Every finding on record at Generations Hospice & Palliative Care, LLC

Upon patient record review 5 of 5 records reviewed (Patient #1, #2, #3, #4, #5) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient #1: There was no evidence of a spiritual care assessment and or a psychosocial assessment. Patient #2: There was no evidence of a spiritual care assessment and or a psychosocial assessment. Patient #3: There was no evidence of a spiritual care assessment and or a psychosocial assessment. Patient #4: There was no evidence of a spiritual care assessment and or a psychosocial assessment. Patient #5: There was no evidence of a psychosocial assessment.

Upon patient record review, 5 of 5 records reviewed (Patient #1, #2, #3, #4, #5) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient #1, #2, #3, #4, #5: The comprehensive assessment does not assess for the imminence of death.

Upon patient record review, 5 of 5 records reviewed (Patient #1, #2, #3, #4, #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 #1, #2, #3, #4, #5: The records indicated the patients had medications listed on the MAR. There was no evidence the following was being reviewed for: Effectiveness of drug therapy, Drug side effects, Actual or potential drug interactions, Duplicate drug therapy and or Drug therapy currently associated with laboratory monitoring. COS. Patient #2 Home visit: The medication administration record was reviewed with the patient daughter. She verbalized she was giving Eliquis 2.5mg po BID, this was not listed on the MAR. Additionally the following medications were on the MAR as active medications but were not being taken: Donepezil 5mg po QHS. Furosemide 20mg po daily (only taking prn), Jardiance 10mg po daily, Theragran-M one tab po daily, Vitamin C, E, and rose hips one tab po daily. Hydrocodone 5/325mg po one tab Q4hours prn pain was listed on the MAR, no medication was in the home and this was not being given to the patient at the time of the survey. COS.

Upon patient record review, 1 of 5 records reviewed (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 had signs and symptoms of a UTI and was treated on 1/29/24. There was not an indication of follow up and assessment until 2/12/24.

Upon patient record review, 2 of 5 records reviewed (Patient #1, #2) 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 #1: The record indicated the patient had signs and symptoms of a UTI and received an antibiotic ordered on 1/29/24 for Keflex 500mg po TID X 7days. In addition, Cipro was ordered on 2/12/24 po BID X 7 days. There was no evidence the care plan was revised to include the changes in the patient including the unresolved infection, ongoing infection and effectiveness of therapy. Patient #2: The record indicated the patient had signs and symptoms of a UTI and received an antibiotic ordered on 8/12/24 for Cipro 500mg po BID X 7 days. There was no evidence the care plan was revised to include the changes in the patient including the effectiveness of therapy.

Upon patient record review 1 of 5 records reviewed (Patient #4) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient #4: The aide supervisory visit was completed on 5/6/24 and 5/21/24. There was no evidence of the aide supervisory having been completed within 14 days.