Every finding on record at Hospice Preferred Choice, Inc.

Based on a review of hospice policy, clinical records (CR), home visit observations, and an interview with the hospice Administrator, the hospice failed to coordinate services with the assisted living facility (ALF) for two (2) of fourteen (14) clinical records (CR# 17 and 19). --- A review of hospice policy #MM-001 PA titled "Medication Management Policy - Pennsylvania" on November 7, 2024, at approximately 2:45 P.M. revealed the following: "Operational Guidelines: E. Medication Reconciliation: 1. Medication reconciliation will be done at admission, recertification, a change in patients condition requiring medication changes, when a medication is discontinued, when a medication is a new order, or a change in existing medication order. Nurse to review patients allergies during medication reconciliation... "; A review of CRs on November 4, 2024, from approximately 12:00 P.M. to 3:00 P.M., November 5, 2024, from approximately 12:00 P.M. to 3:00 P.M., November 6, 2024, from approximately 9:00 A.M. to 3:00 P.M., and November 7, 2024, from approximately 9:00 A.M. to 12:00 P.M. revealed the following: CR#17, start of care and hospice benefit election date February 2, 2024. Certification period reviewed, September 29, 2024, through November 27, 2024. The "Hospice Certification and Plan of Care" (POC) and the hospice Medication Profile (MP) contained orders for the following medications that are not listed on the MP at the Assisted Living Facility (ALF): Acetaminophen 650 mg (milligrams) rectal suppository every four (4) hours PRN (as needed) for fever above 104.1 degrees Fahrenheit, order date February 5, 2024; Dulcolax (Bisacodyl) 10 mg rectal suppository daily PRN for constipation, order date February 5, 2024; Oxygen 2 L (liters per minute) PRN for comfort, order date May 6, 2024; and Omeprazole 20 mg capsule, delayed release daily PRN for gastric reflux, order date June 19, 2024. Documentation in the nursing visit notes dated February 6, 2024, May 6, 2024, and June 20, 2024, contained documentation that the medication regimen was completed/reviewed, and medications were reconciled during the visit. The hospice ";Client Medication Report" contained documentation of a comprehensive medication review by the hospice medical director on October 9, 2024, and October 22, 2024. CR #19, start of care and hospice benefit election date October 31, 2024. Certification period reviewed, October 31, 2024, through January 8, 2025. The hospice POC and MP contained orders for the following medications not listed on the ALF MP: Incruse Ellipta 62.5 mcg (micrograms) per actuation powder for inhalation, one (1) inhalation at bedtime for COPD (chronic obstructive pulmonary disease); Ingrezza 80 mg (milligram) capsule at bedtime for tremors; Morphine concentrate 10 mg/0.5 ml (milliliter) oral syringe 5 mg every three (3) hours for severe pain; Omeprazole 20 mg capsule delayed release daily for gastrointestinal prophylaxis; and Prednisone (steroid) 10 mg tablet daily for respiratory comfort starting November 10, 2024; Primidone (anticonvulsant) 250 mg tablet daily for tremors. The following medication is listed on the ALF MP and not on the hospice POC or MP: Acetaminophen 500 mg, two (2) tablets three (3) times per day for pain. The following medications are listed on both the ALF and hospice MP, but contain discrepancies: Paroxetine (Paxil) for depression, is listed on the hospice POC and MP as 20 mg tablet daily with 40 mg tablet to equal 60 mg and Paroxetine 40 mg tablet daily with 20 mg table to equal 60 mg. The ALF MP lists Paxil 40 mg, one (1) tablet daily. The hospice POC and MP lists Lidocaine pain relief 4% topical patch, apply 1-3 patches to back, neck and shoulder... Not to exceed 3 patches at a time. The ALF MP lists Lidocaine external patch 4%, 2 patches- place one patch on posterior neck and one patch on left shoulder topically in the morning. The hospice POC and MP lists Miralax 17 gram/dose oral powder, mix with 6-8 ounces of water or juice and drink once daily for constipation. The ALF MP lists Gavilax (polyethylene glycol, same as Miralax) 17 grams twice daily for constipation. Documentation in the nursing visit notes dated October 31, 2024, and November 1, 2024, contained documentation that the medication regimen was completed/reviewed, and medications were reconciled during the visit. The hospice ";Client Medication Report" contained documentation of a comprehensive medication review by a registered nurse on October 31, 2024, November 1, 2024, and November 2, 2024, and by the hospice medical director on November 4, 2024. An interview with the hospice Director of Operations and the Area Vice President Clinical, on November 7, 2024, at approximately 2:30 P.M. confirmed the above findings.

Based on a review of hospice policy, clinical records (CRs), and staff interviews, the hospice failed to ensure that a registered nurse (RN) documented an on-site visit to the patient's home no less frequently than every 14 days (two weeks) to assess the quality of care and services provided by the home hospice aide (HHA) for one (1) of nineteen (19) CR reviewed. (CR #16) --- Review of hospice policy AA-105(b) titled "Supervision of Disciplines – Hospice Aide and Homemaker" on November 7, 2024, at approximately 2:15 P.M. stated, "Procedure: 1. The Hospice Aide is supervised by the RN... 3. A supervisory visit will be made to the patients residence at least every 14 days or less, by the RN to assess relationships and determine whether the goals are being met when skilled services are being provided..." A review of CRs on November 4, 2024, from approximately 12:00 P.M. to 3:00 P.M., November 5, 2024, from approximately 12:00 P.M. to 3:00 P.M., November 6, 2024, from approximately 9:00 A.M. to 3:00 P.M., and November 7, 2024, from approximately 9:00 A.M. to 12:00 P.M. revealed the following: CR #16, start of care and hospice benefit election date August 21, 2024. Certification period reviewed, August 21, 2024, through November 18, 2024. The RN conducted a skilled nursing visit (SNV) with supervision of the hospice aide on September 16, 2024. The RN conducted a SNV on September 24, 2024, with no documentation of a supervisory visit. The RN documented a SNV with supervision of the hospice aide on October 1, 2024, which was fifteen (15) days between supervisory visits. An interview with the hospice Director of Operations and the Area Vice President Clinical, on November 7, 2024, at approximately 2:30 P.M. confirmed the above findings.