Every finding on record at Compassionate Care Hospice of Kansas City, LLC

Upon patient record review, 2 of 14 (Patients #2 and 8) did not contain evidence that the Hospice had 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 #2: During the 12/17/24 surveyor-attended home visit the following was noted: 1) There was a sign on the patient's wall that the patient has a right elbow splint, that must be in place whenever the patient is sitting in his Broda Chair; 2) The patient has two different right-hand splints, one to be applied during the daytime, and a different one to be applied over night-time; and 3) The patient had bilateral heel protector/boots. All of these DME were listed in the POC under DME. However, there were no details within the body of the POC regarding their correct application/frequency/duration, responsible personnel, etc... Patient #8: The Physician CTI dated 11/11/24 included, "Patient has a Vascular Boot on RLE." This supply is not included on the most recent IDG dated 12/03/24, nor any details such as when it should be in place, who is responsible for applying, etc... The same IDG note has the RN documenting that, "Patient/caregiver has been applying Compression Stocking for 25" without result." This is not a complete order, as it is not clear as to when the stockings should be applied/removed, nor by whom, etc ...

Upon patient record review, 1 of 14 (Patient #4) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments: Patient #4: The 11/22/24 IDG meeting notes reflected that the patient had bumped her calf resulting in a skin tear. The RN made a visit on 11/23/24 resulting in, "Daughter taught wound care, as follows: Remove old dressing by soaking with warm water, cleanse with Wound Cleanser, apply Triple Antibiotic, non-stick gauze, and secure with Koban. Change every other day." A subsequent verbal order dated 11/26/24 included, "Cleanse with Wound Cleanser, pat dry, apply Xeroform to wound, Kerlix, then tape." This is not a complete treatment order, as it does not clarify where on the body this wound treatment is intended, who is responsible for providing such wound care, nor a frequency. A subsequent verbal order dated 12/03/24 included, "Spray wound with Wound Cleanser, pat dry, apply Xeroform, Kerlix, tape, then ACE Wrap." This is not a complete treatment order, as it does not clarify where on the body this wound treatment is intended, who is responsible for providing such wound care, nor a frequency.

Upon patient client record review, 2 of 14 (Patient #2, 8) did not have evidence that each patient record contains Advance Directives. Patient #2: The record reflected that the patient has a Living Will as one of his Advance Directives. There is not evidence of this document having been filed within the record; nor of Hospice follow-up with the patient/representative to obtain such document. Patient #8: The admission consent reflected that the patient has a: 1) DNR; 2) DPOA Healthcare; and 3) Living Will. There is not evidence of the Living Will document having been filed within the record; nor of Hospice follow-up with the patient/representative to obtain such.

Upon patient record review, 2 of 14 (Patients #1 and 2) did not contain evidence that the Hospice had provided the following documents to the SNF: Patient #1: • Physician Certification and Re-certification of the terminal illness • The most current Hospice Plan of Care. The most recent 90/60 day Hospice POC was the 05/24/24 SOC POC. The most recent IDG POC was dated 11/20/24. Patient #2: • Physician Certification and Re-certification of the terminal illness • The most current Hospice Plan of Care. There were no 90/60 day Hospice POCs provided to the SNF. The most recent IDG POC was dated 11/20/24.

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current: prescription and over-the-counter (OTC) drugs; Supplements; Herbal remedies; and other alternative treatments that could affect drug therapy. It is also required that the drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by clinical record review, policy review, and staff interview. 1 of 11 (9%) records reviewed revealed that the agency failed to ensure the patient’s drug profile was accurate with the current prescription and over the counter drugs. Record #72019: (Start of Care Date: 6/8/2021): The patient drug profile, current as of 1/12/2022, listed Cephalexin 500 milligram capsules; take one capsule every 12 hours for the next ten days; the order was written and initiated on 7/5/2021. There was no end date noted on the drug profile. The order indicated that the medication was ordered to treat a urinary tract infection. Agency policy numbered "MM-001A" and titled “Medication Management” (effective 1/1/2006, last revised 12/30/21) Section E. Medication Reconciliation; states in relevant part, “Medication Reconciliation will be done at admission, recertification, a change in patient’s condition requiring medications changes when a medication is discontinued.” In an interview with the Administrator, conducted on 1/12/2022 at 2:45 pm, she confirmed that the medication (Cephalexin) was only ordered and taken by the patient for the ten-day duration and that the medication should have been discontinued and should no longer be on the current patient drug profile.