Every finding on record at Holistic Hospice Inc

Upon patient record review, 3 of 14 (Patients #5, 6 and 8) 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 #5: The polyethylene glycol order (4/3/23) with no diluent ordered. Corrected on Site. Patient #6: The POC indicated oxygen for DME Supplies. There was not a medication order for O2. Corrected on Site. Patient #8: The polyethylene glycol order (9/12/23) with no diluent ordered. Corrected on Site.

Upon patient record review, 11 of 14 (Patients #1,2,4,6,7,9,14) 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. Patients #1: Did not have Bereavement Risk Assessment completed within 5 days of SOC. Patients #2, 4, 6, 7, 9 and 14: Did not have Bereavement Risk Assessment completed within 5 days of SOC. The BC provided late entry on 10/12/23 with varied reason why this was not completed timely. They were, refused, no family, guardian, patient asked not to contact family and son would not answer questions.

Upon patient record review, 3 of 14 (Patients #4,7 and 8) 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 #4: Chaplain visit frequency for benefit period 9/6/23 to 12/4/23 indicated 3 PRN visits for spiritual services. This frequency did not include a baseline visit frequency for the Chaplain. Patient #7: Chaplain visit frequency for benefit period 9/15/23 to 12/13/23 indicated 3 PRN visits for spiritual services. This frequency did not include a baseline visit frequency for the Chaplain. Patient #8: Chaplain visit frequency for benefit period 9/22/23 to 12/20/23 indicated 3 PRN visits for spiritual services. This frequency did not include a baseline visit frequency for the Chaplain.

Upon patient record review, 3 of 14 (Patients #5,6 and 8) 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 #5: The polyethylene glycol order (4/3/23) with no diluent ordered. Corrected on Site. Patient #6: The POC indicated Oxygen for DME Supplies. There was not a medication order for O2. Corrected on Site. Patient #8: The polyethylene glycol order (9/12/23) with no diluent ordered. Corrected on Site.

Upon patient record review, 2 of 14 (Patients #1, 2) 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 an APP mattress. This was not included on the Plan of Care. POC updated during survey. COS. Patient #2: This patient had aa fall mat. This was not included on the Plan of Care. POC updated during survey. COS.

Upon patient record review, 13 of 14 (Patients #1,2,3,5,6,7,8,9,10,11,12,13 and 14) 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 Patients #1,2,3,5,6,7,8,9,10,11,12,13 and 14: Aide Care Plan indicated "Bath/Shower" and did not indicate parameters of when one or the other was to be performed. POC updated during survey. IDG determined bed or bath on POC. COS.

Upon observation, there was no evidence the hospice documented the cost savings achieved through the use of volunteers. Documentation must include the following: • Estimates of the dollar costs that the hospice would have incurred if paid employees occupied the positions identified in paragraph (d)(1) of CFR 418.78 for the amount of time specified in paragraph (d)(2) of CFR 418.78. The agency had been tracking hours/cost savings. However, did not report the $505.20 cost savings to governing body for 2022. Corrected on site.

Upon client record review, 3 of 14 (Patients #1, 7 and 8) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient #1: The record indicated an order dated 9/27/23 to cleanse sacrum with NSS, apply Santyl to wound bed and cover with foam border gauze daily. There was no evidence of which provider (nursing facility or hospice) was responsible for performing wound care. Corrected on Site. Patient #7: The record indicated an order dated 9/18/23 to provide sacrum wound with wet to dry dressing using with Dankin's solution daily. Also, left heel wound to cleanse with NSS, apply Iodoflex ABD pad and wrap with Kerlix daily. There was no evidence of which provider (nursing facility or hospice) was responsible for performing wound care. Corrected on Site. Patient #8: The record indicated an order dated 9/20/23 for left lateral ankle wound to apply Santyl daily. There was no evidence of which provider (nursing facility or hospice) was responsible for performing wound care. Corrected on Site.