Every finding on record at Homestead Hospice of Columbia, LLC

Observed in Patient Home. In 1 of 2 home visits conducted, the organization failed to assess and reassess its patient's. During home visit for RRHV#2, Hospice Surveyor #1 observed a failed medication reconciliation in the home. During the home visit the surveyor requested the RN do a medication reconciliation per policy. The RN began to count the pain pills. The surveyor then asked the RN to call the meds out loud with doses for review. The RN proceeded to go through two more medications and then begin to end her visit. The surveyor again requested to review the rest of the medications and the RN proceeded to read them off. There were numerous medications the patient was no longer taking including Klor-Con ( although still taking a diuretic), naproxen and colchicine. The patient was also taking a different allergy pill than the one listed. The documentation supported multiple recent medication reconciliations were completed but none had documented these changes. Per the daughter, the patient hadn't been taking some of these medications for at least a month. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 1 of 10 patient records reviewed, the organization failed to maintain a complete and accurate patient record. During record review for RRNHV#2, Hospice Nurse Surveyor #1 observed the nurses narrative on several IDG notes stated DNR but the patient was not actually DNR, the MSW was working with the family regarding that status. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 7 of 9 patient records reviewed, the organization failed to plan the patient's care. During record review for RRNHV#6, RRMNHV#7, RRNHV#8, RRNHV#9, RRNHV#10, RRDC#1, and RRBR#1, the plan of care did not contain all required elements. For example in RRNHV#8, the patient had a goal of appropriate referrals made to deal with mental illness with no goal date and was put into place at SOC one year prior to survey. In RRNHV#6, the patient had a goal of neurological status will be addressed appropriately throughout cert and pt/ CG will verbalize/ demonstrate appropriate pain mgt throughout cert period neither goal was individualized and did not have goal timeframes. In RRNHV#7, the patient had a goal of pain will be managed at a level acceptable to the patient by 8/15 which was not measurable and changes in neurological status will be addressed appropriately throughout cert period which was not individualized. In RRNHV#9 the patient had a goal of Pt/ CG has knowledge of / access to appropriate community resources to provide additional personal care put in place 11 months prior with no goal date. In RRNHV#10 the patient had a goal from the Chaplain of pt has safety needs met with no goal date and it was not measurable. In RRDC#1, the patient had a goal of pt/cg understands how to use pulmonary journal with no goal date. In RRBR#1, the patient had a goal of Pt/CG verbalize understanding of when to utilize PRN medications and to document each usage with no goal date. This was discussed and reviewed with the Hospice Team. Observed in Record Review. In 9 of 10 patient records reviewed, the organization failed to plan the patient's care. During record review for RRHV#1, RRHV#2, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5, RRBR#2, and RRBR#3, Hospice Nurse Surveyor #1 observed the plan of care did not contain all required elements. For example in RRHV#1, the patient had a goal of Pt/ CG verbalizes/ demonstrates understanding of how to correct safety hazards in the home with no timeframe to meet that goal. In RRHV#2, the patient had a goal of pt/ CG verbalize/ demonstrate understanding of oxygen use in the home no timeframe pt stress and anxiety reduced to a level of comfort with no timeframe to meet that goal. In RRNHV#1, the patient had a goal of pt/ CG verbalizes/ demonstrates understanding of proper safety measures related to fall prevention which was placed 1 1/2 years prior to survey with no goal date and the patient had a recent fall. In RRNHV#2, the patient had a goal of facility staff is knowledgeable and involved in hospice plan of care for patient by enter date. The enter date was not filled in and the patient lives at home with her spouse. In RRNHV#3, the patient had a goal of patient/ CG demonstrate proper wound care with no goal date. For RRNHV#4, the patient had a goal of pain is currently managed at a level acceptable to the patient which was not measurable. In RRNHV#5, the patient had a goal of appropriate referrals made to deal with mental illness with no goal timeframe. In RRBR#2, the patient had a goal of patient/ caregiver verbalizes/ demonstrates understanding of oxygen safety with no goal date and had been in place 8 months. In RRBR#3, the patient had a goal of Pt/CG demonstrates proper irrigation of indwelling catheter with no goal date. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 1 of 10 patient records reviewed, the organization failed to document complete and accurate orders. During record review for RRNHV#3, Hospice Nurse Surveyor #1 observed the medication orders did not contain indications for use. The patient was taking Hydrocodone and Tylenol PRN for pain and there was no indication of when the patient should take which medication per policy. This was discussed and reviewed with the Hospice Team. Observed in Record Review. In 2 of 9 patient records reviewed, the organization failed to document complete and accurate orders. During record review for RRNHV#9 and RRBR#1, Hospice Nurse Surveyor #1 observed the medication orders did not contain indications for use. For example in RRNHV#9, the patient had Oxycodone, Naproxen, Acetaminophen and Tramadol PRN for pain but no indications for when to use which medication was documented per organizational policy. In RRBR#1, the patient had orders for Morphine and Tramadol for pain PRN but there was no indication for when to use which medication. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 2 of 9 patient records reviewed, the organization failed to plan the patient's care. During record review for RRDC#1 and RRBR#1, the aide plan of care did not contain all needed elements. For example in RRDC#1, the patient was wearing continuous oxygen but this was not addressed on the aide plan of care. In RRBR#1, the patient had orders for oxygen but oxygen was not addressed on the aide plan of care. This was discussed and reviewed with the Hospice Team. Observed in Record Review. In 2 of 10 patient records reviewed, the organization failed to plan the patient's care. During record review for RRHV#1, RRHV#2, Hospice Surveyor #1 observed the aide care plan did not contain all required elements. For example in RRHV#1, the patient was on intermittent oxygen but there was no education or guidance on the aide plan of care of how to handle it during care if the patient was wearing it. For RRHV#2, the patient was on continuous oxygen and was on long term coagulants but oxygen precautions and bleeding precautions were not on the aide plan of care. This was discussed and reviewed with the Hospice Team.

Observed in Record Review. In 2 of 19 patient records reviewed, the organization failed to supervise effectively. During record review for RRHV#1, and RRHV#2, documentation of aide supervision did not occur at least every 14 days. For example in RRHV#1, there was no documentation of aide supervision for the course of a month. In RRHV#2, the RN had not documented aide supervision in 3 months. This was discussed and reviewed with the Branch Director.

Observed in Record Review. the organization failed to maintain a record that reflected the patient's current treatment, or services. During record review for RRNHV#1, Hospice Nurse Surveyor #1 observed multiple narrative nursing notes stating the patient was taking Tylenol and Tramadol PRN for pain but the Tylenol was not added to the medication list. This was discussed and reviewed with the Hospice Team.

Based on interview and record review, the hospice facility failed to ensure the interdisciplinary group (IDG) completed a comprehensive assessment within 5 days of notice election (NOE)of hospice care for 4 of 10 patient charts reviewed. (Patient 1, 5, 9 and 12). --- The findings include: Record review on 05/15/23 at 3:25 PM of P 1 revealed P 1 was admitted to the hospice on 07/28/22 for Parkinsons Disease. Review of the chart revealed no IDT comprehensive assessment within 5 days of admission. The first IDT meeting for the patient was on 08/08/22, 11 days after the NOE. During an interview on 05/18/23 at 10:44 AM, the Branch Director verified the findings. Record review on 05/15/23 at 2:15 PM of P 5 revealed P 5 was admitted to the hospice on 03/24/23 for Cerebral Infarction. Review of the chart revealed no IDT comprehensive assessment within 5 days of admission. The first IDT meeting for the patient was on 03/31/23, 7 days after the NOE. During an interview on 05/18/23 at 12:21 PM, the Regional Vice President of Operations verified the findings. On 5/17/23, at 11:05 AM, Patient 9's record was reviewed. Patient 9 elected hospice care on 7/7/23 with a diagnosis of cancer of the larynx. The Registered Nurse (RN) admission nursing Visit Note Report dated 7/7/22 indicated, "...PT (patient) REQUESTS...SW (social worker) EVALUATION..." The first Medical Social Worker (MSW) Visit Note Report was dated 7/28/22 (21 days after admission). The first Chaplain Visit Note Report was dated 7/15/22 (8 days after admission). On 5/18/23, at 2:00 PM an interview was conducted with the Regional Vice President of Operations. During a concurrent record review, the RVPO confirmed the IDG comprehensive assessment was not completed with five days of admission. On 5/16/23 at 3:45 PM Patient 12's record was reviewed. Patient 12 elected hospice care on 3/21/23 with a diagnosis of protein calorie malnutrition. The first Interdisciplinary Group (IDG) meeting was on 3/31/23 (10 days after admission). On 5/18/23 at 1:47 PM, during an interview with the RVPO and a concurrent review of Patient 12's record, she/he confirmed the there was no documented evidence the IDG collaborated regarding the comprehensive assessment to create the plan of care within five days of admission. On 5/18/23, the hospice's policy titled, "Patient Assessment," was reviewed. The policy indicated, "...The Interdisciplinary Group...will complete the comprehensive assessment no later than five calendar days after the election of the Hospice benefit..."

Based on record reviews, interviews, and review of the hospice's policy and procedure, the hospice failed to ensure the patient's home health agency drug profiles were accurate for two of three patient home visit records reviewed (Patient 3 and 9) and one of seven patient records reviewed without home visits (Patient 10). --- The findings include: Observation on 05/15/23 at 3:25 PM of P 1s home medications revealed P 1 was not taking the following medications Ketoconazole 2% topical cream, memantine 28 mg (milligram) capsule sprinkle, extended release, and senna plus 8.6 mg-50 mg tablet compared to the hospices MAR. The following medications were noted as medications P 1 was taking: Lactulose 10 gm/15 ml, mineral oil, levetiracetam 500 mg tablet, stool softener laxative 50 mg/8.6 mg tablet, melatonin 10 mg gummy, trazodone 100 mg tablet, simethicone gas relief liquid and Mucinex ER 600 mg tablet. During an interview on 05/18/23 at 10:44 AM the Branch Director verified the findings. Facility policy, entitled ";Medication List and Monitoring" revealed, ";I. The Hospice will maintain a current, accurate Medication Profile of all prescription, over-the-counter (OTC), sample and investigational medications, herbal and home remedies taken by the patient, alternative treatments that could affect drug therapy, and drug therapy currently associated with laboratory testing...". On 5/16/23, at 10:20 AM a home visit to Patient 3 was conducted with Registered Nurse (RN) 1. Patient 3 was admitted to the hospice on 11/3/21 with a diagnosis of Senile Degeneration of the Brain. RN 1 was observed reconciling Patient 3's medication list with the medications in the home. Patient 3 was taking the following medications which were not on the medication list: Ciprofloxacin 500 mg one tablet twice a day for ten days (filled by the pharmacy on 5/9/23); Haldol 1 mg one tablet daily (filled 5/2/23); and Loperamide 2 mg as needed. Additionally, RN 1 stated Seroquel 100 mg and Seroquel 50 mg were discontinued and Seroquel ER 150 mg twice a day was started on 5/2/23. Seroquel ER 150 mg was not on the medication list. During a concurrent interview, RN 1 confirmed these discrepancies and that the medication list was not accurate. On 5/17/23, at 10:53 AM Patient 10's record was reviewed. Patient 10 was admitted to the hospice on 2/1/23 with a diagnosis of Alzheimers. The RN Visit Note Report dated 4/12/23 indicated, "...CONTINUES TYLENOL 500 MG PRN (as needed)...INCREASED AGITATION. WILL ORDER BUSPIRONE 10 MG DAILY..." The RN Visit Note Report dated 4/19/21 indicated, "...CONTINUES TYLENOL 500 MG PRN...INCREASED AGITATION...CONTINUES BUSPIRONE 10 MG DAILY..." Review of Patient 10's Client Medication Report revealed Tylenol and buspirone were not on the medication list. Review of the hospice's policy titled, "Medication List and Monitoring," indicated, "...The Hospice will maintain a current, accurate Medication Profile of all prescription, over-the-counter (OTC), sample and investigational medications, herbal and home remedies taken by the patient...the RN will compare the medication information (list) the patient is currently taking with the medications ordered to identify and resolve discrepancies, to include omissions, duplications, contraindications, unclear information, and changes..."

Based on record review and interviews, the hospice failed to ensure the patient's initial bereavement risk level assessment was completed within 5 days of the patient's signing the hospice Notice of Election (NOE) for the hospice benefit for 2 of 10 patient charts reviewed. (Patient 5 and 9) --- The findings include: Record review on 05/15/23 at 2:15 PM of P 5 revealed P 5 was admitted to the hospice on 03/24/23 for Cerebral Infarction. Review of the chart revealed no initial bereavement assessment within 5 days of P 5s admission. During an interview on 05/18/23 at 12:21 PM with the Regional Vice President of Operations verified the findings. On 5/7/23, at 11:05 AM, Patient 9's record was reviewed. Patient 9 was admitted on 7/7/22 with a diagnosis of cancer of the larynx. There was no documented evidence an initial bereavement assessment was conducted within five days of admission. On 5/18/23, at 2:00 PM, during an interview with the Regional Vice President of Operations, she/he confirmed the findings. On 5/18/23, the hospice's policy titled, "Patient Assessment," was reviewed. The policy indicated, "...The Hospice will perform an initial bereavement assessment no later than five calendar days after the election of the Hospice benefit..."

Based on record review, interview, and review of the hospice's policy, the hospice failed to ensure the patient's plan of care was individualized for one of 10 patients charts reviewed. (Patient 10) --- On 5/18/23 at 9:08 AM, review of Patient 10's record revealed the patient was admitted on 2/1/23 with a diagnosis of Alzheimer. Review of the Nursing Visit Note dated 4/26/23, revealed, "...PT (patient) ADMITTED FOR DIAGNOSIS OF ALZHEIMERS DISEASE. PMH (past medical history) INCLUDES...FREQUENT FALLS..." The nursing visit note dated 4/19/23, revealed, "...PT HAD ANOTHER FALL ON 4/15/23, HIT BACK OF HIS HEAD IN THE BATHROOM. WENT TO LOCAL UC (urgent care) AND 5 STAPLES WERE PLACED...". Review of the Registered Nurse initial Visit Note dated 2/1/23, revealed, "...FALLS...ACCORDING TO THE MAHC 10 FALL RISK ASSESSMENT, THIS PATIENT'S SCORE IS...7...WAS PATIENT AT RISK OF 4 OR HIGHER? YES..." Review of the patient's Initial Hospice Certification and Plan of Care for the benefit period dated 2/1/23 to 5/1/23 revealed there was no care plan regarding fall risk/prevention. Review of the Hospice IDG (Interdisciplinary Group) Comprehensive Assessment and Plan of Care Update Report dated 5/8/23 revealed there was no care plan regarding fall risk/prevention. On 5/18/23, at 1:30 PM, the Regional Vice President of Operations (RVPO) confirmed there was no documented evidence in the patient's plan of care that included fall risk/prevention and confirmed the hospice staff should have included safety related to fall risk/prevention in the patient's plan of care. Hospice policy, titled, "Plan of Care," revealed, "...The Hospice will develop an individualized written POC (plan of care) for each patient. The POC must...be based on the problems identified in the initial, comprehensive, and updated comprehensive assessments..."

Based on record reviews and interview, the hospice failed to ensure the Skilled Nurses (SN), Master of Social Worker (MSW) and Chaplain completed home visits per the ordered frequency on the patient's plan of care for 6 of 10 patient charts reviewed. (Patient 1, 2, 4, 5, 6 and 10) --- The findings include: Record review on 05/15/23 at 3:25 PM of P 1 revealed P 1 was admitted to the hospice on 07/28/22 for Parkinsons Disease. Review of certification period 01/04/23 to 03/04/23, SN visit frequency was 1 time a week for 1 week, 2 times a week for 7 weeks and 5 times a week for 1 week. Review of patient 1s visits revealed 3 missed nursing visits the week of 02/26/03/ to 03/04/23. Hospice aide visit frequency was 3 times a week for 1 week. Review of P 1s visits revealed 1 missed hospice aide visit the week of 01/08/23. During an interview on 05/18/23 at 10:44 AM, the Branch Director verified the findings. Record review on 05/15/23 at 10:53 AM of P 2 revealed P 2 was admitted to the hospice on 02/11/23 for senile degeneration of brain. Review of certification period 02/11/23 to 04/11/23, SN visit frequency was 4 times a week for 1 week, 2 times a week for 2 weeks, 5 times a week for 1 week and 1 time a week for 1 week. Review of patient visits revealed 1 missed visit the week of 03/12/23 to 03/18/23, 2 missed visits the week of 03/19/23 to 03/25/23 and 4 missed visits the week of 04/02/23 to 04/08/23. During an interview on 05/18/23 at 11:30 AM, the Regional Vice President of Operations verified the findings. Record review on 05/15/23 at 9:07 AM of P 4 revealed P 4 was admitted to the hospice on 10/08/21 for Atherosclerotic Heart Disease. Review of certification period 01/31/23 to 03/31/23, SN visit frequency was 1 time a week for 1 week, 2 times a week for 4 weeks then effective 03/19/23, 7 times a week for 1 week, and effective 03/26/23, 3 times a week for 1 week. Review of patient visits revealed 1 missed visit the week of 02/19/23 to 02/25/23, 4 missed visits the week of 03/19/23 to 03/24/23 and 1 missed visit the week of 03/26/23 to 04/01/23. During an interview on 05/18/23 at 12:05 PM, the Regional Vice President of Operations verified the findings. Record review on 05/15/23 at 2:15 PM of P 5 revealed P 5 as admitted to the hospice on 03/24/23 for Cerebral Infarction. Review of certification period 03/24/23 to 06/21/23, SN visit frequency was 4 times a week for 1 week, 3 times a week for 2 weeks, 2 times a week for 6 weeks, 5 times a week for 1 week, 1 time a week for 1 week and hospice aide visit frequency was 2 times a week for 11 weeks and 1 time a week for 1 week. Review of P 5s visits revealed 1 missed hospice aide visit the week of 03/02/23/ to 03/08/23 and 3 missed SN visit frequencies the week of 04/09/23 to 04/15/23 and 1 missed SN visit the week of 04/23/23 to 04/29/23. During an interview on 05/18/23 at 12:21 PM, the Regional Vice President of Operations verified the findings. Record review on 05/16/23 at 12:24 PM of P 6 revealed P 6 was admitted to the hospice on 08/03/22 for Chronic Obstructive Pulmonary Disease. Review of certification period 12/31/22 to 02/28/23, SN visit frequency was 2 times a week for 8 weeks and MSW visit frequency was 1 time a month for 2 months. Review of patient visits revealed 1 missed SN visit the week of 01/01/23 to 01/07/23, 1 missed visit the week of 01/08/23 to 01/14/23, 4 missed visits the week of 02/19/23 to 02/25/23 and 1 missed MSW visit the month of 02/23. During an interview on 05/18/23 at 12:34 PM, the Regional Vice President of Operations verified the findings. On 5/17/23 at 10:05 AM, Patient 10's record was reviewed. Patient 10 was admitted to the hospice on 2/1/23 with a diagnosis of Alzheimers. The Hospice Certification and Plan of Care for the benefit period 2/1/23 to 5/1/23 indicated, "...SN (Skilled Nurse) 2WK1 (two times a week for one week), 1WK11 (one time a week for eleven weeks)..." There was no documented evidence of nursing visits the weeks of 3/19/23, 3/2/23, or 5/1/23. On 5/18/23, at 1:30 PM, the Assistant Vice President of Operations was interviewed. During a concurrent review of Patient 10's record, the AVPO confirmed there was no documented evidence nursing visits were completed according to the plan of care.

Based on record review and interview, the hospice failed to provide ongoing sharing of information between all health disciplines providing care and services for patients in all settings whether provided directly or under arrangement for 1 of 10 patient chart reviews. (Patient 2) --- The findings include: Observations on 05/16/23 at 08:15 AM to 08:21 AM for Patient 2 who resides in a facility revealed the chart had no current hospice medication profile and/or hospice or attending physician orders. During an interview on 05/18/23 at 11:30 PM, the Regional Vice president of Operations verified the findings.

Based on observation and interview, the hospice failed to ensure 1 of 1 Certified Nursing Assistant (CNA) performed hand hygiene post glove changes during the provision of patient care. (CNA 1) --- The findings include: Observations on 05/16/23 at 5:20 AM to 6:13 AM for Patient 1 revealed CNA 1 performed hand hygiene and applied shaving cream to the patient's face. Post application, CNA 1 discarded the gloves and donned a clean pair of gloves without performing hand hygiene. CNA 1 completed the patient's bed bath including the patient's upper and lower body, dried the patient with a towel and applied lotion to the patient's upper and lower body wearing the same gloves. During an interview on 05/16/23 at 5:05 PM, CNA 1 stated, ";We are to change our gloves when dirty depending on the situation. I use my own hand sanitizer or wash my hands at the patients home".

Based on record review and interview, the hospice failed to ensure bereavement services were available to the family up to one year post patient death based on the patient's bereavement plan of care for 1 of 2 deceased patients. (Patient 8) --- The findings include: On 05/16/23 at 02:27 PM, review of Patient 8s chart revealed the patient expired on 06/17/22. Review of the patients bereavement plan of care revealed there was no documentation that the patient's plan of care was completed based on services and frequencies outlined in the patient's plan of care. During an interview on 05/18/23 at 12:01 PM, the Regional Vice President of Operations verified the findings.

Based on record reviews, interview, and review of hospice policy, the hospice failed to ensure physician orders were in the medical records for three of ten patient records reviewed, (Patient 3, 10, and 12). --- The findings are: On 5/16/23, at 10:20 AM, a home visit with Registered Nurse (RN) 1 to Patient 3's home revealed the patient was admitted on 11/3/21 with a diagnosis of Senile Degeneration of the Brain. RN 1 stated the patient takes Tylenol, Loperamide, Diflucan, Nystatin powder, Haldol 1 mg (milligram) once daily, and Seroquel 150 mg ER once daily. The bottle labeled Haldol revealed a pharmacy fill date of 5/2/23. The Tylenol and Loperamide were opened over the counter (OTC) packages. RN 1 stated she/he "ordered the Nystatin powder and Diflucan the day before". After the home visit, RN 1stated the medications were at the pharmacy and ready to be picked up. The caregiver stated she/he could not find the bottle of Seroquel 150 mg ER. On 5/16/23, at 12:45 PM, review of Patient 3's record revealed a nursing visit note dated 5/2/23, that reads, "...DONTINUES (sic) TYLENOL 500 MG PRN (as needed).PT (patient) WITH INCREASED NONSENSICAL BEHAVIORS, EPISODES OF WANDERING...WILL ADJUST MEDICATIONS...WILL START SEROQUEL 150 MG ER (extended release) BID (twice a day) AND HALDOL 1 MG Q HS (every night).." There was no documentation indicating communication with the physician. The patient's Hospice IDG (Interdisciplinary Group) Comprehensive Assessment and Plan of Care Update Report dated 5/8/23, revealed, "...REGISTERED NURSE...TAKE TYLENOL 500 MG PRN...NEW MED...SEROQUEL 150 MG ER BID(twice a day) AND HALDOL 1 MG QHS (every hour sleep) ADDED...PT(Patient) TREATED FOR UTI (Urinary Tract Infection) AND YEAST INFECTION WITHIN LAST 2 MONTHS...COMPLETED CIPRO 500 MG BID X 7 DAYS AND FLUCONAZOLE 150 MG DAILY X7 DAYS...". Review of the physician orders revealed there were no physician orders in the patient's record for Tylenol, Diflucan, Nystatin powder, Seroquel 150 mg ER, Haldol, Cipro 500 mg, or Fluconazole 150 mg. On 5/18/23, at 12:45 PM, the Regional Vice President of Operations (RVPO) in a concurrent review of Patient 3's record confirmed there was no documented evidence of physician orders for the medications Tylenol, Diflucan, Nystatin powder, Seroquel 150 mg ER, Haldol, Cipro and Fluconazole. The RVPO revealed there should be physician orders in the patient's record for these medications. On 5/17/23, at 10:53 AM, review of Patient 10's record revealed the patient was admitted on 2/1/23 with a diagnosis of Alzheimer. The RN Visit Note Report dated 4/12/23, revealed, "...CONTINUES TYLENOL 500 MG PRN (as needed)...INCREASED AGITATION. WILL ORDER BUSPIRONE 10 MG DAILY...". The RN Visit Note Report dated 4/19/21, revealed, "...CONTINUES TYLENOL 500 MG PRN...INCREASED AGITATION...CONTINUES BUSPIRONE 10 MG DAILY..." Review of physician orders revealed there were no physician orders for the Tylenol and Buspirone. On 5/16/23, at 3:46 PM, review of Patient 12's record revealed the patient was admitted on 3/21/23 with a diagnosis of protein calorie malnutrition. The RN Visit Note Report dated 4/5/23 revealed, "...PT CONTINUES IBUPROFEN OR TYLENOL ARTHRITIS PRN..." Review of the physician orders in Patient 12's record revealed there were no physician orders for Tylenol Arthritis or Ibuprofen. Hospice's policy, titled, "Medical Record Content", indicated, "...Each medical record will contain the following...Physician's orders...the medication profile will also include...Reconciliation with physician order..."

Based on record review and interview, the hospice failed to ensure the patient's discharge summary was sent to the patient's primary physician for 1 of 2 discharged patients. (Patient 7) --- On 05/16/23 at 1:58 PM, review of Patient 7's chart revealed the patient was admitted on 05/07/21 for Senile Degeneration of Brain and discharged on 12/23/22 for no longer meeting medically eligible with no decline. Review of the patient's chart revealed there was no documentation of a discharge summary completed on 12/23/22 being sent to the patient's primary physician post discharge. During an interview on 05/18/23 at 3:18 PM, the Regional Vice President of Operations stated, "There is no documentation in the chart about sending the form".

Based on record reviews, interviews, and review of the hospice's policy and procedure, the hospice failed to ensure 2 of 2 patient death charts reviewed contained documentation for controlled medication disposal. (Patients 8 and 14) --- The findings include: On 05/16/23 at 2:22 PM, review of Patient 8s chart revealed the patient was admitted on 06/16/22 for Prostate cancer with metastasis to the spine and expired on 06/17/22. There was no documentation of a medication disposal form completed post the patients death with a witness for the disposal. On 05/18/23 at 12:01 PM, the Regional Vice President verified the findings. On 05/17/23 at 11:23 AM, review of Patient 14s chart revealed the patient was admitted on 03/02/22 for Senile Degeneration of the brain and expired on 04/28/23. There was no documentation of a medication disposal form completed post the patients death with a witness for the disposal. On 05/18/23 at 11:53 AM, the Regional Vice President stated, ";There should have been a disposal form completed". Hospice policy, entitled, ";Disposal of Controlled Substances", revealed, ";Procedure A. If the death of a patient occurs while receiving outpatient services, in the presence of a witness, the Hospice nurse will record in the medical record the name and quantity of each unused controlled substance. B. The Hospice nurse then will conduct immediate disposal at the site of care by complying with Environmental Protection Agency and Drug Enforcement Administration guidelines for safe disposal or immediate mail-back to a registered collector. C. If conducting immediate disposal at the site of care, the Hospice nurse will perform the disposal in the presence of a witness, who will sign a document (Controlled Substance Disposal Log) indicating their witnessing of the disposal...".