Every finding on record at Excel Hospice, Inc

Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the patient has received effective pain management and symptom control from the hospice for conditions related to the terminal illness. Patient #1: The record indicated the patient was yelling and agitated on 4/10/24. On 4/12/24 the patient was refusing medications still yelling and screaming. There was no evidence of a nurse following up until 4/16/24 to manage patient symptoms.

Upon patient record review, 4 of 14 record reviewed (Patient #2, #4, #5, #7) 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 record indicated on the medication profile the following medications: Lidocaine 5% topical apply to affected area 4 times per day. There was no location/site listed. Hydrochloride 3.75g powder for suspension once a day with meals mix with water. There was no amount of water indicated. Diclofenac Sodium 1% 2 gms topical apply to affected area 4 times a day. There was not location/site indicated. Triamcinolone Acetonide 0.025% Topical Ointment 1gm once a day as needed. There was no location or site indicated. Corrected on site. Patient #4: Acetaminophen 650mg oral Q6hours prn pain/fever over 100, no max dose. In addition, Acetaminophen 650mg Rectal Suppository Q6hours prn mild pain or fever, no max dose. Corrected on site. Patient #5: Acetaminophen 325mg 2 tablets every 8 hours prn pain, no max dose. In addition, Acetaminophen 650mg 1 rectal Q6hours prn mild pain or fever, no max dose. Patient #7: Voltaren 1% topical Gel, 1gm tid as needed for pain, no site location listed. Corrected on site.

Upon patient record review, 1 of 14 records reviewed (Patient #2) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #2: The record indicated the start of care was on 6/9/23; There was no evidence of the bereavement risk assessment being complete until 6/22/23.

Upon patient record review, 1 of 14 record reviews (Patient #1) 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 #1: The record indicated the patient was yelling and agitated on 4/10/24. On 4/12/24 the patient was refusing medications still yelling and screaming. There was no evidence of a nurse following up until 4/16/24. Corrected on site with a late entry telephone call.

Upon patient record review, 1 of 14 records reviewed (Patient #5) 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: This home visit revealed the following: 6 bottles of Simvastatin, 3 bottles of Metoprolol, 4 bottles of Tamsulosin, Glyburide 2 bubble packs and 2 bottles of Metformin. Surveyor was told by the CNA the medications were on the second floor. The Resident Care Director stated his medications were in his room. After returning to his room these medications were found in various pharmacy bags some having been opened and some were stapled closed. There was evidence that he is not taking the medications as prescribed and evident the nurse was not checking the medication counts. The medical record indicated he was "compliant" with medications, but after review and interviewing the hospice staff he was not compliant. There were no evidence in the record for this problem to have goals and interventions. Corrected on site.

Upon patient record review, 4 of 14 records reviewed (Patient #2, #4, #5, #7) 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: The record indicated MD order for the following medications: Lidocaine 5% topical apply to affected area 4 times per day. There was no location/site listed. Hydrochloride 3.75g powder for suspension once a day with meals mix with water. There was no amount of water indicated. Diclofenac Sodium 1% 2 gms topical apply to affected area 4 times a day. There was not location/site indicated. Triamcinolone Acetonide 0.025% Topical Ointment 1gm once a day as needed. There was no location or site indicated. Corrected on site. Patient #4: Acetaminophen 650mg oral Q6hours prn pain/fever over 100, no max dose. In addition, Acetaminophen 650mg Rectal Suppository Q6hours prn mild pain or fever, no max dose. Corrected on site. Patient #5: Acetaminophen 325mg 2 tablets every 8 hours prn pain, no max dose. In addition, Acetaminophen 650mg 1 rectal Q6hours prn mild pain or fever, no max dose. Patient #7: Voltaren 1% topical Gel, 1gm tid as needed for pain, no site location listed. Corrected on site.

Upon patient record review, 1 of 14 (Patient #8) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #8: The record indicated the patient had a UTI on 11/30/23 and an antibiotic was ordered on 12/5/23. There was no evidence of a care plan for this infection that included goals and interventions for this infection. Corrected on site.

Upon patient record review, 1 of 14 (Patient #1) did not have evidence that Social work services are based on the patient's psychosocial assessment and the patient/family's needs and acceptance of these services. Patient #1: The record indicated the patient was yelling and agitated on 4/10/24; The Social Worker made a visit on 4/11/24 documenting the patient caregiver requested the Social Worker to make biweekly visits. Between 4/14/24 to 4/20/24 there were no social worker visits as requested by the patient caregiver

Upon patient record review, 2 of 14 (Patient #7, #9) 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 #7: The record indicated the CNA should have 1 person assist. The patient had a hoyer lift placed in the home on 1/15/24 and fell on 1/30/24. The record did not indicate the CNA Care Plan had been updated regarding the assistance necessary for fall precautions and hoyer lift usage. Corrected on site. Patient #9: The record indicated a hoyer lift was placed in the home on 4/18/24, the hospice aide made a visit on 4/19/24 and 4/22/24. There was no evidence the Hospice Aide Care plan was updated for the mechanical lift. Corrected on site.

Upon client record review, 1 of 14 (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 record indicated all care plans to have interventions that did not specify who was responsible i.e. facility nurse, hospice nurse, facility SW, Hospice SW, etc.