Every finding on record at Hearth Hospice of Brunswick, LLC

Upon patient record review, 2 of 14 (Patient #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 4: The medication profile includes orders for Furosemide 20mg daily as needed, Hydroxyzine 20 mg 3 times a day as needed, Tums daily as needed, and Echinacea 380 daily as needed. No evidence that an indicator was listed for any of these listed PRN medications. Corrected on site Patient 5: The current medication profile includes orders for Guaifenesin 600mg twice a day for 5 days ordered on 02/03/25. Keflex for 5 days ordered on 02/03/25. Macrobid for 5 days ordered on 02/03/25. No evidence that a stop date was entered on the medication profile or the medication profile was updated to remove these medications. Corrected on site.

Upon patient record review, 1 of 14 (Patient #1) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual's attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient's progress toward desired outcomes • Reassessment of the patient's response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient 1: No evidence that an RN assessed the patient as the condition required but no less frequently than every 15 days. The record indicates that there were 17 days between RN assessments 04/02/2025 and 04/19/2025.

Upon patient record review, 2 of 14 (Patient #1,9) 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: No evidence that the wound to the right lower leg was measured for the week of 04/02/25, 04/19/2025, and 04/24/2025. Wound remains active in the wound chapter, the plan of care has active wound care orders. Agency policy is for wounds to be measured weekly. Patient 9: No evidence that the wound to the left heel and the sacrum was measured for the week of 02/23/25, 03/02/25, 03/23/25, 04/13/25, 04/20/25, and 05/4/25. Wound remains active in the wound chapter, the plan of care has active wound care orders. Agency policy is for wounds to be measured weekly.

Upon patient record review, 1 of 14 (Patient #3) 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: The medical record indicated that the patient has oxygen in the home and uses it as needed for shortness of breath. The medical record also indicates that the patient continues to smoke 1/2 a pack of cigarettes a day. No evidence that the plan of care included oxygen safety specifically related to fire hazard with smoking near oxygen.

Upon patient record review, 2 of 14 (Patient #4,9) 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: The plan of care included orders for Furosemide 20mg daily as needed, Hydroxyzine 20mg 3 times a day as needed, Tums daily as needed, and Echinacea 380 daily as needed. No evidence that an indicator was listed for either of the listed PRN medications. Corrected during survey. Patient 9: Nursing documentation indicated that the patient was using continuous oxygen at 5LNC on 3/7, 3/12, 3/19, 3/22. No evidence that an order was placed for continuous oxygen at 5LNC. The medication profile contained an order for 4LNC continuously without a titration order to increase.

Upon patient record review, 1 of 14 (Patient #10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 10: The clinical IDG documentation indicates that chaplain services were to be provided at one visit/phone call/text once a month. The record indicates that the chaplain made one text message a month since the time of admit. No evidence that an order was obtained to ever start these services or that the visit was made at the request of the patient/caregiver.

Upon patient record review 1 of 14 (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 a registered nurse made a supervised visit every 14 days between the following dates: 03/10/25-03/25/25 (15 days), 04/02/25-04/24/25 (22 days).

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. No evidence that the agency utilized volunteers at least 5% of the total patient care hours in 2024. The total usage of volunteers for 2024 was 0.46%.

Upon patient record review, 1 of 14 (Patient #7) 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 7: The medical record contained nursing clinical notes that were copied and pasted to several nursing assessments notes. The nursing notes written on 04/02/25 and 04/09/25 were the same note. The nursing notes 04/24/25, and 04/28/25 were the same note.

Upon client record review, 1 of 14 (Patient #1) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 1: Plan of care has nurse frequency as once a week. No evidence that patient received a visit for the week of 04/06/2025. No evidence that the visit was missed at the request of the patient/CG or that a physician order was entered to change the frequency for the week.