Every finding on record at Destiny Hospice and Palliative Care LLC

Upon patient record review 1 of 5 records (Patient #5) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #5: The patient was admitted on 7/28/22. The record indicated that the spiritual assessment was completed on 8/4/22.

Upon patient record review, 2 of 5 records (Patient #1,#2) 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 management of the terminal illness and related conditions, including medications and treatments. Patient #1: The nurse narrative note conducted on 7/31/22 during the comprehensive assessment indicated that Benadryl was ordered for itching. There was not evidence that this was in the medication profile. Patient #2: The record indicated orders for Acetaminophen 650mg suppository q8h prn elevated temperature and Hydrocodone 10/350 q4h prn pain. The medication profile did not contain evidence of a parameter for the elevated temperature and there was not evidence of a maximum allowable dose for the Acetaminophen/24hours.

Upon patient record review, 1 of 5 records (Patient #5) 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. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #5: The patient was admitted on 7/28/22. The record indicated that the bereavement assessment was completed on 8/4/22.

Upon patient record review, 5 of 5 records (Patient #1,#2,#3,#4,#5) did not have evidence the plan of care 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 #3: The visit frequencies for the social worker and the spiritual care counselor were 1x/month and prn. There was not evidence of a quantifier for the prn visits. Patient #1,#2,#4,#5: The visit frequency for the spiritual care counselor was 1x/month and prn. There was not evidence of a quantifier for the prn visits.

Upon patient record review, 2 of 5 records (Patient #1,#2) did not have evidence the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #1: The nurse narrative note conducted on 7/31/22 during the comprehensive assessment indicated that Benadryl was ordered for itching. There was not evidence of an order. Patient #2: The record indicated orders for Acetaminophen 650mg suppository q8h prn elevated temperature and Hydrocodone 10/350 q4h prn pain. There was not evidence of a parameter for the elevated temperature and there was not evidence of a maximum allowable dose for the Acetaminophen/24 hours.

Upon client record review, 1 of 5 records (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: The visit frequency for the skilled nurse was 1x/week and 2 prn. The record indicated 2 visits for the week of 7/31/22-8/6/22 (7/31/22, and 8/1/22) without evidence indicating if 1 visit was a prn.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #3: Aide: During observed home visit, the staff member was observed using bar soap that was in the bathroom of the group home, to cleanse her hands prior to providing care.