Every finding on record at Infinite Hospice

Upon patient record review, 1 of 14 records reviewed (Patient #10) did not have evidence that the patient has received effective pain management and symptom control from the hospice for conditions related to the terminal illness. Patient #10:  The record indicated the patient was on continuous care on 11/09/23 and had shortness of breath while receiving Ativan.  There was no evidence in the record of the effectiveness of the Ativan and it presented this symptom was not being managed.

Upon patient record review, 10 of 14 records reviewed (Patient #1, #2, #3, #4, #5, #6, #7, #8, #9, #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 Patients #1 - #10: The records indicate multiple medications listed on the Medication Administration record. There was no evidence the review included the effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy and drug therapy currently associated with laboratory monitoring. Patient #2: During the home visit the MAR indicated Acetaminophen 325mg 2 tabs po Q6hours prn pain, the prescription bottle read 325mg 2 tabs po Q8hour. COS. In addition, Carbidopa/Levodopa/Entacapone 25/100/200 2 tabs po bid was indicated on the MAR, the pills were in the separate prescription bottles as Carbidopa/Levodopa 25/100 and a separate prescription bottle for the Entacapone 200. COS.

Upon patient record review, 1 of 14 records reviewed (Patient #7) 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 #7: The record indicated the patient was on Eliquis. There was no evidence of bleeding precautions on the Safety Plan of Care. COS.

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: During the home visit it was noted the MD ordered Acetaminophen 325mg 2 tabs po Q6hours prn pain, the prescription bottle read 325mg 2 tabs po Q8hour. COS. In addition, Carbidopa/Levodopa/Entacapone 25/100/200 2 tabs po bid was ordered by the hospice physician, the pills were in the separate prescription bottles as Carbidopa/Levodopa 25/100 and a separate prescription bottle for the Entacapone 200. The orders was not evidence of orders for the medications in the home. COS.

Upon patient record review, 3 of 14 (Patient #3, 10, 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 #3: The record indicated the patient had nails debrided on 4/10/24. There was no evidence of patient/family goals and interventions based on the problem identified from the updated comprehensive assessment. In addition, The record indicated the patient was on lithium and had a level drawn on 5/25/24. There was no evidence of the patient/family goals and interventions based on the problem/need for the lab draw that was identified from the updated comprehensive assessment. Both were COS. Patient #10: The record indicated the patient was placed on continuous care on 11/09/23 starting at 9 a.m. There was no evidence of the patient/family goals and interventions based on the problem/need for the continuous care that was identified from the updated comprehensive assessment. Patient #14: The record indicated the patient was placed on continuous care on 4/29/24 starting at 7 a.m. There was no evidence of the patient/family goals and interventions based on the problem/need for the continuous care that was identified from the updated comprehensive assessment.

Upon personnel record review, 1 of 16 records reviewed (Personnel #2 ) did not have evidence the alternate administrator's personnel record verifies that: • The employee has appropriate education and experience requirements • There is a signed job description for this role • The employee has been orientated to this role Personnel Record #2 did not have evidence the Alternate Administrator was oriented to this role.

Upon observation, there was no evidence the hospice is primarily engaged in providing the following care and services: • Nursing services • Medical social services • Physician services • Counseling services, including spiritual counseling, dietary counseling and bereavement counseling • Hospice aide, volunteer, homemaker services • Physical therapy, occupational therapy, speech-language pathology services • Short-term inpatient care • Medical supplies (including drugs and biologicals) and medical appliance Contract review for PT/OT/Speech did not include Speech Therapy. Corrected on site