Every finding on record at Elite Hospice & Palliative Care Inc

Upon patient record review, 4 of 19 (Patient #2,#3,#4,#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 2: The medication profile includes an entry for Metamucil 3.4gms daily. The entry does not include the type and amount of diluent. Patient 3:The medication profile includes an entry for a Lidocaine patch to be applied daily. The entry does not include the location of application. Patient 4:The medication profile includes an entry for acetaminophen 500mg 2 tabs every 4 hours as needed for pain and acetaminophen 650 mg suppository every 6 hours as needed for pain with no instruction not to exceed 4000 mg of acetaminophen daily noted. Patient 14:The medication profile includes MiraLAX 17gms po daily with no inclusion of the type and amount of diluent needed for administration. The medication profile includes an entry for Acetaminophen 650 rectal suppository every 6 hours as needed for pain with Tylenol 325 2 tabs q 6 hours as needed for pain with no instruction not to exceed 4000 mg of acetaminophen daily.

Upon patient record review, 2 of 19 (Patient #7, 9) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient 7:The plan of care includes the intervention of assessment of wounds. There is no evidence of documentation in the medical record of a wound assessment from 8/20/24 through 10/29/24. Patient 9:The plan of care includes the intervention of assessment of wounds. There is no evidence of documentation in the medical record of a wound assessment from 7/18/24 through 10/29/24.

Upon patient record review, 4 of 19 (Patient #5,#8,#9,#14) 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 5 and 9:The medical record included documentation of a primary diagnosis of cardiovascular disease. There is no evidence that the plan of care includes problems, goals and interventions to manage cardiac disease. Patient 8:The medical record includes documentation of skin tears on 10/8/24 and 10/24/24 requiring wound care to be provided. There is no evidence that the plan of care includes problems, goals and interventions for skin integrity and wound care. Patient 14:The medical record includes an order for oxygen 2 lpm as needed for shortness of breath. There is no evidence that the plan of care includes problems, goals and interventions for the use and safety of oxygen.

Upon patient record review, 1 of 19 (Patient #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 medications and treatments. Patient 6:The plan of care includes an order for Jevity via Gastrostomy tube for nutrition. The order does not include an amount to be infused.

Upon patient record review, 1 of 19 (Patient #8) did not have evidence that the IDG documents the sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement. Patient 8:The medical record includes an order for x-ray of the hip on 9/4/24. There is no documentation in the record of a report to the physician of the results of the x-ray.

Upon patient record review, 2 of 19 (Patient #1#2) 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 1:The aide plan of care includes diet as tolerated. The patient is NPO. Patient 2:The aide plan of care includes the task of dress patient with no assigned frequency.

Upon patient record review, 1 of 19 (Patient #7) did not have evidence that each patient record contains responses to medications, symptom management, treatments, and services. Patient 7:SN documented wound care provided during visits on 10/23/24 and 10/9/24. No documentation regarding how the treatment was tolerated by the patient.

Upon patient record review, 1 of 19 (Patient #14) 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 14:The plan of care includes an order for wound care to right elbow and right lower leg. The order does not include who is to perform care, hospice SN or facility nurse.

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: The patient utilizes a hospital bed, over the bed table, wheelchair, and shower chair, the DME/ supplies were not listed on the plan of care. (corrected on site)