Every finding on record at Dove Hospice Services of New Jersey LLC

Upon patient record review, 11 of 19 records (Patient #1,#3,#5,#6,#7,#8,#10,#11,#12,#13,#14) 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 #1: The medication profile dated 4/27/23 contained aminocaproic acid 250mg/ml of IV solution. Apply 1 application topically 4x/day as needed and no longer than 10 days. This remained on the medication profile. The order was also unclear as to the location to apply the solution. In addition, Acetaminophen 650 mg rectal supp. Administer 1 supp rectal q6h as needed for constipation. Insert 1 q6h prn pain or fever. There was not evidence of a parameter for fever, and Acetaminophen is not typically indicated for constipation. Also the record indicated that the patient was on oxygen 2-4L/min prn. There was not evidence of a route and this was not on the medication profile. Patient #3: The medication profile contained zinc oxide 10% topical, 1 application topical 3x/day q shift skin protectant without evidence of a specific location, and Lidocaine topical 4%, apply 1 patch topically daily. There was not evidence of a specific location. In addition oxygen 2-5L/min via nasal cannula continuously as needed. It could not be determined if oxygen was continuously or as needed. Also duplicate orders (from dates of 11/21/23 and 1/3/24) for Rifaxim 550 mg oral tabs 2x/day. Patient #5: The medication profile included Tylenol 325 mg, 2 tabs q6h prn pain, Percocet 325-5, 1 BID prn severe pain, and Acetaminophen-oxycodone 325-5, 1 BID prn pain, and Acetaminophen 500mg, 2 tabs BID mild pain. The Percocet was in duplicate and there was not evidence of a maximum allowable dose for acetaminophen per 24h. In addition, Lidocaine 5%, 1 patch daily for pain without evidence of a location. Also oxygen via nasal cannula, 2-5L/min continuous as needed. Patient #6: The medication profile contained Acetaminophen 650 mg rectal supp. Administer 1 supp rectal q6h as needed for constipation. Insert 1 q6h prn pain or fever. There was not evidence of a parameter for fever, and Acetaminophen is not typically indicated for constipation. Patient #7,#10: Acetaminophen was ordered for constipation or fever with no evidence of a parameter for fever. Oxygen was listed as continuous as needed. Patient #7: The patient was on Senna and Dulcolax tablets daily. There was also a Dulcolax supp 1 daily prn constipation and MOM 30 cc daily prn constipation without evidence of which prn drug to administer first and under what circumstances to administer the second prn laxative. Patient #8: The medication profile contained Acetaminophen 1 q6h pain or fever with no fever parameter and Tylenol 500 mg, 2 tabs bid, no max allowable dose. O2 continuous as needed and Miralax 17 Gm daily as needed without evidence of a diluent. Also Cipro 500 bid x3 days dated 11/24/23 and Doxycycline 100mg 2x/day for 7 days dated 11/28/23 remained on the medication profile. Patient #11: Morphine 20mg/ml for pain or SOB. Take 0.25 ml listed in duplicate, dates 12/12/22 and 10/23/23. Patient #12: Acetaminophen 650 rectal supp q6h fever >101 and acetaminophen 325, 2 tabs q6h prn pain with no max allowable dose. Also O2 continuous as needed. Patient #13: Tylenol 325, 2 tabs q6h prn mild pain, Acetaminophen-hydrocodone 325-10 2x/day and Acetaminophen-Hydrocodone 325-2.5 1 q6h prn. No evidence of max allowable dose. Patient #14: Acetaminophen 325 mg, 2 tabs q6h prn in duplicate. In addition, Polyethylene Glycol 17 Gm daily constipation without evidence of a diluent.

Upon patient record review, 3 of 19 records (Patient #1,#3,#11) 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 #1,#3,#11: There was not evidence of a bereavement assessment.

Upon patient record review, 7 of 19 records (Patient #2,#4,#5,#7,#9#12,#14) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient that reflects 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: The patient was admitted with a diagnosis of cerebral atherosclerosis. She was agitated, had a cognitive decline, with behaviors, was confused and has frequent falls. There was not evidence that the plan of care reflected patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments related to her neurological problems. Patient #4: The patient was admitted with a diagnosis of malignant neoplasm of the bronchus/lung. There was not evidence of a care plan reflecting respiratory disease. Patient #5: The record indicated that the patient was on Eliquis 5mg, 1 tablet BID. There was not evidence that the plan of care included safety measures in regards to bleeding precautions. Patient #7: The patient was admitted with a diagnosis of cerebral atherosclerosis. The patient was non-verbal dependent in 6/6 ADL's, incontinent, required a Hoyer lift, must be fed and was on aspiration precautions. There was not evidence of a care plan that reflected the patient's neurological status. In addition she had a stage I wound on her buttocks, and there was not evidence of a care plan for wounds or skin integrity. Patient #9: The patient was admitted with a diagnosis of COPD. There was not evidence of a care plan reflecting respiratory disease. Corrected on site. Patient #12: The record indicated that the patient was on Eliquis 2.5mg, 1 tablet BID. There was not evidence that the plan of care included safety measures in regards to bleeding precautions. Patient #14: The record indicated that the patient was on Eliquis 5mg, 1 tablet BID. There was not evidence that the plan of care included safety measures in regards to bleeding precautions. In addition, the patient was admitted with a diagnosis of cerebral atherosclerosis. She had behaviors, anxiety, depression, sun-downing and was aggressive and uncooperative at times. There was not evidence of a care plan that reflected the patient's neurological status. Corrected on site.

Upon patient record review, 10 of 19 records (Patient #1,#2,#4,#5,#6,#7,#8,#9,#10,#11) did not have evidence the plan of care must 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 #1: The visit frequency for the skilled nurse was 2x/week and 14 prn. Patient #2,#8: The visit frequency for the skilled nurse was 1x/week and 14 prn. Patient #4,#5,#7,#9,#10,#11: The visit frequency for the skilled nurse was 1x/week and 10 prn. Patient #6: The visit frequency for the skilled nurse was 1x/week and 13 prn.

Upon patient record review, 10 of 19 records (Patient #1,#3,#5,#6,#7,#8,#10,#12,#13,#14) 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 #1: The record indicated that the patient was on oxygen 2-4L/min prn. There was not evidence of a route. In addition, Acetaminophen 650 mg rectal supp. Administer 1 supp rectal q6h as needed. Insert 1 q6h prn pain or fever. There was not evidence of a parameter for fever. Patient #3: The record contained an order for zinc oxide 10% topical, 1 application topical 3x/day q shift skin protectant without evidence of a specific location, and Lidocaine topical 4%, apply 1 patch topically daily without evidence of a specific location. Patient #5: The medication profile included Tylenol 325 mg, 2 tabs q6h prn pain, Percocet 325-5, 1 BID prn severe pain, and Acetaminophen-oxycodone 325-5, 1 BID prn pain, and Acetaminophen 500mg, 2 tabs BID mild pain. There was not evidence of a maximum allowable dose for acetaminophen per 24h. In addition, Lidocaine 5%, 1 patch daily for pain without evidence of a location. Patient #6: The record contained an order for Acetaminophen 650 mg rectal supp. Administer 1 supp rectal q6h as needed. Insert 1 q6h prn pain or fever. There was not evidence of a parameter for fever. Patient #7,#10: Acetaminophen was ordered for fever with no evidence of a parameter for fever. Patient #7: In addition the patient was on Senna and Dulcolax tablets daily. There was also a Dulcolax supp 1 daily prn constipation and MOM 30 cc daily prn constipation without evidence of which prn drug to administer first and under what circumstances to administer the second prn laxative. Patient #8: The record contained an order for Acetaminophen 1 q6h pain or fever with no fever parameter and Tylenol 500 mg, 2 tabs bid, no max allowable dose and Miralax 17 Gm daily as needed without evidence of a diluent. Patient #12: Acetaminophen 650 rectal supp q6h fever >101 and acetaminophen 325, 2 tabs q6h prn pain with no max allowable dose. Patient #13: Tylenol 325, 2 tabs q6h, Acetaminophen-hydrocodone 325-10 2x/day and Acetaminophen-Hydrocodone 325-2.5 1 q6h prn. No evidence of max allowable dose. Polyethylene Glycol 17 Gm daily constipation without evidence of a diluent.

Upon client record review, 2 of 19 record (Patient #1,#5) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1: The routine skilled nurse visit frequency was 2x/week. For the week of 11/5/23-11/11/23, the record indicated only 1 visit. Patient #5: The volunteer visit frequency was 2m2 from 11/1/23-12/31/23. The record indicated only 1 visit in December.

Upon patient record review, 5 of 19 records (Patient #2,#5,#12,#13,#14) 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 plan of care indicated to shower. Provide a bed bath if patient not showered. Bed, shower prn as patient agrees/tolerates. Corrected on site. Patient #5: The record indicated that the patient was on Eliquis 5mg, 1 tablet BID. There was not evidence that the aide plan of care included bleeding precautions. Corrected onsite. Patient #12: The record indicated that the patient was on Eliquis 2.5mg, 1 tablet BID. There was not evidence that the aide plan of care contained bleeding precautions. Patient #13: The aide plan of care indicated to provide hygiene-bath , and provide complete am care. The directions were not specific. Corrected on site. Patient #14: The record indicated that the patient was on Eliquis 5mg, 1 tablet BID. There was not evidence that the aide plan of care included bleeding precautions.

Upon patient record review 6 of 19 records (Patient #1,#2,#8,#9,#10,#12) 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 #1: The aide plan of care indicated to shower and shampoo at all visits. On 1/4/24, the aide documentation indicated 'not applicable' for these tasks. Patient #2: The aide plan of care indicated to make bed, assist with dressing, shower, peri care and skin care with each visit. For the dates of 12/28/23, 1/3/24, and 1/4/24, the aide documentation revealed 'not applicable.' Patient #8: The aide visit frequency was 5x/week. There was not evidence of visits on 12/13/23, 12/14/23, or 12/15/23. Patient #9: The aide visit frequency was 2x/week. There was not evidence of an aide visit. Patient #10: The aide visit frequency from 9/27/23-12/23/23 was 2x/week. There was not evidence of a visit by the aide since 11/3/23. Patient #12: The aide plan of care listed the task of shower and shampoo to be performed at every visit. Upon observation visit and interview with the aide, she indicated that she showers and shampoos 2x/week and the patient sits on the commode or a chair in the bathroom and the bath is provided in this manor on the other days. The observed visit was the day a bath on the commode was provided by the aide.

Upon patient client record review, 1 of 19 records (Patient #15) did not evidence that each patient record contains physician orders. Patient #15: The patient was discharged due to no longer meeting hospice criteria. There was not evidence of a discharge order from the Medical Director..

Upon patient client record review, 1 of 19 records (Patient #1) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #1: The Patient Notification of Hospice Non-Covered Items, Services, and Drugs of a different patient was in the electronic medical record of this patient. Corrected on site.