Every finding on record at Gsr Hospice Inc.

Upon patient record review, 3 of 14 (Patient #4, 7, 9) 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 #4: Fleets enema ordered "as needed" for constipation daily (12/4/23). The instructions read to give if Bisacodyl and MOM not effective. There is no MOM on med profile. Corrected on Site. Patient #7: The Bisacodyl Suppository 10 mg PRN Daily (12/4/23) was ordered. On the medication profile, Bisacodyl is listed twice (duplicated). Corrected on Site. Patient #9: The Bisacodyl Suppository 10 mg PRN Daily (12/4/23) was ordered. On the medication profile, Bisacodyl is listed twice (duplicated). Corrected on Site.

Upon patient record review, 1 of 14 (Patient #4) 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 #4: There was no evidence the Bereavement Risk Assessment was timely. The SOC was 3/8/24 and Bereavement Risk Assessment was completed late on 3/18/24.

Upon patient record review, 1 of 14 (Patient #11) 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 Patient 11: MSW visit frequency ordered "as needed" and the SC visit frequency ordered as 1x then "as needed." These frequencies did not include a baseline visit frequency for the MSW or a quantity for the prn visits and not quantity for the prn visits for the SC.

Upon patient record review, 1 of 14 (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 medications and treatments. Patient #4: Fleets enema ordered "as needed" for constipation daily (12/4/23). The instructions read to give if Bisacodyl and MOM not effective. There is no order for MOM. Corrected on Site.

Upon patient record review, 3 of 14 (Patients #1,2,14) 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 #1: This patient had a Hoyer lift. This was not included on the Plan of Care. Corrected on Site. Patient #2: This patient had a wheel chair. This was not included on the Plan of Care. Corrected on Site. Patient #14: The record reflected that this patient had a nebulizer treatment order. There was no nebulizer machine/equipment included on Plan of Care. Corrected on Site.

Upon client record review, 1 of 14 (Patient #2) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2: The POC listed MSW visit frequency of, 1 X's per month (5/5/23). There were no visits by the MSW for the months of July, September or November in the year 2023.

Upon patient record review, 1 of 14 (Patient #13) 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 #13: The POC listed Aide visit frequency of, 3 X's per week + 2 PRN (12/4/23). The PRN did not identify if patient or caregiver were cognizant to provide the Aide direction for a PRN visit to occur.

Upon patient record review 5 of 14 (Patients #4,5,6,8,9) 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 Patient #4: The POC listed Aide visit frequency of, 3 X's per week (3/8/24). There were no visits performed by the Aide the first benefit week. Patient #5: The POC listed Aide visit frequency of, 3 X's per week (2/16/24). There was only one visit the first benefit week performed by the Aide on 2/17/24. Patient #6: The POC listed Aide visit frequency of, 4 X's per week (2/15/24). There were two visits the first benefit week on 2/16/24 and 2/17/24 only. Patient #8: The POC listed Aide visit frequency of, 2 X's per week (9/3/23). There was only one visit the first benefit week performed by the Aide on 9/7/23. Patient #9: The POC listed Aide visit frequency of, 3 X's per week (8/3/23). There were no visits performed by the Aide until 8/15/23.