #3's LTC facility current Medication Administration Record (MAR) revealed Carbidopa 25mg-Levodopa 100mg (medication used to treat tremors) three times a day with a start date of 3/13/2024, Gabapentin (medication used to treat nerve pain) 100 mg once daily with a start date of 3/7/2025, Gabapentin (medication used to treat nerve pain) 100 mg twice daily with a start date of 3/7/2025.Review of the Patient #3's agency medication profile dated 3/31/2025 showed the Carbidopa-Levodopa and Gabapentin had not been updated to reflect Patient #1's current medications.During an interview with the Administrator and Regional Director on 4/1/2025 at 10:15 AM, showed the medication reconciliation are to be completed on each skilled nurse visit and confirmed the medication reconciliation had not been updated.

Based on agency policy review, medical record review and interview the agency failed to complete a thorough assessment to include the pain and bowel status, for 4 patients (#6, #7, #8, and #10) out of 13 patients reviewed. The findings include: Review of the agency policy titled, "Pain and Symptom Management" reviewed 2/25/2020 showed "...Pain is re-assessed during every visit...This information is documented in the patient's clinical record..." Medical record review revealed Patient #6 was admitted to the agency on 3/24/2022 with diagnoses of Senile Degeneration of the Brain. Record review of a nursing clinical note dated 4/1/2022, revealed no documentation of Patient #2's bowel assessment. Medical record review revealed Patient #7 was admitted to the agency on 4/1/2022 with diagnoses of Senile Degeneration of the Brain. Record review of a nursing clinical note dated 4/5/2022, 4/12/2022, 4/18/2022, and 4/27/2022 revealed no documentation of Patient #7's bowel assessment. Record review of a nursing clinical note dated 4/12/2022, 4/18/2022, and 4/27/2022 revealed no documentation Patient #7's pain had been assessed. Medical record review revealed Patient #8 was admitted to the agency on 3/30/2022 with diagnoses of Senile Degeneration of the Brain. Record review of a nursing clinical note dated 3/31/2022, 4/6/2022, and 4/18/2022 revealed no documentation of Patient #8's bowel assessment. Record review of a nursing clinical note dated 3/31/2022, 4/6/2022, and 4/27/2022 revealed no documentation Patient #8's pain had been assessed. Medical record review revealed Patient #10 was admitted to the agency on 3/23/2022 with diagnoses of Senile Degeneration of the Brain. Record review of a nursing clinical note dated 4/12/2022, and 4/26/2022 revealed no documentation of Patient #10's bowel assessment. During an interview on 5/4/2022 at 10:20 AM, the Administrator confirmed the pain or bowel assessment had not documented on patients #6, #7, #8, and #10 and further confirmed the pain and bowel assessments should have been completed with each skilled nurse visit.

Based on agency policy review, medical record review, Long Term Care Facility (LTCF) record review, and interview the agency failed to update the medication profile for 2 patients (#1 and #3) of 3 patients reviewed with home visits. The findings include: Review of the agency's policy titled, "Medication Assessment and Reconciliation," revised 7/5/2021, showed "...To provide a standardized process for the nurse to follow to ensure patient's medication profile is reviewed at every visit to assure the accuracy and appropriate interventions are in place...On every skilled nurse visit, perform medication reconciliation to ensure all medications are correctly documented in the electronic health record...Medication reconciliation for patients in the long-term care centers includes the following...Review facility Medication Administration Record (MAR) and confirmed against what is in the Medication Profile of the electronic medical record. If discrepancies noted, make changes in the electronic medical record...Review each medication's strength/dosage/frequency..." Medical record review showed Patient #1 was admitted to the agency on 6/19/2021 with diagnoses including Chronic Obstructive Pulmonary Disease, Type 2 Diabetes Mellitus, Generalized Anxiety Disorder, and Hypertensive Heart Disease. Further review showed the Patient resided in a LTCF. Review of Patient #1's Client Medication Report showed the patient had current medication orders for "...Imodium [antidiarrheal medication]...2 MG [milligrams] Capsule...2 capsules...daily...Diarrhea..." with an order date of 3/29/2022, an order for "Lorazepam [antianxiety medication] 0.5 MG Tablet...every 4 hours [as needed]...Anxiety..." with an order date of 3/29/2022, Ondansetron [medication used to treat nausea]...4 MG/2 ML [milliliters] Injection...3 Times Daily PRN [as needed]...N/V [nausea and vomiting]..." with an order date of 3/29/2022, an order for "...Polyethylene Glycol [medication used to treat constipation]...17 Gram/Dose Oral Powder...Daily...Constipation..." with an order date of 3/29/2022, an order for "...Tizanidine [medication used to treat muscle spasms] 2 MG Tablet...2 Times Daily...Muscle Spasms..." with an order date of 3/29/2022, Bisacodyl [laxative] 10 MG Rectal Suppository...Daily PRN...Constipation..." with an order date of 3/29/2022, and an order for Hydrocodone [pain medication] 10 MG...3 Times Daily...For Pain..." with an order date of 4/23/2022. Review of Patient #1's LTCF MAR dated 5/1/2022-5/3/2022, showed "...hydrocodone...tablet...7.5...mg...Three Times A Day...for pain...Start Date 09/14/2021..." Further review showed no documentation the patient had orders to receive the Imodium, Lorazepam, Ondansetron, Polyethylene Glycol, Tizanidine, or Bisacodyl. During an interview on 5/4/2022 at 8:53 AM, The Regional Director of Clinical Care (RDCC) confirmed Patient #1's medication profile had not been reconciled with the LTCF's MAR to assure all medications on the agency medication profile were also on the LCTF's MAR. She further confirmed the dosage of Hydrocodone on the agency's medication profile did not match the dosage on the LCTF's MAR. Medical record review showed Patient #3 was admitted to the agency on 3/31/2022 with diagnoses including Atherosclerotic Heart Disease, Essential Hypertension, Major Depressive Disorder, and Pain. Review of Patient #3's Client Medication Report showed the patient had current medication orders for "...Potassium Chloride...10 MEQ [milliequivalent] Capsule...daily..." with an order date of 4/5/2022. Further review showed no documentation the patient had a medication order for Aspirin [pain medication], Bisacodyl, or Fleets Enema [for constipation]. Review of Patient #3's LTCF's MAR dated 5/1/2022-5/3/2022, showed an medication order for "...aspirin tablet, chewable...81 mg...Once A Day...Start Date 04/04/2022...bisacodyl...suppository...10 mg...Once A Day - PRN...Start Date 04/04/2022...potassium chloride tablet...20 meq...Once A Day...Start Date 04/04/2022..." During an interview on 5/4/2022 at 9:36 AM, the RDCC confirmed the medications of aspirin and bisacodyl that were on the LTCF's MAR were not on the agency's medication profile. She further confirmed the dosage for the potassium chloride on the agency's medication profile did not match the dosage on the LTCF's MAR. The RDCC confirmed the medication profiles were to be reconciled at least weekly during the skilled nurse visit and had not been completed for Patient's #1 and #3.

Based on agency policy review, record review, and interview, the agency failed to follow the plan of care (POC) related to visit frequency for 4 patients (Patient #8, #9, #10, and #11) of 13 patients reviewed. The findings include: Review of the agency policy titled, "Plan of Care" reviewed 2/25/2020, showed "...The patient's plan of care specifies the care and services necessary to meet the needs of the patient/caregiver as identified in the initial, comprehensive and updated assessment of the patient..." Medical record review revealed Patient #8 had a diagnosis of Senile Degeneration of the Brain. Record review showed Patient #8's Plan of Care for recertification period 3/30/2022-6/27/2022 showed an order for visit frequency for "...AIDE [Hospice Aide] 2 Week 12...VC [Volunteer Coordinator] 1 Every Other Week 2..." Record review showed Patient #8's visit calendar (calendar that documents all disciplines scheduled to provide services) showed no completed Aide visits for the week of 4/16/2022 for Patient #8. Record review showed Patient #8's visit calendar showed no completed Volunteer Coordinator visit for the week of 4/23/2022 for Patient #8. Medical record review revealed Patient #9 had a diagnosis of Senile Degeneration of the Brain. Record review showed Patient #9's Plan of Care for recertification period 3/26/2022-6/23/2022 showed an order for visit frequency for "...AIDE [Hospice Aide] 2 Week 12..." Record review showed Patient #9's visit calendar showed 1 completed Aide visit for the week of 4/16/2022 for Patient #9. Medical record review revealed Patient #10 had a diagnosis of Senile Degeneration of the Brain. Record review showed Patient #10's Plan of Care for recertification period 3/25/2022-6/22/2022 showed an order for visit frequency for "...AIDE [Hospice Aide] 2 Week 12..." Record review showed Patient #10's visit calendar showed 1 completed Aide visit for the week of 3/26/2022, 4/2/2022, 4/16/2022, and 4/23/2022 for Patient #10. Medical record review revealed Patient #11 had a diagnosis of Chronic Kidney Disease Stage 4. Record review showed Patient #11's Plan of Care for recertification period 3/21/2022-6/18/2022 showed an order for visit frequency for "...AIDE [Hospice Aide] 3 Week 13...SN [Skilled Nurse] 2 Week 13..." Record review showed Patient #11's visit calendar showed 1 completed Aide visit for the week of 3/19/2022, 2 completed Aide visits for the week of 4/9/2022 and 4/23/2022, and no completed Aide visits for the week of 4/16/2022 for Patient #11. Record review showed Patient #11's visit calendar showed 3 completed skilled nurse visits for the week of 4/2/2022, 5 completed skilled nurse visits for the week of 4/16/2022, and 6 completed skilled nurse visits for the week of 4/23/2022 for Patient #11. During an interview conducted on 5/4/2022 at 10:07 AM, the Administrator confirmed the agency had not followed the plan of care for visit frequency for patients #8, #9, #10, and #11.