Every finding on record at Hpa Idaho, LLC

Upon patient record review, 3 of 14 (Patient #3,6,9) 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: Patient 3: The medication profile contains an order for albuterol 0.083% with no dose and Polyethylene Glycol with no diluent. Corrected on site. Patient 6: The medication profile on 3/4/25 contains an order for Cyclobenzaprine 10mg 0.5-1 tab as needed. There are no instructions listed for frequency. Corrected on site. Patient 9: The medication profile contains an order for Gavilax 17gm daily with no diluent. Corrected on site.

Upon patient record review, 5 of 14 (Patient # 1,2,4,5,8) 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 1: The POC 3/11/25 contains orders for ASA and Eliquis there is no risk for bleeding care plan with goals and interventions. Patient has a diagnosis of dysphagia and there is no risk for aspiration care plan with goals and interventions. Corrected on site. Pt is incontinent of bowel and bladder with frequent episodes of diarrhea and there is no care plan for risk for skin breakdown with goals and interventions. Corrected on site. Patient 2: The POC 3/13/25 the SN documented in the comprehensive assessment that the patient has dysphagia with recurrent aspiration and is a high fall risk, there was no care plan for risk for aspiration or high risk of falls with goals and interventions. Corrected on site. Patient 4: The patient had a fall during the current certification period and is incontinent of bladder, there was no fall risk or risk for skin break down care plans with goals and interventions. Corrected on site. Patient 5: Patient has a diagnosis of dysphagia with no risk of aspiration care plan and is up with a walker with no fall risk care plan with goals. Corrected on site. Patent 8: The POC contains a goal for risk for skin breakdown with no goals or interventions. Corrected on site.

Upon patient record review, 10 of 14 (Patient #1-10) 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 measurable outcomes are anticipated from implementing and coordinating the plan of care for each patient by using data elements identified by the hospice and is used as part of the Hospice's QAPI program. Patient 1: The most recent revised plan of care contains a goal of "Pt caregiver verbalizes understanding of the administration and side effects of pain medication" this goal is not measurable. "Pt/caregiver/facility staff will verbalize understanding of methods to decrease choking risks and prevent aspiration" the goal is not measurable. Corrected on site. Patient 2: The most recent revised POC contains a goal of "caregiver to verbalize measures to promote comfort related to respiratory system in a terminal patient". "Pt/caregiver verbalizes understanding of administration and side effects of pain medication". These goals are not measurable. Corrected on site. Patient 3: The most recent revised POC contains a goal of " Caregiver/pt. verbalizes medication (dosage route frequency) to be given to prevent constipation". "Pt./caregiver verbalizes proper nutrition and fluid intake in order to maintain proper bowel movement". These goals are not measurable. Corrected on site. Patient 4: The most recent revised POC contains goal "Pt/caregiver verbalizes the importance and rationale for use of support surfaces to prevent skin breakdown". "Pt./caregiver verbalizes dietary and fluid required to promote healing process and healthy skin". These goals are not measurable. Corrected on site. Patient 5: The most recent revised POC contains a goal of "Pt/caregiver verbalizes understanding of proper safety measures related to fall awareness". "Pt/caregiver demonstrates appropriate measures to prevent infection". These goals are not measurable. Corrected on site. Patient 6: The most recent revised POC contains a goal of Caregiver to verbalize understanding of seizure precautions" and Pt/caregiver verbalizes understanding of measures to manage cardiac symptoms". These goals were not measurable. Corrected on site. Patient 7: The most recent revised POC contains a goal of "Pt/caregiver verbalizes the importance and rationale for use of support surfaces to prevent skin breakdown". "Pt./caregiver verbalizes dietary and fluid required to promote healing process and healthy skin". These goals are not measurable. Corrected on site. Patient 8: The most recent plan of revised POC "Pt/caregiver understands the causes of pain". "Pt/caregiver verbalizes understanding of the administration and side effects of medication". These goals are not measurable. Corrected on site. Patient 9: The most recent revised POC contains goals of "Pt tolerates administration of pain medication, understands the pain scale, medication regimen including administration and potential side effects". "Pt/caregiver administers prescribed medication properly as a result of nurse filled". "Pt/caregiver verbalizes understanding phycological effects of incontinence and measures". These goals are not measurable. Corrected on site. Patient 10: The POC 1/30/25 contains goals of "Pt/caregiver verbalizes understanding of the administration and side effects of pain medication". "Pt/caregiver verbalizes understanding psychological effects of incontinence and measures to improve/maintain dignity". These goals are not measurable.

Upon patient record review, 3 of 14 (Patient #3,6,9) 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 3: The POC 3/1/25 contains an order for albuterol 0.083% with no dose and Polyethylene Glycol with no diluent. Corrected on site. The SN documented on 3/27/25 "pt. on 3.5L of O2" and on 3/17/25 O2 was increased from 3L to 3.5L. There was no evidence of an order for the Oxygen level to be increased. Corrected on site. Patient 6: The POC on 3/4/25 contains an order for Cyclobenzaprine 10mg 0.5-1 tab as needed. There are no instructions listed for frequency. Corrected on site. Patient 9: The POC 2/9/25 contains an order for Gavilax 17gm daily with no diluent. Corrected on site.

Upon patient record review, 4 of 14 (Patient #1,2,3,4) 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: The skilled nurse documented on 3/17/24, "ordered gel mattress overlay" there was no order on the plan of care. Corrected on site. Patient 2: The SN documented on SOC comprehensive assessment patient has grab bars and a walker they were not included on the plan of care. Corrected on site. Patient 3: The Pt is on albuterol 0.083% solution for nebulization. There is no nebulizer added to the plan of care. The SN documented on 3/17/25 that patient is using a CPAP and is using it four hours a day instead of BIPAP every afternoon, these items were not included on plan of care. Corrected on site. Patient 4: The SN documented on 3/19/25 Pt. has a walker, hospital bed, over the bed table and a shower chair. These items were not included on the plan of care. Corrected on site.

Upon client record review, 1 of 14 (Patient #2) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 2: Upon home visit finding, the SN removed the patient's sock to assess a wound on his great left toe for signs and symptoms of infection. She educated patient and his spouse that the wound needs to be open to air and to continue to watch for signs and symptoms of infection. There is no orders on the POC for this wound. Corrected on site.

Upon patient record review, 1 of 14 (Patient #1) did not have evidence in the patient record that hospice aide assignments and duties are: Patient 1: The POC 1/22/25 contains the directive fall precautions with no frequency. Corrected on site.

Upon patient client record review, 1 of 14 (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: The POC 3/13/25 contains an order for Fluticasone for "COPK". Corrected on site.

Upon patient record review 1 of 13 (Patient #9) 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 9: Patient SOC date 3/19/2022. Initial spiritual comprehensive assessment dated 3/28/2022.

Upon patient record review 1 of 13 records (Patient #6) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient 6: Patient admitted 2/23/2022. There was no evidence of a spiritual assessment as part of the comprehensive assessment.

Upon patient record review, 5 of 13 records (Patient #1, #2, #4, #6, #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 1: medication profile contained Miralax 17 GM daily and as needed, mix with fluid. There was no evidence of a diluent or reason. Corrected on site. Patient 2: medication profile includes O2 2-5 L as needed for resp. distress/sob. There was no evidence of a route. Corrected on site. Patient 4: medication profile includes Aspercreame (Lidocaine) 4% topical patch daily apply to affected area leave on 12 hours. There was no evidence of site. Corrected on site. Patient 6: medication profile includes Citracel sugar free oral powder per instructions PRN daily for constipation. There was no evidence of a diluent. Corrected on site. Patient 8: medication profile includes Tacrolimus 0.1% topical ointment per instructions as directed skin special ointment. There was no evidence of a site or frequency. Medication profile included skin cleanser salicyclic acid ER-Ceramides1,3,6-11 6% topical PRN. There was no evidence of a site. Medication profile included O2 at 0.5-3L/M as needed for comfort/SOB route as oxygen provider use as directed. There was no evidence of a route. All orders corrected on site.

Upon patient record review, 6 of 13 records (Patient #5, #6, #8, #9, #10, #12) 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 5: Patient diagnosis on SOC Parkinson's Disease with Dementia. There was no evidence of a Neurological problem/plan of care. Corrected on site. Patient 6: Patient diagnosis on SOC Dementia. There was no evidence of a Neurological problem/plan of care. Corrected on site. Patient 8: Patient diagnosis on SOC Malignant Neoplasm Right lower lung with acute CHF. There was no evidence of a Cardiac problem/care plan. Corrected on site. Patient 9: Patient diagnosis on SOC Parkinson's and Dementia with Lewy Bodies. There was no evidence of a Neurological problem/care plan. Corrected on site. Patient 10: Patient diagnosis on SOC COPD. There was a problem/care plan for safety and teaching O2. There was no evidence of a Respiratory problem/plan of care. Corrected on site. Patient 12: Patient diagnosis on SOC Hypertensive Heart disease, CHF, Renal disease. There was no evidence of a Cardiac problem/care plan.

Upon patient record review, 5 of 13 records (Patient #1, #2, #4, #6, #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 1: Order dated 4/27/2022 Remedy Phytoplex z-guard zinc oxide 17-57% topical paste as directed each shift and with wound care. There was no evidence of a site. Order for Miralax 17 GM daily and as need for (no reason stated), mix with fluid. There was no evidence of a diluent. Both orders corrected on site. Patient 2: An order dated 3/21/2022 includes O2 2-5 L as needed for resp. distress/sob. There was no evidence of a route. Corrected on site. Patient 4: Order dated 3/2/2022 Aspercreame (Lidocaine) 4% topical patch daily apply to affected area leave on 12 hours. There was no evidence of site. Corrected on site. Patient 6: Order dated 2/28/2022 includes Citracel sugar free oral powder per instructions PRN daily for constipation take one tsp by mouth. There was no evidence of a diluent. Corrected on site. Patient 8: Order dated 3/23/2022 Tacrolimus 0.1% topical ointment per instructions as directed skin special ointment. There was no evidence of a site or frequency. Order dated 3/23/2022 included skin cleanser salicyclic acid ER-Ceramides1,3,6-11 6% topical PRN. There was no evidence of a site. Order dated 3/24/2022 O2 at 0.5-3L/M as needed for comfort/SOB route as oxygen provider use as directed. There was no evidence of a route. All three orders corrected on site.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient 3: Visit made with SW, there was no evidence of hand cleansing prior to or upon entering patients home.

Upon patient record review 1 of 7 applicable records (Patient #10) 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 10: SOC HHA order included 1x week one, then 2x week. For week of 4/24/2022 there was a missed visit for 4/25/2022. There was no evidence of a second visit or missed visit for the week of 4/24/2022.

Upon observation, there was no evidence a copy is provided of the hospice written policies and procedures on the management and disposal of controlled drugs to the patient or patient representative and family. Agency Policy Home use and disposal of controlled substances 4-054.1, dated 11/28/2016 includes Case manager will provide a copy of the written policies and procedures on the management and disposal of controlled drugs to the patient/family. There was no evidence of this.

Upon client record review, 13 of 13 records (Patient #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11, #12, #13) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed.

Upon personnel record review, 1 of 10 applicable (Personnel #10) did not have evidence that personnel credentialing activities are conducted to verify qualifications of all credentialed/licensed personnel in the positions they hold at the time of hire, at renewal or in accordance with specific state practice act requirements. Employee 10: Idaho State Registry Verification for HHA was expired as of 3-31-2022. Corrected on site.