Every finding on record at Doctors Hospice of Idaho, LLC

Upon patient record review, 3 of 14 (Patient #2,4,9) 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 2: Current medication record contains an order dated 8/09/25 for Citrucel Powder, administer 1 dose powder oral daily. Order does not include a diluent. Current medication list contains an order dated 02/03/25 for Polyethylene glycol, 17g powder oral twice daily. Order does not include a diluent. Corrected on site, Med list updated. Patient 4: Current medication list dated 10/15/25 contains orders for Hydrocodone-Acetaminophen 5/325, take one tablet by mouth every 4 hour prn, Acetaminophen tab 500 mg, 1 tab every 8 hours prn and Acetaminophen 500mg tab three times daily. There is no directive not to exceed 4000mg in all forms daily of acetaminophen. Corrected on site, Med list updated. Patient 9: Current medication list dated 10/15/25 contains an order for Silver Sulfadiazine External cream to be applied topically as needed for skin infection. Order is missing location of application. Corrected on site, Med list updated.

Upon patient record review, 3 of 14 (Patient #2,4,9) 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 2: Current POC dated 10/15/25 contains order for Citrucel Powder, administer 1 dose powder oral daily. Order does not include diluent. Current POC dated 10/15/25 contains order for Polyethylene glycol, 17g powder oral twice daily. Order does not include a diluent. Corrected on site, POC updated. Patient 4: The POC dated 10/15/25 contains orders for Hydrocodone-Acetaminophen 5/325, take one tablet by mouth every 4 hour prn, Acetaminophen tab 500 mg, 1 tab every 8 hours prn and Acetaminophen 500mg tab three times daily There is no directive not to exceed 4000mg in all forms daily of acetaminophen. Corrected on site, POC updated. Patient 9: The POC dated 10/15/25 contains an order for Silver Sulfadiazine External cream to be applied topically as needed for skin infection. Order is missing location of application. Corrected on site, POC updated

Upon patient record review, 4 of 14 (Patient #2,8,9,10) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient 2: Pt on long term ASA; the most recent POC does not include a risk for bleeding care plan with appropriate goals and interventions. Patient 8: The most recent POC dated 10/10/25 includes orders for ASA and Eliquis (anticoagulant). POC does not include a does not include a risk for bleeding care plan with appropriate goals and interventions. Corrected on site, POC updated. Patient 9: Patient has an order for Silver Sulfadiazine cream to be applied topically as needed for skin infection. There is no evidence of plan of care. Corrected on site, plan of care updated. Patient 10: Pt on long term ASA; the most recent POC does not include a risk for bleeding care plan with appropriate goals and interventions. Corrected on site, POC updated.

Upon client record review, 1 of 14 (Patient #6) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 6: Care Coordination note dated 09/19/25 indicates patient requesting spiritual care visit be moved to next week. There is no evidence that the visit was made or patient contacted.

Upon review of policy and procedure, Doctors Hospice of Idaho policy titled "Emergency Preparedness and Procedure" Reference 1018 did not include the development of arrangements with other hospices and other providers to receive patients in the event of limitations or cessation of operations to maintain the continuity of services to hospice patients.

Upon patient record review, 4 of 11 (Patients #2,#3,#4,#10) 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. Patient 2: The medication profile contains bactrim 9/1/22 and debrox with instructions for 7 days, both listed as current medications. The profile also contains diclofenac topical gel for pain with no defined area for administration, and psyllium husk oral powder with no instructions for a diluent. Corrected on site. Patient 3: The medication profile contains ammonium lactate external lotion for pain with no defined area for administration. Corrected on site. Patient 4: The medical record contains nursing documentation upon admission identifying patient use of oxygen and an order 10/12/22 for morphine, lorazepam, haloperidol, and hyoscyamine. There was no evidence of the oxygen and listed medications included on the medication profile. The medication profile contained nystatin topical powder with no area defined for administration. Corrected on site. Patient 10: The medical record contains an order 2/8/22 for morphine, lorazepam, haloperidol, hyoscyamine and senna s. There was no evidence of the medications listed on the medication profile.

Upon patient record review, 3 of 11 records (Patients #2,#3,#4) 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 2: The medical record contains an order for bactrim 9/1/22 with no defined length of treatment. The record also contains orders for diclofenac topical gel for pain with no defined area for administration, and psyllium husk oral powder with no instructions for a diluent. Corrected on site for current medications. Patient 3: The medical record contains an order for ammonium lactate external lotion for pain with no defined area for administration. Corrected on site. Patient 4: The medical record contains nursing documentation upon admission identifying patient use of oxygen. There was no evidence of an order for oxygen. The medical record also contains an order for nystatin topical powder with no area defined for administration. Corrected on site.

Upon client record review, 2 of 11 records (Patients #7,#8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 7: The medical record contains an ordered spiritual care frequency of two to three times monthly. There was only evidence of one spiritual care visit completed on 10/5/22 for the current benefit period starting 8/19/22. Visits labeled as music visits were completed by a chaplain 8/19/22 and a missed music visit 9/30/22 under the chaplain section of documenting. Patient 8: The medical record contains an ordered nursing frequency of two to three times weekly. There was no evidence of a second visit completed the weeks of 9/25/22, 10/2/22, 10/9/22.

Upon patient record review, 4 of 10 applicable (Patients #2,#4,#8,#10) 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. Patient 2: The aide care plan contained tasks for two bath types including complete bed bath as needed and shower each visit. Corrected on site. Patient 4: The aide care plan contained tasks for two bath types including partial bath or shower each visit. Corrected on site. Patient 8: The aide care plan contained task for two bath types including complete bed bath if patient unable to shower and shower every visit. Corrected on site. Patient 10: The aide care plan contained tasks for multiple bath types including partial bath or shower each visit as tolerated, complete bed bath each visit, and complete shower as allowed.

Upon patient record review 4 of 10 applicable (Patients #4,#5,#6,#9) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care Patient 4: The medical record contains aide documentation 10/13/22 identifying the aide trimmed patient nails. The aide care plan did not have a task for nail care. Patient 5: The medical record contains aide documentation 10/1/22, 10/4/22, and 10/12/22 identifying the patient received a bed bath. The bath type ordered by the RN was a shower each visit. The medical record contained an ordered aide frequency for once weekly on 9/6/22 and three times weekly on 10/3/22. There was evidence of two visits completed the weeks of 9/4/22, 9/11/22, 9/18/22, 10/2/22, and 10/9/22. Patient 6: The medical record contains an ordered frequency of twice weekly. There was no evidence of a second visit the week of 9/25/22 and only a missed visit the week of 9/4/22. Corrected on site with missed visit documentation. Patient 9: The medical record contains an ordered aide frequency for twice weekly. There was no evidence of a second visit completed the week of 3/20/22.

Upon review of policy and procedure, File Folder labeled HSP4-7A_3003 did not describe the method for assessment of competencies and procedure for maintaining a written description of the in-service training provided during the previous 12 months.