Every finding on record at Dierksen of Texarkana Arkansas, LLC

Upon patient record review and home visit, 2 of 19 (Patient #4,9) 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 4: Clinical documentation on 6/16 indicated that oxygen was increased to 3L via NC by the MD order. No evidence that the active medication profile was updated to include the new order. Oxygen at 2LNC continuous listed on the active medication profile. In addition, during home visit and medication reconciliation, the active medication profile contained Advair inhaler twice a day. The patient reported that he did not take the Advair inhaler and it was not in the home. COS-active medication profile updated during survey and an order was written to discontinue and remove the medication from the active medication profile during the survey. Patient 9: The active medication profile had an order for Milk of Magnesium and Dulcolax both listed as daily PRN for constipation. No evidence that instructions were given to the patient/CG for which medication should be used first in the event of constipation. COS-new orders written during the survey that gives instructions on what medication to use in the event of constipation.

Upon patient record review, 1 of 19 (Patient #14) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient 14: The medical record indicated that the patient currently has a wound to the coccyx. No evidence that the wound was measured for the week of 06/05/2025.

Upon patient record review, 3 of 19 (Patient #1,3,8) 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. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 1: The clinical documentation indicated that patient was depressed, currently prescribed Zoloft for depression. No evidence of problems, goals, and interventions related to depression included in the plan of care. COS-order written to update the plan of care during the survey. Patient 3: The clinical documentation indicated that the patient was at risk for aspiration due to dysphagia. No evidence of problems, goals, and interventions related to dysphagia. COS-order written to update the plan of care during the survey. Patient 8: The clinical documentation indicated that patient had anxiety and was currently prescribed Xanax for anxiety. No evidence of problems, goals, and interventions related to anxiety included in the plan of care. COS-order written to update the plan of care during the survey.

Upon patient record review, 1 of 19 (Patient #13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 13: The POC has an order for OT to eval and treat. The medical record included 2 additional visits after the initial evaluation visit that occurred on 06/12/25. No evidence that an MD order was placed to include those visits. COS-order written during survey.

Upon patient record review, 2 of 19 (Patient #18,19) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery. of the bereaved family. Patient 18: The medical record indicated that the spouse declined bereavement services but called back several days later to ask if bereavement services could be provided to another member of the family. The medical record showed that the bereavement letters continued to be sent to the spouse. No evidence that the additional person was contacted for bereavement services. No evidence that a follow-up was completed. Patient 19: Clinical documentation on 07/29/2024 indicated that the patient's spouse would be open to chaplain visits. No evidence that the bereavement plan of care was updated to include chaplain visits. No evidence that follow-up was completed. No evidence that this was done at the request of the bereaved family member.

Upon patient record review, 1 of 19 (Patient #1) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate 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 not acceptable Patient 1: The medical record indicated that patient was being seen by 2 aides per visit for 2 person assist baths since the beginning of the 9th benefit period. No evidence that the aide plan of care was updated to include those orders at the start of survey. COS- orders written to update the aide plan of care during survey.