Every finding on record at Heavenly Comfort Hospice LLC

Upon patient record review 2 of 14 records reviewed (Patient #7, #8) 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 #7: The record indicated the psychosocial comprehensive assessment was completed on 10/18/23. The start of care was 10/12/23. There was no evidence of this assessment being completed within 5 days from the start of care date. Patient #8: The record indicated the psychosocial comprehensive assessment was completed on 10/19/23. The start of care was 10/10/23. There was no evidence of this assessment being completed within 5 days from the start of care date.

Upon patient record review, 9 of 14 records reviewed (Patient #2, #3, #4, #5, #6, #7, #8, #9, #10) 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 #2: Upon home visit patient Patient #2 had Tramadol and Lorazepam on the medication profile but did not have it in the home. When the daughter (caregiver) was asked what she would give her mom if she had pain during the night and or anxiety and she replied, "Zyquil". The nurse reported she threw these two mediations away. She also had Atorvastatin 20mg oral table QHS on the medication profile, this was also not in the home. The nurse stated she had not taken it in a while. Mupirocin 2% topical cream prn BID,no specific site as to where this medication needed to be applied. Travoprost 0.004% opthalmic solution one drop in (eye) @ QHS, no indication of which eye. Miralax oral powder 17gram by mouth prn BID, no liquid to reconstitute with or the amount of liquid. Calmoseptine 0.44%-20.6% Topical ointment prn, no site to where this medication needed to be applied. Patient #3: Calmoseptine 0.44%-20.6% Topical ointment prn, no evidence of the specific site to where this medication needed to be applied. Miralax 17gm by mouth prn BID for reconstitution, no evidence of the what type of liquid to reconstitute the medication in or the amount of the liquid. Silvadene 1% topical cream one dime size QID prn, no evidence in the record of where to apply this cream. Patient #4: Metamucil (2) by mouth daily, no evidence of what (2) was i.e. tablets, scoops, etc. Multi Vitamin mineral (1) daily by mouth, no evidence of what (1) was i.e. tablet or liquid Patient #5: Triamcinolone Acetonide 1% one dime size amount topically BID, no evidence of where the cream needed to be applied. Patient #6: Calmoseptine 0.44% - 20.6% topical ointment one application topical BID prn, no amount or where the ointment should be applied. Patient #7: Calmoseptine 0.44% -20.6% topical ointment one nickel size drop prn QID, no evidence of where the ointment should be applied. Miralax oral powder for reconstitution 1 capful by mouth BID prn, no liquid or the amount of liquid was listed. Mupirocin 2% Topical small amount topically tid, no evidence in the record as to how much and where the medication should be applied. Patient #8: Calmoseptine 0.44% - 20.6% topical oint. Nickel size prn QID, no evidence in the record where this medication should be applied. Solonpas Large Pain Relief Patch – 1 patch transdermal tid prn, no evidence of where the patch should be placed. Patient #9: Cholecalciferol tablet 1000U 2 tabs by mouth daily. The patient verbalized on home visit she had not taken this medication in a long while, no discontinuation of the medication. Nystatin 100,000 units/g topical powder as directed topical prn BID yeast, no evidence in the record where this powder should be applied. Patient #10: Miralax oral powder for reconstitution 1 cap 17gm by mouth prn daily for constipation, no liquid was listed that should be reconstituted in or the amount of liquid.

Upon patient record review, 9 of 14 records reviewed (Patient #2, #3, #4, #5, #6, #7, #8, #9, #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 #2: Travoprost 0.004% opthalmic solution one drop in (eye) @ QHS, no indication of which eye. Miralax oral powder 17gram by mouth prn BID, no liquid to reconstitute with or the amount of liquid. Calmoseptine 0.44%-20.6% Topical ointment prn, no site to where this medication needed to be applied. The record indicated the patient had a foley catheter, the MD order from 6/23/23 read SN may place a foley catheter prn. SN may collect a UA & C&S prn s/s UTI. SN may change foley catheter monthly and prn. Complications per sterile technique and may irrigate. There was no evidence in the record for an MD order to include the foley catheter size or the amount of saline to go into the balloon. This was corrected on site. Patient #3: Calmoseptine 0.44%-20.6% Topical ointment prn, no evidence of the specific site to where this medication needed to be applied. Miralax 17gm by mouth prn BID for reconstitution, no evidence of the what type of liquid to reconstitute the medication in or the amount of the liquid. Silvadene 1% topical cream one dime size QID prn, no evidence in the record of where to apply this cream. Patient #4: Metamucil (2) by mouth daily, no evidence of what (2) was i.e. tablets, scoops, etc. Multi Vitamin mineral (1) daily by mouth, no evidence of what (1) was i.e. tablet or liquid Patient #5: Triamcinolone Acetonide 1% one dime size amount topically BID, no evidence of where the cream needed to be applied. Patient #6: Calmoseptine 0.44% - 20.6% topical ointment one application topical BID prn, no amount or where the ointment should be applied. Patient #7: Calmoseptine 0.44% -20.6% topical ointment one nickel size drop prn QID, no evidence of where the ointment should be applied. Miralax oral powder for reconstitution 1 capful by mouth BID prn, no liquid or the amount of liquid was listed. Mupirocin 2% Topical small amount topically tid, no evidence in the record as to how much and where the medication should be applied. Patient #8: Calmoseptine 0.44% - 20.6% topical oint. Nickel size prn QID, no evidence in the record where this medication should be applied. Solonpas Large Pain Relief Patch – 1 patch transdermal tid prn, no evidence of where the patch should be placed. Patient #9: Cholecalciferol tablet 1000U 2 tabs by mouth daily. The patient verbalized she had not taken this medication in a long while, no discontinuation of the medication. Nystatin 100,000 units/g topical powder as directed topical prn BID yeast, no evidence in the record where this powder should be applied. Patient #10: Miralax oral powder for reconstitution 1 cap 17gm by mouth prn daily for constipation, no liquid was listed that should be reconstituted in or the amount of liquid.

Upon patient record review 1 of 14 (Patient #3) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient #3: The record indicated the patient had 3 falls on 3/8/24, 3/15/24, and on 3/25/24. In the nurses note for a future plan it was noted the patient would have an exercise plan. There was no evidence in the record for this exercise plan and by who would be providing it. Upon nurse interview she stated this is what the daughter wanted.

Upon patient client record review, 1 of 14 records reviewed (Patient #11) did not evidence that each patient record contains physician orders. Patient #11: Upon hospice discharge due to no longer meeting medical criteria there was no evidence of the Medical Director giving a discharge order prior to the discharge date. This was corrected on site with a late entry for the MD order.