Every finding on record at Hospice Care of Kansas, LLC

Upon patient record review 3 of 19 (Patients #1,#2,#10) 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 1: The initial comprehensive spiritual assessment was completed 9/26/24 with start of care 9/20/24. Patient 2: The initial comprehensive spiritual assessment was completed 9/27/24 with start of care 9/20/24. Patient 10: The initial comprehensive spiritual assessment was completed 10/17/24 with start of care 10/10/24.

Upon patient record review, 7 of 19 (Patients #2,#3,#4,#7,#9,#11,#14) 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: The medication profile contained acetaminophen 650mg with instructions identifying to be administered for pain or fever listed as scheduled every four hours in error instead of as needed. Corrected on site. Patient 3: The medication profile contained Miralax oral powder with no instructions to mix with a diluent and active diflucan listed that was ordered for 3 days on 11/8/24. Corrected on site. Patient 4,14: The medication profile contained oxygen with no delivery method. Corrected on site. Patient 7: Upon medication reconciliation during home visit, the facility medication profile contained narcan and baclofen that were not on the hospice profile. The hospice medication profile contained Celebrex 200mg capsules stating dose was 1 mg in error. Corrected on site. Patient 9: The medication profile contained Miralax oral powder with no instructions to mix with a diluent and oxygen with no delivery method. Corrected on site. Patient 11: Upon medication reconciliation during home visit, the facility medication profile contained narcan that was not on the hospice profile and had oxygen as needed instead of continuous as ordered by hospice. The hospice medication profile contained morphine with instructions identifying to be administered for pain or air hunger listed as scheduled every 2 hours in error instead of as needed. Corrected on site.

Upon patient record review, 7 of 19 (Patients #2,#3,#4,#7,#9,#11,#14) 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: The medical record contained an order for acetaminophen 650mg with instructions identifying to be administered for pain or fever listed as scheduled every four hours in error instead of as needed. Corrected on site. Patient 3: The medical record contained an order for Miralax oral powder with no instructions to mix with a diluent. The record also contained nursing documentation since admission identifying patient has an indwelling catheter. There was no evidence of an order for the catheter type, size, change frequency, and maintenance. Corrected on site. Patient 4,14: The medical record contained an order for oxygen with no delivery method. Corrected on site. Patient 7: The hospice medical record contained and order for Celebrex 200mg capsules stating dose was 1 mg in error. Corrected on site. Patient 9: The medical record contained orders for Miralax oral powder with no instructions to mix with a diluent and oxygen with no delivery method. Corrected on site. Patient 11: The medical record contained an order for morphine with instructions identifying to be administered for pain or air hunger listed as scheduled every 2 hours in error instead of as needed. Corrected on site.

Upon patient record review, 2 of 19 (Patients #7,#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 equipment and supply needs. Patient 7: The medical record contained nursing documentation 11/21/24 identifying patient use of a fall alarm. There was no evidence of an order for the alarm included in the plan of care. Corrected on site. Patient 10: The medical record contained nursing documentation upon admission identifying patient use of a low air loss mattress and Hoyer lift. There was no evidence of an order for the mattress and lift included in the plan of care. Corrected on site.

Upon patient record review, 3 of 19 (Patients #1,#3,#5) did not have evidence in the patient record that hospice aide assignments and duties are specific to the patient needs. Patient 1,3,5: The aide care plan did not contain instructions for level of assistance needed for transfers. Corrected on site.

Upon patient record review 2 of 19 (Patients #10,#13) 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 Patient 10: The medical record contained an ordered aide frequency of twice weekly. There was no evidence of a second visit completed the week of 11/10/24. Corrected on site with late entry of missed visit data. Patient 13: The medical record contained an ordered aide frequency of twice weekly. There was no evidence of a second visit completed the week of 11/3/24. Corrected on site with late entry of missed visit data.

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. The agency had a volunteer utilization rate of 0.93% for 2023.

Upon patient record review, 1 of 19 (Patient #13) did not have evidence that each patient record contains Physician certification and recertification of terminal illness. Patient 13: The initial CTI on file for admission 9/24/24 did not contain the attending physician's signature. Corrected on site.

Upon patient record review, 1 of 19 (Patient #18) did not evidence that each patient record contains physician orders. Patient 18: There was no evidence of an order to discharge the patient for extended prognosis.

Upon patient record review, 1 of 19 (Patient #10) 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 10: The medical record contained nursing documentation upon admission mistakenly identifying the patient as using intermittent oxygen. There was no further evidence of oxygen use and the agency verified the patient does not have oxygen in the home.

Upon personnel record review, 1 of 15 (Personnel #1) did not have evidence of criminal background checks being obtained in accordance with state requirements. In the absence of state requirements, criminal background checks are obtained within three months of the date of employment for all states that the individual has lived or worked in the past 3 years. Personnel 1: There was no evidence of a criminal background check results in the personnel file.

Upon patient record review, 2 of 11 (Patient #1,7) 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 Medication profile documented O2@4L. In nursing visit notes dated 12/10/21, 12/17/21, 12/27/21,12/31/21, documentation states O2 2-4L. No evidence of O2 2-4L on medication profile. Patient#7 Nursing visit on 12/14/21 documented O2 at 8L via mask continuously and 12/15/21 O2 at 7L via mask continuously. No evidence of oxygen documented on medication profile.

Upon patient record review, 7 of 11 (Patient #1,3,4,5,8,10,11) did not have evidence that each patient and family received education and training provided as appropriate to their responsibilities for the care and services identified in the plan of care. Patient#1,3,4,5,8,10,11 No evidence of documented patient teaching for purpose, interactions and side effects, and directions for use are present on medications on medication profile.

Upon patient record review, 5 of 11 (Patient #2,3,4,9,11) 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 #2 12/07/21, 12/28/21, 01/05/22 nursing visit notes document that patient has increasing dysphagia. No evidence of current plan of care goals/interventions for aspiration precautions. Patient#3 Aspirin included on 09/03/20 plan of care as an active medication. No evidence of bleeding precautions or goals and interventions related to identified risk. Patient has documented diagnosis of CAD, HTN, ESRD with documented symptoms of chest pain and edema. No evidence of goals/interventions related to identified problems. Patient#4 Diagnosis of dysphasia noted for 05/01/21. No evidence of goals/interventions related to identified risks. Patient#9 O2 @2-4L NC PRN ordered on 04/15/21. No evidence of respiratory and O2 safety precautions, goals, and interventions related to identified risks. Patient#11 Patient has diagnosis of dysphagia noted on initial plan of care. No evidence of safety precautions and goals/interventions for identified risks.

Upon patient record review, 2 of 11 (Patient 1,7) 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#1 Nursing visit notes on 12/10/21,12/17/21,12/27/21,12/31/21 documented O2 at 2-4L. O2 order dated 12/06/21 states O2@4L. Patient#7 Nursing visit note on 12/14/21 documents 16fr Foley catheter present and O2 at 8L via mask continuously and 12/15/21 documents 20fr Foley catheter present and O2 at 7L via mask continuously. No evidence of order for Foley catheter or oxygen.

Upon patient record review, 2 of 9 applicable (Patient #2,3) 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 #2 Nursing visit notes dated 12/07/21, 12/09/21, 12/16/21, 12/28/21, 01/05/22, and 01/06/22 document patient having dysphagia. No evidence of aspiration precautions noted on Aide Care Plan. Patient#3 Aide Care Plan dated 12/06/21 documented tasks of daily bathing (shower) every visit and change linens upon patient request. Aide visit frequency ordered 11/17/21 as 1wk1,2wk8.

Upon patient record review 1 of 9 applicable (Patient #2) 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 #2 Aide Care Plan dated 12/06/21 has tasks of shampoo every Monday and Friday and change linens every Friday. Aide visits documented on Thursday, 12/30/21 and Wednesday, 01/05/22 note that both tasks were completed.

Upon patient client record review, 1 of 11 (Patient #2) 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#2 Goals and interventions are present on current plan of care for MSW. No evidence of MSW's involvement in the patient's care.