Every finding on record at Guardian Home Care LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following the effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, and drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by interview and observation. In 1 of 3 (33%) home visit observations revealed that the agency did not ensure a medication reconciliation was completed and medications updated to the medication profile. Clinical Record 3/Home Visit 3: The patient’s election of hospice benefit was dated 09/11/2023 with a diagnosis of unspecified sequelae of cerebral infarction. During the home visit with the hospice aide (Personnel Record 8) on 12/28/2023 the medication review identified that Lansoprazole 30mg daily via PEG for gastritis; metformin 1000mg oral tablet twice daily via PEG for diabetes; and atorvastatin 40mg oral tablet at bedtime via PEG for cholesterol was on the medication profile dated 9/11/2023-12/28/2023. The patient's spouse stated that the above medications had not been used "for a while." Lorazepam 2mg/ml, take 0.5ml sublingually every 4 hours as needed for anxiety or restlessness, last filled on 9/12/2023; and Acetaminophen 650mg supp. use one suppository rectally every 6 hours as needed for pain last filled on 9/12/2023 was present in the home for the patient's use, however the Lorazepam and Acetaminophen were not on the agency medication profile. The Director of Nursing confirmed in a joint record review and interview on 12/28/2023 that there was no documented evidence the medication was reconciled at the time of each comprehensive assessment and updated to the drug profile.

It is required that the hospice designates a registered nurse member of the IDG to provide coordination of care, ensure continuous assessment of each patient’s and family’s needs, and ensure the implementation of the interdisciplinary plan of care. Hospice care and services provided to patients and families follow the individualized plan of care established by the hospice IDG in collaboration with the attending physician (if any), the patient or patient representative, and the primary caregiver in accordance with the patient’s needs. This standard was not met as evidenced by clinical record review and interview. In 1 of 9 (11%) clinical records reviewed revealed that the agency did not ensure the medical social worker and spiritual counseling services were provided per the plan of care. Clinical Record 4: The patient’s election of hospice was dated 4/21/2023 with a diagnosis of Alzheimer’s disease. The recertification plans of care dated 6/20/2023-8/18/2023 and 8/19/2023-10/17/2023 stated, "Spiritual Counselor, Frequency 1m2, Start 7/1/2023 and 8/19/2023." The recertification plan of care dated 10/18/2023-12/16/2023 stated, "Medical Social Worker, Frequency: 1m2: Start 10/18/2023, End: 11/30/2023." A medical social worker visit note dated 11/29/2023 stated, "There was no answer to door." There was no documented evidence of a Spiritual Counselor visit or missed visit for the month of August and no documented evidence of any additional attempts by the Medical Social Worker to contact the patient after the note dated 11/29/2023. During a joint record review and interview on 12/28/2023, the Director of Nursing confirmed that the records lacked evidence of missed visits and documentation of medical social worker and spiritual counselor visits according to the plan of care.