Every finding on record at Horizons Hospice Care, LLC

Upon patient record review, 3 of 14 (Patient #1, #2, #6) 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: 1, 2 and 6:The medication profile includes an entry for oxygen 2 liters per minute as needed for shortness of breath. There is no evidence that the entry includes a route for administration of oxygen. COS

Upon patient record review, 1 of 14 (Patient #8) 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 8:The medical record contains an order for oxygen 2 liters per minute via nasal cannula PRN for shortness of breath. There is no evidence of problems, goals and interventions for the use and safety of oxygen on the plan of care. COS

Upon patient record review, 2 of 14 (Patient #7,#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 equipment and supply needs. Patient 7 and 8:The medical record includes nursing documentation that the patient's equipment needs include a Hoyer lift. There is no evidence that a Hoyer lift is included as equipment needs on the plan of care. COS

Upon patient record review, 1 of 14 (Patient #6) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient 6:The medical record includes nursing documentation on 2/25/24 that the patient was experiencing unmanaged anxiety and that after collaboration with the medical director there was a subsequent order to increase the Xanax dosage. There is no evidence that the plan of care includes problems, goals or interventions related to anxiety. COS

Upon patient record review, 1 of 14 (Patient #3) 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 3:The patient's plan of care includes seizure and aspiration precautions. There is no evidence that the Aide plan of care includes seizure and aspiration precautions.

Upon patient record review 2 of 14 (Patient #7,#8) 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 • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 7:The aide plan of care includes the task of nail care to be completed weekly with a visit frequency of 2 visits per week. The aide documented that the task was completed every visit from 4/10/24 through 4/24/24. Patient 8:The aide plan of care includes the task of shampoo hair to be completed weekly with a visit frequency of 2 visits per week. The aide documented that the task was completed every visit from 3/12/24 through 4/11/24.