Every finding on record at Eden Hospice at Cheyenne, LLC

Upon patient record review, 4 of 14 (Patient #1,#2,#8,#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 1:The patient medical record includes an order on admission for Hydrocortisone 1% top cream per instructions. There is no evidence that instructions on the patients medication profile includes the location for application. corrected on site. Patient 2: The patients medical record includes an order for MiraLAX 17 gm po daily for constipation. There is evidence on the patient's medication profile of duplicate entries for MiraLAX. corrected on site. Patient 8: The patients medical record includes an order for oxygen to be delivered at 2-5 liters per minute via nasal cannula as needed for shortness of breath. The patients medication profile includes an entry for oxygen 5 liters per minute with no delivery method noted. Patient 9:The patients medical record includes documentation of patient with tracheostomy with ventilator settings including oxygen to be delivered at 8 liters. The patients medication profile with entry for oxygen does not include rate of delivery for oxygen.

Condition of Participation: Interdisciplinary Group, Care Planning, and Coordination of Services. L536

Upon patient record review, 2 of 14 (Patient #4,#9) 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 4: The patient medical record includes nursing documentation on admission that the patient has a gastrostomy tube due to dysphagia. There is no evidence problems, goals and interventions related to management of a gastrostomy Tube included on the plan of care. Patient 9:The patient medical record includes nursing documentation on admission that the patient is receiving high flow oxygen via a tracheostomy tube and bolus feedings are being delivered via at gastrostomy tube. There is no evidence of problems, goals and interventions related to respiratory issues and management of a tracheostomy or management of a gastrostomy tube included on the plan of care.

Upon patient record review, 2 of 14 (Patient #1,#5,) 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 patient medical record includes an order on admission for Hydrocortisone 1% top cream per instructions and there is no evidence that the instructions include the location for application. There was a wound care regimen order entered onto the of plan of care on 8/23/23 for break down noted in the abdominal fold. There is no evidence of the frequency that care is to be performed. corrected on site Patient 5:The patient record includes on order on admission for oxygen at 2 liters per minute via nasal cannula as needed for shortness of breath. On 5/18/23 the nurse documented that O2 was in use via nasal cannula at 3.5 LPM. There is no evidence that updates were made to the plan of care to reflect the increased oxygen.

Upon client record review, 1 of 14 (Patient #5) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 5: On 5/17/23 the nurse documented that a bordered dressing was applied to the coccyx due to skin breakdown with no corresponding order noted. There is no evidence of orders to perform wound care.

Condition of Participation: Hospices that Provide Hospice Care to Residents of a SNF/NF or ICF/MR.

Condition of Participation: Hospice Aide and Homemaker Services. L607

Upon patient record review, 2 of 14 (Patient #3, #8) 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 3: There is documentation in the patient record on admission of a history of seizures with recent discontinuation of anti-seizure medication due to side effects. There is no evidence of seizure precautions included on the aide plan of care. corrected on site. Patient 8: There is documentation in the record on admission that the patient has issues including dysphagia, difficulty with safely ingesting food and fluids and altered diet of pureed food with thickened liquids and indicates that patient uses oxygen at 2-5 liters per minute via nasal cannula as needed for shortness of breath. There is no evidence that aspiration and oxygen precautions are included on the plan of care.

Upon patient record review 1 of 14 (Patient #1) 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 • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 1: Aide documentation on 8/18/23 indicates that task of change linens was completed. There is no evidence that the task of change linens was assigned on the aide plan of care. Corrected on site

Upon client record review, 1 of 14 (Patient #1) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 1: The medical record includes an order on admission for the discontinuation of iron. The facility medication administration record still lists iron 200mg daily po as an active medication.

Upon client record review, 1 of 14 (Patient #1) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient 1: There was a wound care regimen order entered onto the of plan of care on 8/23/23 for break down noted in the abdominal fold. There is no evidence that the plan of care includes who is to perform the wound care and frequency that care is to be performed. corrected on site