Every finding on record at Idahealth Home Care LLC

Upon patient record review 1 of 14 (Patient #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 #10 - The patient was admitted on 5/01/25. The spiritual care assessment was completed on 05/07/25.

Upon patient record review, 1 of 14 (Patient #10) 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 #10 - Medication profile contained Triamcinolone 0.1% ointment apply 1 application 2 x day to rash - did not specify amount to apply or site. Azelastine 0.5% 1 drop once a day - did not specify which eye.

Upon patient record review, 3 of 14 (Patient #10, 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. Medications #10 - Medication order Triamcinolone 0.1% ointment apply 1 application 2 x day to rash - did not specify amount to apply or site. Azelastine 0.5% 1 drop once a day - did not specify which eye. #11 - Order for catheter to be changed monthly. Foley catheter changed twice in May and no Foley catheter change in June. #14 - Order for urine specimen for C&S did not specify type of specimen - clean catch or in and out catheter.

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 record indicated a PRN visit by the RN on 05/10/25 due to pain secondary to constipation. There was no evidence the care plan was revised to include new problem of constipation.

Upon patient record review, 1 of 14 (Patient #6) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #6 - No order for digital exam or removal of impaction performed by RN on 05/10/25.

Upon patient record review, 1 of 14 (Patient #5) 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 #5 - The aide written instructions indicated to provide a complete bath every visit, it does not specify bed, chair or shower.

Upon patient record review 3 of 14 (Patient #6, 8, 13) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient #6 - The record indicated that an aide supervisory visit was conducted on 05/14/25 and not again until 05/29/25 (15 days). Patient #8 - The record indicated that an aide supervisory visit was conducted on 05/18/25 and not again until 06/09/25. Patient #13 - The record indicated that an aide supervisory visit was conducted on 06/11/25 and not again until 06/26/25 (15 days).

Upon patient record review, 1 of 14 (Patient #11) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #11 - Patient admitted 05/14/25 and requested Patient Notification of Hospice Non-Covered Items. This document was not created until 05/20/25 and provided to patient/cg on 05/22/25.

Upon patient record review, 1 of 14 (Patient #14) 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 #14 - SN visit note 06/19/25 documented "urine specimen obtained and dropped off for C&S" and "blood draw was delivered to lab for CBC, SER and CRP", lack of details of documentation of how urine or blood obtained.

Upon patient record review, 1 of 11 (Patient #6) did not have evidence that the patient chooses a health care provider, including an attending physician.

Upon patient record review, 1 of 11 (Patient #11) 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. Patient #11 - SN documented on 06/28/22 changing oxygen from 3L to 4L. Oxygen at 4L is not noted on the medication profile.

Upon patient record review, 2 of 11 (Patient #5, 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 #5 - Wound care effective 05/21/22 did not contain site. Patient #9 - Wound care effective 04/11/2022 did not contain frequency.

Upon client record review, 1 of 11 (Patient #9) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient #9 - SOC 03/22/22 - first IDG documented 04/08/22, 17 days after admission.

Upon patient record review, 1 of 11 (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 - New infection documented on 06/23/22 but POC not updated with interventions or goals.

Upon client record review, 4 of 11 (Patient #6, 8, 9, 11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #6 - POC 05/17/2022 - NS frequency 1wk1, 2wk8. 1 visit made wk 3 with no documentation regarding the missed visit. Patient #8 - POC 05/12/22 SN documented good output from Foley catheter after flushing. There was no order for for flushing Foley. Order to change catheter every month on the 15th + or - 2 days. Catheter change completed 06/27/2022. Patient #9 - POC dated 03/22/22 - SN documented urine specimen obtained, however, there was no order for UA. SN documented on 04/23/22 that she placed Foley catheter on 04/22/22 and it is draining well. No order for Foley catheter insertion. Patient #11 - POC 05/06/22 - SN documented changing oxygen from 3Lto 4L but no order noted for oxygen at 4L.

Upon patient record review 4 of 7 applicable patients (Patient #1, 2, 5, 11) did not have evidence documentation in the patient record that a hospice aide provides services that are ordered by the IDG and included in the plan of care. Patient #1 - Aide visit frequency effective 06/16/2022 1wk1, 2wk8 - 0 visits made wk1 - no documentation of reason for missed visit. All aide task frequencies ordered every visit - no oral care provided 06/20/22, 06/27/22 or 06/30/22, no shampoo 06/27/22, no shave 06/20/22 or 06/27/22. Patient #2 - Aide visit frequency effective 06/13/2022 1wk1, 2wk8 - 0 visits made wk1, 1 visit wk2 - no documentation of reason for missed visit. All aide task frequencies ordered every visit - no oral care, make bed, change linen, shaving, nail care skin care provided 06/23/22, 06/27/22 or 06/30/22. Patient #5 - Aide visit frequency effective 05/23/2022 2wk13 - 1 visits made wk1 and 2 - no documentation of reason for missed visit. All aide task frequencies ordered every visit - no oral care, make bed, assist with dressing, perineal care provided 05/24/22, 05/30/22, 06/06/22. Patient #11 - POC effective 05/06/2022. All aide task frequencies ordered every visit - no oral care, make bed, assist with dressing, nail care or foot care provided 05/23/22, 06/02/22, 06/20/22. 06/27/22.

Upon patient client record review, 1 of 11 (Patient #6) did not have evidence that each patient record contains a signed election statement in accordance with 418.24. Patient #6 - The election statement did not include identification of an attending physician.

Upon patient client record review, 3 of 11 (Patient #5, 9, 11) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated. Patient #5 - SN documented on 06/07/22 wound to coccyx cleaned and dressed at this time but did not document procedure as ordered. Patient #9 - SN documented on 04/23/22 Foley catheter inserted on 04/22/22 but not documentation of size, output or tolerance to procedure. Patient #11 - SN documented 0n 06/07/2022 Foley catheter changed but did not document size, output or tolerance to procedure.