Every finding on record at Ihcc Hospice Inc.

Upon patient record review, 4 of 14 records reviewed (Patient #2, #3, #5, #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 #2: The MAR indicated barrier cream, apply to skin as needed to prevent skin breakdown. The record did not indicate the site location as to where to apply the skin barrier. COS. Patient #3: The MAR indicated Norco one to two tabs po Q4hours prn pain and Tylenol ES 500mg one tab Q6hours prn fever and/or one to two tabs prn for pain/fever. The record did not indicate a max dose of 4000mg daily. COS. Patient #5: The MAR indicated eyelid cleaning scrubs-scrub bilateral eyelids @ night with scrub pads provided by family. There was not evidence of what ingredients these scrub pads included. COS. Patient #8: The MAR indicated Oxygen @ 2 - 10L per NC Continuous for SOB. There was no evidence of parameters for the liter flow. COS.

Upon patient record review, 2 of 14 records reviewed (Patient #5, #13) 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 record indicated a UA with C&S was ordered on 5/28/24, Macrobid was ordered and delivered on 5/29/24. There was no evidence of follow up on the C&S report as of 06/10/24. COS. Patient #13: The record indicated on 2/27/24 the RN made a visit and the following was noted the patient was lethargic, sleeping most of the time, disoriented, heart rate 101. Atropine and oxygen was added. It was also noted she was minimally eating and only drinking a little. The reason for the visit was her oxygen level had a desaturation down to 52%. There was no evidence in the record of a nursing follow up visit on 2/28/24, 2/29/24 and or on 3/1/24 until the time of death @ 14:14 on 3/1/24.

Upon patient record review, 2 of 14 records reviewed (Patient #5, #6) 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: The record indicated the patient had signs and symptoms of a UTI, an antibiotic was ordered and a UA with a C&S. The record identified a problem from the nurses updated comprehensive assessment. There was no evidence of interventions and or goals for this problem. COS. Patient #6: The record indicated the patient had a Speech evaluation ordered on 3/18/24 that resulted in an order for a pureed diet, puddings due to severe oropharyngeal dysphagia. There was no evidence of a plan of care for the dysphagia. COS.

Upon patient record review, 4 of 14 records reviewed (Patient #2, #3, #5, #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 #2: The MD order indicated barrier cream, apply to skin as needed to prevent skin breakdown. The order did not indicate the site location as to where to apply the skin barrier. COS. Patient #3: The MD order indicated Norco one to two tabs po Q4hours prn pain and Tylenol ES 500mg one tab Q6hours prn fever and/or one to two tabs prn for pain/fever. The record did not indicate a max dose of 4000mg daily. COS. Patient #5: The MD order indicated eyelid cleaning scrubs-scrub bilateral eyelids @ night with scrub pads provided by family. There was not evidence of what ingredients these scrub pads included. COS. Patient #8: The MD order indicated Oxygen @ 2 - 10L per NC Continuous for SOB. There was no evidence of parameters for the liter flow. COS.

Upon patient record review, 2 of 14 record reviewed (Patient #13, #14) 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 #13: The record indicated on 2/27/24 the RN made a visit and the following was noted the patient was lethargic, sleeping most of the time, disoriented, heart rate 101. Atropine and oxygen was added. It was also noted she was minimally eating and only drinking a little. The reason for the visit was her oxygen level had a desaturation down to 52%. There was no evidence in the record of the care plan being revised to note the progress towards outcome/goals from the plan of care for imminent death. Patient #14: The record indicated there was a change in condition on 11/23/23. There was no evidence of the plan of care being revised to note the progress towards outcome/goals from the plan of care for imminent death.

Upon patient record review, 1 of 14 records reviewed (Patient #6) did not have evidence that the IDG documents the sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement. Patient #6: The record indicated the patient who was in a skilled nursing facility had a Speech consult with new orders for a dietary change. There was no evidence in the hospice record that the IDG shared this information between all disciplines. COS.

Upon patient record review, 1 of 14 records reviewed (Patient #11) did not have evidence that the discharge summary includes all required information. Patient #11: The record did not indicate the discharge summary included the current plan of care, latest physician orders and or if any other documents were requested by the VA Physician and or VA Facility.

Upon patient record review, 1 of 14 records reviewed (Patient #6) did not have evidence that the hospice provided the following information: • The most recent hospice plan of care specific to each patient • Hospice election form and any Advance Directives specific to each patient • Physician certification and recertification of the terminal illness specific to each patient • Names and contact information for hospice personnel involved in hospice care of each patient • Instructions on how to access the hospice's 24-hour on-call system • Hospice medication information specific to each patient • Hospice physician and attending physician (if any) orders specific to each patient Patient #6: The record at the facility did not have evidence of any integrated hospice plan of care, Physicians CTI, Names and contact information for the hospice personnel involved in hospice care, instructions on how to access the hospice's 24 hour on call system, hospice medication information and or hospice physician and attending physician orders specific for this patient. COS.