Every finding on record at Epworth at Home, LLC

Based on record review and interview, the hospice failed to ensure a timely review of medications for three (Patients #5, 6 and 11) of eleven patients. --- Patient #5 A review of clinical records showed skilled nurse assessments dated 11/16/22, 111/18/22, 11/21/22, 11/23/22, 12/07/22, 12/14/22, 12/27/22, 01/06/23 and 01/11/23 which documented the use of oxygen. Documentation showed no addition of oxygen to the medication profile. Patient #6 A review of clinical records showed skilled nurse assessments dated 01/20/23, 01/21/23, 01/22/23 and 01/23/23 which documented the use of oxygen. Documentation showed no addition of oxygen to the medication profile. Patient #11 A review of clinical records showed skilled nurse assessments dated 10/29/22, 10/21/22, 11/01/22, 11/02/22, 11/03/22, 11/25/22, 12/16/22, 12/21/22 and 12/23/22 which documented the use of oxygen. Documentation showed no addition of oxygen to the medication profile. On 03/08/23 at 12:50 pm, Staff A stated oxygen was not added to the medication profile for Patients #5, 6 and 11.

Based on record review and interview, the hospice failed to ensure the plan of care was fully developed to include all services necessary for the palliation and management of the terminal illness for eleven (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11) of 11 patients reviewed. --- Patient #1 A review of the plan of care dated 12/09/22 to 02/06/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #2 A review of the plan of care dated 12/30/22 to 02/27/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #3 A review of the plan of care dated 12/02/22 to 01/30/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #4 A review of the plan of care dated 12/19/22 to 02/16/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #5 A plan of care dated 11/14/22 to 02/16/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #6 A plan of care dated 01/20/23 to 04/19/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #7 A review of the plan of care dated 02/25/23 to 04/25/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #8 A review of the plan of care dated 09/08/22 to 12/06/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #9 A plan of care dated 01/27/23 to 04/26/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #10 A plan of care dated 01/08/23 to 03/08/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #11 A plan of care dated 10/29/22 to 01/26/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. On 03/08/23 at 12:20 pm, Staff A stated the plans of care for Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11 failed to include all services necessary for the palliation and management of the terminal illness.

Based on record review and interview, the agency failed to ensure the plan of care outlined skilled nurse frequencies and hospice aide frequencies for one (Patient #8) of eleven patients. --- Patient #8 A review of the plan of care dated 09/08/22 to 12/06/22 showed no skilled nurse frequencies and no hospice aide frequencies. A review of the clinical record showed the following: A skilled nurse assessment dated 09/08/22. A skilled nurse assessment dated 09/09/22. A skilled nurse assessment dated 09/10/22. A skilled nurse assessment dated 09/12/22. A hospice aide visit dated 09/12/22. A skilled nurse assessment dated 09/13/22. A skilled nurse assessment dated 09/14/22. A skilled nurse assessment dated 09/15/22. A hospice aide visit dated 09/15/22. A skilled nurse assessment dated 09/16/22. A skilled nurse assessment dated 09/17/22. A skilled nurse assessment dated 09/18/22. A skilled nurse assessment dated 09/19/22. A hospice aide visit dated 09/19/22. On 03/08/23 at 12:30 pm, Staff A stated the plan of care for Patient #8 failed to document skilled nurse and hospice aide frequencies.

Based on record review and interview, the hospice failed to ensure the plan of care was revised to reflect interventions for the care and management of a wound for one (Patient #1) of eleven patients. --- A review of a plan of care dated 12/09/22 to 02/06/23 with plan of care updates dated 12/14/22, 12/28/22, 01/11/23 and 01/25/23 showed no interventions for the care and management of wounds. A review of the clinical record showed the following: A skilled nurse assessment dated 12/09/22 showed the presence of a wound to the right hip. A skilled nurse assessment dated 12/14/22 showed the presence of a wound to the right hip. A skilled nurse assessment dated 12/16/22 showed the presence of a wound to the right hip. A skilled nurse assessment dated 12/19/22 showed the presence of a wound to the right hip. A skilled nurse assessment dated 12/21/22 showed the presence of a wound to the right hip. A skilled nurse assessment dated 12/28/22 showed the presence of a wound to the right hip. A skilled nurse assessment dated 12/30/22 showed the presence of a wound to the right hip. A skilled nurse assessment dated 01/04/23 showed the presence of a wound to the right hip. A skilled nurse assessment dated 01/06/23 showed the presence of a wound to the right hip. A skilled nurse assessment dated 01/09/23 showed the presence of a wound to the right hip. A skilled nurse assessment dated 01/11/23 showed the presence of a wound to the right hip. A skilled nurse assessment dated 01/18/23 showed the presence of a wound to the right hip. A skilled nurse assessment dated 01/20/23 showed the presence of a wound to the right hip. A skilled nurse assessment dated 01/24/23 showed the presence of a wound to the right hip. A skilled nurse assessment dated 01/27/23 showed the presence of a wound to the right hip. A skilled nurse assessment dated 01/30/23 showed the presence of a wound to the right hip. A skilled nurse assessment dated 02/01/23 showed the presence of a wound to the right hip. A skilled nurse assessment dated 02/03/23 showed the presence of a wound to the right hip. On 03/08/23 at 12:40 pm, Staff A stated the plan of care for Patient #1 did not include interventions for the care and management of the wound to the right hip.

Based on record review and interview, the hospice failed to ensure wound measurements were coordinated with the long-term care facility for one (Patient #1) of eleven patients. --- A review of a plan of care dated 12/09/22 to 02/06/23 with plan of care updates dated 12/14/22, 12/28/22, 01/11/23 and 01/25/23 showed a skilled nurse frequency of 2-3 visits per week. A review of the clinical record showed the following: Skilled nurse assessments dated 12/19/22 and 12/21/22 for the week of 12/19/22 to 12/25/22 documented no wound measurements or assessments of the wound. Skilled nurse assessments dated 12/28/22 and 12/30/22 for the week of 12/26/22 to 01/01/23 documented no wound measurements or assessments of the wound. Skilled nurse assessments dated 01/04/23 and 01/06/23 for the week of 01/02/23 to 01/08/23 documented no wound measurements or assessments of the wound. Skilled nurse assessments dated 01/09/23 and 01/11/23 for the week of 01/09/23 to 01/15/23 documented no wound measurements or assessments of the wound. Skilled nurse assessments dated 01/18/23 and 01/20/23 for the week of 01/16/23 to 01/22/23 documented no wound measurements or assessments of the wound. Skilled nurse assessments dated 01/24/23 and 01/27/23 for the week of 01/23/23 to 01/29/23 documented no wound measurements or assessments of the wound. Skilled nurse assessments dated 01/30/23, 02/01/23 and 02/03/23 for the week of 01/30/23 to 02/05/23 documented no wound measurements or assessments of the wound. On 03/08/23 at 12:45 pm, Staff A stated the skilled nurse assessments for Patient #1 failed to show wound measurements and assessments of the wound. Staff A stated the skilled nurse assessment failed to show measurements and assessments of the wound bed, with the exception of drainage, from facility staff.