Every finding on record at Gilbert's Hospice Care, LLC

Upon patient record review 1 of 19 (Patient #7) 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 7: No evidence that a spiritual assessment was completed within 5 days of election of hospice care. Patient was admitted on 08/19/2024, no evidence that an assessment had been completed at the time of survey. COS.

Upon patient record review, 3 of 19 (Patient #1,2,8) 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: Clonazapam/Klonipine 1mg twice a day listed on the current medication profile at the SNF. No evidence that medication was added to the hospice active medication profile. COS. Patient 2: Robitussin and Lorazepam listed on the hospice active medication profile . No evidence that those medications were being taken by the patient or listed on the active medication profile for the SNF. COS. Patient 8: The record indicates duplicate drug therapy for Ferosul and Lantanopost on the current medication profile. Ferosul 325mg (65mg iron) daily one ordered for 05/24/2024 and the other ordered on 09/16. Latanopost 0.005% eye drops 1 drop for each eye at bedtime daily one ordered for 05/24/2024 and the other ordered on 09/16. Corrected on site

Upon patient record review, 5 of 19 (Patient #3,4,6,10,13) 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 3: Patient currently takes Wellbutrin and Cymbalta as anti-depressants. There was no evidence of problems, goals, and interventions related to depression included in the plan of care. COS. Patient 4: Patient currently takes Keppra 250mg daily for seizures, Remeron and Seroquel 25mg for anti-depressant. There was no evidence of problems, goals, and interventions related to seizures and depression included in the plan of care. COS. Patient 6: The record indicates that the patient has a current diagnosis of Diabetes, blood sugar checks 3 times a day, and currently takes insulin/metformin. No evidence that problems, goals, and interventions related to endocrine/blood sugars on the current POC. COS. Patient 10: Patient currently takes Xarelto 20mg and has a related diagnosis of heart failure and currently suffers from anxiety. There was no evidence of problems, goals, and interventions related to anxiety, cardiac status, and risk for bleeding included in the plan of care. COS. Patient 13: Patient currently has Major depressive disorder listed as a related diagnosis. There was no evidence of problems, goals, and interventions related to depression included in the plan of care. COS.

Upon patient record review, 5 of 19 (Patient #1,2,3,5,7) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient 1,2,3,5,7: The plan of care has volunteer orders for weekly tuck in visits and PRN visits. No evidence that a number was added to the specify the amount of PRN visits. Corrected on site.

Upon patient record review, 1 of 19 (Patient #8) 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 8: The record indicates that the current supply list has wound care supplies and active orders for wound care treatments. The RN documentation indicated that the patient's wound was healed on 07/22/2024 and there was no updated order to deactivate the wound care.

Upon patient record review, 3 of 19 (Patient #2,5,6) 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 equipment and supply needs. Patient 2: RN documentation stated that the patient uses a hoyer lift to get patient out of the bed to the chair. No evidence that a hoyer lift was added on the equipment plan of care. Patient 5: RN documentation stated that the patient uses a wheelchair for mobility. No evidence that a wheelchair was added to the equipment plan of care. Patient 6: RN documentation stated that the patient uses a rollator/walker to help with mobility and a nebulizer was used for oxygen treatments. No evidence that a nebulizer or the rollator/walker was added on the equipment plan of care.

Upon patient record review, 2 of 19 (Patient #9,11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 9: Plan of care has RN frequency ordered as twice weekly. No evidence that 2 visits occurred during the week of 08/25/24 with only one visit on 08/27. Patient 11: Plan of care has RN frequency ordered as twice weekly. No evidence that 2 visits occurred during the week of 09/25/24 with only one visit on 10/02.

Upon patient record review 3 of 19 (Patient #1,4,14) 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 plan of care indicates for linens to be changed and shampoo to be completed weekly. The aide documentation shows that the hospice aide provided hair care at both visits for the week of 09/08/24. Aide plan of care has orders to complete 3 visits weekly. No evidence that patient received 3 visits during the week of 07/14, 09/01, 09/15, and 10/06. Patient 4: Aide plan of care has orders to complete 3 visits weekly. No evidence that patient received 3 visits during the week of 09/01/24 and 09/15/24. For the week of 09/01, only 2 visits occurred, on 09/04 and 09/06. For the week of 09/15, only 2 visits occurred on 09/16 and 09/18. Patient 14: Aide plan of care indicates hair care to be completed weekly. Aide documentation shows that the hospice aide provided hair care at every visit instead of weekly as ordered for the following weeks: 8/4/24, 8/11/24,8/18/24, 8/25/24, 9/15/24, 9/22/24, & 10/6/24.

Upon patient record review 1 of 19 (Patient #1) 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 1: No evidence that the RN performed supervised visits every 14 days. The record shows that the last supervised visit was completed on 09/25/24.

Upon patient record review, 1 of 19 (Patient #9) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient 9: Patient's family elected to receive notice of non-covered items at the time of admission on 07/20/2024. No evidence that the list of non-covered items had been provided at the time of survey.

Upon patient record review, 3 of 19 (Patient #1,3,11) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 1: Missed visit note entered on 10/07/2024 by the RN. No evidence that the date of the visit included in the note. Patient 3: Missed visit note entered on 10/09/2024 by the aide. No evidence that the date of the visit or who was notified of the missed visit was included in the note. Patient 11: Mississippi Physician Orders for Sustaining treatment missing the required signature date for the signing MD. Corrected on site.

Upon patient record review 1 of 11 (Patient #1) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #1: The patient was admitted 10/06/21. The spiritual assessment was not completed until 10/12/21.

Upon patient record review, 4 of 11 (Patient #1, #2, #4, #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. Patient #1- The medication profile includes Miralax 17 gm dose oral powder 1 daily for constipation. A diluent and amount is not listed for the powder.(corrected on site) Patient #2- The medication profile includes Nitrostat .4mg sublingual tablets 1 tablet as needed under tongue for chest pain. The frequency and number of allowable doses is not included. On 09/16/21 an order was obtained to DC Mucinex. Mucinex is currently listed on the medication profile. corrected on site Patient #4- The medication profile has 2 current dosages of Lorazepam listed. 09/04/19 Lorazepam 1mg tab 1 tab q6h prn anxiety. 02/19/20 Lorazepam 2mg .5mg-2mg q4h prn anxiety. (Duplicative drug therapy). Nitrostat .4mg sublingual tablets 1 tablet as directed for chest pain is listed on the medication profile - did not include freqeuncy, max allowable, etc. (corrected on site) Patient #7-The 6/26/21 plan of care includes specific orders for Humalog sliding scale insulin. Humalog sliding scale was not listed on the medication profile. The medication profiles include Miralax 17 gm dose oral powder 1 daily for constipation. A diluent and amount is not listed for the powder.

Upon patient record review, 4 of 11 (Patient #1, #2, #4, #10) 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 10/26/21 order to update the plan of care is for Miralax 17 gm dose oral powder 1 daily for constipation. A diluent and amount is not listed for the powder. (corrected on site) Patient #2- The 09/27/21 order to update the plan of care includes Nitrostat .4mg sublingual tablets 1 tablet as needed under tongue for chest pain. The frequency and number of allowable doses is not included. On 09/05/21 an order was written to update the plan of care for Medrol dose pack po as directed 4 mg tabs in a dose pack daily for 6 days. Dosage not specified in order. (corrected on site) Patient #4-The 10/04/21 plan of care includes Nitrostat .4mg sublingual tablets 1 tablet as directed for chest pain. (dosage, frequency and maximal allowable dosages are not included in the order) Patient #10- On 09/30/21 an order was written to update the plan of care which reads: Cleanse wound with soap and water and apply skin barrier cream to affected area. The location of the wound is not included in the order.

Upon patient record review, 2 of 11 (Patient #2, #11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2- As of 10/01/21 the Chaplain is ordered to visit once monthly. The patient was visited with two routine visits in October on 10/07/21 and 10/25/21. Patient #11- On 08/27/21 the nurse documented the patients INR was checked and results were 2.0. An order is not on record for the 8/27/21 bloodwork.

Upon patient record review, 1 of 8 applicable (Patient #3) did not have evidence in the patient record that hospice aide assignments and duties are complete. Patient #3-The patient is on Oxygen and the aide assignment sheet does not include Oxygen precautions. (corrected on site)

Upon patient record review, 1 of 3 applicable (Patient #7) did not have evidence that the discharge summary includes all required information. Patient #7-The patient revoked the election on 08/30/21 to seek aggressive treatment for L hip and thigh pain. The discharge summary does not include a brief summary of the patient's stay, including treatments, symptoms, and pain management prior to the revocation. The discharge summary only documents the patient revoked Hospice to seek aggressive treatment.