Every finding on record at Echo Hospice of Ohio LLC

Upon home visit review, 1 of 5 (Patient #5) 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 5: On the hospice medication profile there is an order for Prochlorperazine 10mg 1 tablet every 6 hours as needed, this medication is not on facility plan of care.

Upon patient record review, 1 of 5 (Patient #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 equipment and supply needs. Patient 4: There is documentation of a g-tube for enteral feedings. There are not supplies or items needed for enteral feedings and g-tube care listed on the plan of care.

Upon client record review, 1 of 5 (Patient #4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 4: In the patient record there is documentation that the patient has a g-tube, on the plan of care there is not instructions for care of the g-tube with goals and interventions.

Upon patient record review, 6 of 19 (Patients #1,2,3,4,10,11) 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: Patient had an oxygen concentrator. Oxygen was not included on the medication profile. COS. Patient #2: During medication reconciliation in patients home, the meds being administered by caregiver were not included on the medication profile. They were, Eliquis, Atorvastatin, Clopidogrel, Sertraline, Loperamide, Insulin N, Metoprolol, Spirnolactone, Furosemide and Melatonin. COS. Patient #3: During medication reconciliation at facility where the patient resides, the meds on the hospice medication profile did not match facility med profile. Hospice had multiple entries for lorazepam 0.25 mL to give every 3 hours PRN, every 6 hours PRN and routine TID. Whereas, that facility had new order for 0.5mL every 6 hours. Also, the hospice medication profile for morphine indicated TID and Q1hr PRN. The facility medication profile indicated morphine Q6 hours. Additionally, the Cranberry tab was listed as 450 mg and the facility is giving 500 mg. COS. Patient #4: During medication reconciliation at facility the patient resides, The hospice medication profile indicated Lorazepam 5mg solution and the facility indicated lorazepam in tablet form. COS. Patient #10: The record reflected the patient had oxygen. Oxygen was not included on the medication profile. COS. Patient #11: The medication profile indicated Polyethylene Glycol 17gm powder order with no diluent. COS.

Upon patient record review, 6 of 19 (Patients #1,2,3,4,10,11) 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: Patient had an oxygen concentrator. Oxygen was not included on the Plan of Care. COS. Patient #2: During medication reconciliation in the patient home, the meds being administered by caregiver were not included on the Plan of Care. They were, Eliquis, Atorvastatin, Clopidogrel, Sertraline, Loperamide, Insulin N, Metoprolol, Spirnolactone, Furosemide and Melatonin. COS. Patient #3: The following medication patient is taking was not included on the Plan of Care. They are, Lorazepam 0.5mL every 6 hours, morphine sulfate every 6 hours, and Cranberry Tab 500 mg Daily. COS. Patient #4: The following medication patient is taking was not included on the Plan of Care, Lorazepam 5mg tablet (not solution). Patient #10: The record reflected this patient had oxygen. Oxygen was not included on the Plan of Care. COS. Patient #11: The Plan of Care indicated Polyethylene Glycol 17 gm powder order with no diluent. COS.

Upon patient record review, 3 of 19 (Patients #2,3,6) 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 equipment and supply needs. Patient #2: This patient had a wheelchair and bedside commode. These items were not included on the Plan of Care. COS. Patient #3: This patient had a fall mat, Hi-Lo Bed and bedside table. These items were not included on the Plan of Care. COS. Patient #6: The record reflected that this patient had an order for Duo-neb inhalation solution. There was no nebulizer machine listed as DME on the Plan of Care. COS.

Upon patient record review, 2 of 19 (Patients #17,19) did not have evidence the hospice offers bereavement counseling that includes: • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient #17: This patient timeline is in 12 month timeline since patient passed. There is only phone call after death completed on the Bereavement Plan of Care. There is no evidence of 2,4,6,8,10,12 and 13 month follow-up as indicated in Bereavement Plan of Care. Patient #19: This patient is in the 3 month timeline since patient passed. There is no evidence of any follow-up as indicated in Bereavement Plan of Care.

Upon patient record review, 2 of 19 (Patients #9,10) did not have evidence in the patient record that hospice aide assignments and duties are: • 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 Patients #9 and #10: The POC listed the Aide visit frequency of 3X's per week and PRN. There is no indication of PRN listed. COS.

Upon patient record review 1 of 19 (Patient #2) 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 (POC) • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #2: The POC listed the Aide visit frequency of 3X's per week. For first Benefit Week there were only 2 visits on 12/26/24 and 12/27/24. COS.

Upon personnel record review, 1 of 14 (Personnel #14) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel #14: The Volunteer did not have competency validation completed. There was a self-assessment only.

Upon patient record review, 1 of 19 (Patient #2) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #2: The beneficiary elected to receive the “Patient Notification of Hospice Non-Covered Items, Services, and Drugs”. The Patient Notification was not signed and dated by the beneficiary. There was a note by hospice employee that this form was handed to patient at start of care.

Upon patient record review, 1 of 19 (Patient #3) did not have evidence that the hospice provided the following information: • Hospice election form • Physician certification and recertification of the terminal illness specific to each patient Patient #3: The patient file at the SNF facility did not include Hospice Election Form or current Certification of Terminal Illness. Corrected on Site