Every finding on record at Echo Hospice of Cleveland, LLC

Upon patient record review, 9 of 14 (Patients #2,3,4,5,6,7,8,9,10) 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. 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: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours. Additionally, during medication reconciliation at the SNF, the following medications were not on the SNF medication profile but were on the hospice medication profile: Amlodipine 10mg QD, ASA 81mg QD, Lorazepam 0.5mg 1-4 tabs Q1hr PRN, Ketoprofen 5% QD, Betadine TID. The SNF medication profile had Incruse Ellipta 62.5 mcg QD and Linzess 72 mcg QD but was not included on Hospice medication profile Patient #3: This patient is prescribed Acetaminophen 325mg 2 tablets every 8 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 4 hours as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours. Patient #4,5: This patient is prescribed Acetaminophen 325mg 2 tablets every 4 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours. Patient #6: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed, Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed and Hydrocodone/Acetaminophen 5/325 one tablet 4 times daily as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours. Patient #7: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours. Patient #8: This patient is prescribed Acetaminophen 500mg 2 tablets every 8 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours. Patient #9: This patient is prescribed Acetaminophen 500mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours. Patient #10: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 4 hours as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours.

Upon patient record review, 3 of 14 (Patients #3,4,6) 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 #3: The patient record showed evidence that the patient is a diabetic. The medication profile indicates patient has Metformin 500 mg BID and Glucagon Emergency Kit-1 hypoglycemia IM Q24 hours. There was no evidence of problems, goals, or interventions related to the endocrine system. Corrected on site. Care plan updated. Patient #4: The patient record showed evidence that the patient is a diabetic. The medication profile indicates patient has Lantus 22 units at bedtime and Humalog per sliding scale. There was no evidence of problems, goals, or interventions related to the endocrine system. Corrected on site. Care plan updated. Patient #6: The patient record showed evidence that the patient is a diabetic. The medication profile indicates patient has Insulin Glargine 33 units daily. There was no evidence of problems, goals, or interventions related to the endocrine system. Corrected on site. Care plan updated.

Upon patient record review, 9 of 14 (Patients #2,3,4,5,6,7,8,9,10) 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: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours. Patient #3: This patient is prescribed Acetaminophen 325mg 2 tablets every 8 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 4 hours as needed. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours. Patient #4,5: This patient is prescribed Acetaminophen 325mg 2 tablets every 4 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours. Patient #6: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed, Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed and Hydrocodone/Acetaminophen 5/325 one tablet 4 times daily as needed.. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours. Patient #7: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours. Patient #8: This patient is prescribed Acetaminophen 500mg 2 tablets every 8 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours. Patient #9: This patient is prescribed Acetaminophen 500mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours. Patient #10: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 4 hours as needed. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours.

Upon personnel record review, 1 of 15 (Personnel #10) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: ·Normal range of motion and positioning

Upon patient record review, 1 of 14 (Patient #2) did not have evidence that the hospice provided the following information in patient file at the SNF: • The most recent hospice plan of care specific to each patient • Hospice election form • Physician certification and recertification of the terminal illness specific to each patient

Upon patient record review, 4 of 11 (Patients #1, 2, 8 and 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 #1: The POC effective 09/02/22 included Change and irrigate Foley as ordered. This order does not include 'when/the frequency' at which the Hospice is to change the Foley, by 'whom' the Foley could be irrigated, with what solution the Foley is to be irrigated, nor for what indication(s) the Foley should be irrigated. Patient #2: The POC effective 09/02/22 included Apply warm compresses to right eye BID prn discharge/discomfort. This order does not include who was responsible for this B.I.D. intervention. Patient #8: A verbal order was obtained on 07/15/22 for, Cleanse left heel with Normal Saline, pat dry, apply skin prep, ABD, then Kerlix, every other day and p.r.n. This is not a complete order, as it does not include an indication for such prn wound care, nor delineate who is to provide such wound care on dates the Hospice nurse is not present. Patient #9: A verbal order was obtained on 06/09/22 for, Cleanse right ischium wound with Normal Saline, pat dry, apply Silver Alginate (cut to fit), and cover with foam dressing, daily. This same verbal order included, Cleanse right hip wound with Normal Saline, pat dry, apply Silver Alginate (cut to fit), and cover with foam dressing, daily. These are not a complete orders, as they do not delineate 'who' is to provide such wound care on dates the Hospice nurse is not present.

Upon patient record review, 9 of 9 applicable (Patients #1, 2, 3, 4, 5, 6, 8, 9, and 10), receiving Aide care/services, did not contain evidence that the Hospice Aide Plan of Care/assignments included all pertinent patient information required by the Aide. Each of these patients' records reflected that these patients were a D.N.R. status. However, this pertinent information was not included on these Aide Plan(s) of Care.

Upon personnel record review, 1 of 9 applicable (Personnel #8) did not contain evidence that this Hospice employee/contract employee had received orientation on the Hospice Philosophy.