Every finding on record at Heart of America Hospice Kansas, LLC

Upon patient record review, 8 of 19 (Patients #1,#4,#6,#8,#9,#10,#12,#14) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 1: The medication profile contained oxygen with no delivery method and polyethylene glycol oral powder with no instructions for a diluent. Corrected on site. Patient 4: The medication profile contained oxygen with no delivery method. Corrected on site. Patient 6: The medication profile contained oxygen with no delivery method and polyethylene glycol oral powder with no instructions for a diluent. Corrected on site. Patient 8: The medication profile contained hydrocortisone with a route of g-tube. There was no evidence in nursing documentation that the patient had a g-tube. The medication profile also contained aspirin, amlodipine, atorvastatin, Compazine, immodium, lisinopril, oxycodone-acetaminophen, tacrolimu, and Ventolin with route identified as none. Corrected on site. Patient 9: The medication profile contained duplicative daily furosemide listed with 20 mg dose dated 12/7/23 and 40 mg dose dated 10/26/23. The medication profile contained oxygen with no delivery method. Corrected on site. Patient 10: The medication profile contained MiraLax oral powder with no instructions for a diluent. Corrected on site. Patient 12: The medication profile contained Calmoseptine topical ointment with no area defined for administration, atropine for excessive secretions with route eye, MiraLax oral powder with no instructions for a diluent, and oxygen with no delivery method. Corrected on site. Patient 14: The medication profile contained atropine for secretions with route eye, hydrocortisone topical cream with no area defined for administration, polyethylene glycol oral powder with no instructions for a diluent, and oxygen with no delivery method. Corrected on site.

Upon patient record review, 1 of 19 (Patient #10) 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 10: The medical record and nursing documentation upon admission identified patient diagnosis and difficulty with dysphagia. There was no evidence of problems, goals, and interventions related to dysphagia included in the plan of care.

Upon patient record review, 8 of 19 (Patients #1,#4,#6,#8,#9,#10,#12,#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 medications and treatments. Patient 1: The medical record contained orders for oxygen with no delivery method and polyethylene glycol oral powder with no instructions for a diluent. Corrected on site. Patient 4: The medication profile contained an order for oxygen with no delivery method. Corrected on site. Patient 6: The medical record contained order for oxygen with no delivery method and polyethylene glycol oral powder with no instructions for a diluent. Corrected on site. Patient 8: The medical record contained an order for hydrocortisone with a route of g-tube. There was no evidence in nursing documentation that the patient had a g-tube. The record also contained orders for aspirin, amlodipine, atorvastatin, Compazine, immodium, lisinopril, oxycodone-acetaminophen, tacrolimu, and Ventolin with route identified as none. Corrected on site. Patient 9: Furosemide was listed twice with differing doses to be taken daily. The medical record contained an order for oxygen with no delivery method. Corrected on site. Patient 10: The medical record contained an order for MiraLax oral powder with no instructions for a diluent. Corrected on site. Patient 12: The medical record contained order for Calmoseptine topical ointment with no area defined for administration, atropine for excessive secretions with route eye, MiraLax oral powder with no instructions for a diluent, and oxygen with no delivery method. Corrected on site. Patient 14: The medical record contained orders for atropine for secretions with route eye, hydrocortisone topical cream with no area defined for administration, polyethylene glycol oral powder with no instructions for a diluent, and oxygen with no delivery method. Corrected on site.

Upon patient record review, 4 of 19 (Patients #5,#6,#7,#12) 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 5: The medical record contained nursing documentation 11/21/23 identifying patient use of a Hoyer lift for transfers. There was no evidence of an order for a lift included in the plan of care. Patient 6: The medical record contained nursing documentation 11/20/23 identifying patient use of a wheelchair. There was no evidence of an order for a wheelchair included in the plan of care. Patient 7: Upon home visit observation, it was identified that the patient uses a Broda chair. There was no evidence of an order for a Broda included in the plan of care. Patient 12: The medical record contained nursing documentation 10/10/23 identifying patient use of a Hoyer lift for transfers. There was no evidence of an order for a lift included in the plan of care. Corrected on site.

Upon client record review, 1 of 19 (Patient #6) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 6: The medical record contained an ordered nursing frequency of twice weekly. There was no evidence of a second visit completed the weeks of 10/22/23 and 10/29/23.

Upon patient record review, 2 of 19 (Patients #5,#7) 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 5: The medical record contained nursing documentation 11/21/23 identifying patient use of a Hoyer lift for transfers. There was no evidence of instructions for transfer with Hoyer on the aide care plan. Patient 7: Upon home visit observation, it was identified the patient required a Hoyer lift for transfers. There was no evidence of instructions for transfer with Hoyer on the aide care plan.

Upon patient record review 4 of 19 (Patients #1,#5,#6,#7) 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 1: The aide care plan contained tasks to record BM dates every visit and obtain weight at the beginning of each month. There was no evidence the aide recorded BMs or obtained weights all December visits completed on 12/1/23, 12/4/23, 12/7/23, 12/11/23, and 12/14/23. Patient 5: The medical record contained an ordered aide visit frequency of twice weekly. There was no evidence of a second visit completed the week of 11/19/23. Patient 6: The aide care plan contained tasks to obtain weights twice monthly. There was no evidence the aide obtained weight in November. Patient 7: The aide care plan contained tasks to shower weekly during first visit of the week and bed bath alternate visit. There was no evidence the aide completed a shower in December. During home visit interview, the aide stated the first visit of the week was a companion visit and bed baths were given on Fridays.

Upon personnel record review, 1 of 15 (Personnel #3) did not have evidence that the hospice employees have received orientation on their specific job requirements. Personnel 3: There was no evidence of orientation in the personnel file.

Upon patient record review, 1 of 19 (Patient #7) did not have evidence that the hospice provided the following information: • The most recent hospice plan of care specific to each patient • Physician certification and recertification of the terminal illness specific to each patient • Hospice medication information specific to each patient Patient 7: Upon home visit observation, the facility did not have the CTI and plan of care in the hospice binder and the hospice could not provide evidence these documents were sent to facility.

Upon personnel record review, 2 of 15 (Personnel #13,#15) did not have evidence the hospice obtained a criminal background check on all contracted individuals who have direct patient care and access to patient records. Personnel 13,15: There was no evidence of criminal background checks included in the personnel files.