Every finding on record at Hpa Idaho, LLC

Upon patient record review, 1 of 14 (Patient #14) did not have evidence that if a state court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with state law may exercise the patient's rights to the extent allowed by state law. Patient #14: Patient had designated a healthcare POA and a financial POA. Financial POA signed patient transfer paperwork.

Upon patient record review, 4 of 14 (Patient #2, #3 #7, #10) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications Patient #2: Medication profile contains two separate orders for loperamide, one for capsule and one for tablet. Corrected on site. Patient #3: Upon interview, patient stated he is taking biotin, vitamin c and hyaluronic acid. The supplements were not listed on the medication profile. Patient #7: Medication profile contains two separate scheduled orders for Zofran, one for Q8 hours and one daily. Corrected on site. Patient #10: Medication profile contains two separate daily orders for levothyroxine, one for 125mcg and one for 100mcg with no instructions the doses were to be taken together. Corrected on site ALSO-Upon observation of medications in the home and upon interview, patient stated he takes Repatha injections daily. Medication is not listed on medication profile.

Upon patient record review, 1 of 14 (Patient #5) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #5: The medical record contained aide notes the last week of June identifying patient had new wounds to coccyx and buttocks. There was no evidence of RN assessment and measurements weekly as required per agency policy.

Upon patient record review, 3 of 14 (Patient #1, #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: Patient was documented as a fall risk. No evidence of problems, goals or interventions developed to address falls. Patient #5: Aide and nurse narrative in June, 2024 refer to five wounds. No evidence of goals or interventions outlined under the active problem of wounds. Patient #8: Aspiration pneumonia and dysphagia are documented in the medical record. No evidence of problems, goals and interventions developed to address.

Upon patient record review, 2 of 14 (Patient #3, #9) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #3: MSW frequency of plan of care is 3prn without an indication. Corrected on site. Patient #9: SC frequency on plan of care is 6prn as a stand alone order with no regularly scheduled visits. Corrected on site.

Upon patient record review, 1 of 14 (Patient #2) 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: Nursing narratives and aide notes mention patient has several foot ulcers. There is no evidence of orders for the treatment of wounds.-Corrected on site.

Upon patient record review, 8 of 14 (Patient #1, #2, #3, #4, #5, #6, #8, #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 #1: Nursing assessments indicate patient utilizing the following DME not without evidence of an order: walker, bedside table and shower chair. Corrected onsite. Patient #2: Medical record indicates patient utilizing the following DME without evidence of an order: walker, shower chair, bedside commode. Corrected on site. Patient #3: RN recertification assessment on 6/27 indicates patient utilizing the following DME without evidence of an order: raised toilet seat, shower chair. Corrected on site. Patient #4: Medical record indicates patient utilizing the following DME without evidence of an order: bed, bedside table and raised toilet seat. Corrected on site. Patient #5: Medical record indicates patient utilizing the following DME without evidence of order: wheel chair, walker, raised toilet seat and shower chair. Corrected on site. Patient #6: Medical record indicates patient utilizing the following DME without evidence of an order: bed, bedside table, wheel chair, shower chair, raised toilet seat, walker. Corrected on site. Patient #8: Medical record indicates patient utilizing the following DME without evidence of an order: oxygen DME, raised toilet seat, shower chair and wheel chair. Corrected on site. Patient #10: Medical record indicates patient is utilizing oxygen. Oxygen DME without evidence of an order. Corrected on site.

Upon client record review, 1 of 14 (Patient #10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #10 Plan of care visit frequency for nurse is 2xweek. Patient received one visit week of 06/30/2024.

Upon patient record review, 1 of 14 (Patient #6) 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 Patient #6: Patient record includes a POLST/DNR order. Aide Care plan documents patient as full code. Corrected on site.

Upon patient record review 1 of 14 (Patient #9 ) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group Patient #9: Medical record contains order for HHA visits 1xweek. There are no HHA visits the week of 07/07/2024 and 07/14/2024. Corrected on site with late entry documentation with reason for missed visits.

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. Agency had a volunteer utilization rate of 0.11% in 2023.

Upon patient client record review, 2 of 14 (Patient #3, #9) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #3: Upon admission to hospice on 01/28/22, patient chose to receive the election addendum. The hospice must provide this information, in writing, within 5 days from the effective date of the election. Medical record contains signed addendum dated 04/22/22. Patient #9: Upon admission to hospice on 06/04/2024, patient chose to receive election addendum. The hospice must provide this information, in writing, within 5 days from the effective date of the election. Medical record contains signed addendum dated 07/09/2024.

Upon client record review, 1 of 14 (Patient #2) patient record did not contain Physician certification of terminal illness. Patient #2 There is no evidence of a verbal or written certification obtained by attending physician.