Every finding on record at Iowa Hospice, LLC

Upon patient record review, 2 of 14 (Patient #5,7) 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 5: The current medication profile contains an order oxycodone 5mg every 4 hours PRN and Tramadol 50mg 1 tab every 6 hours PRN, instructions for both say that they are to be used for moderate pain. No evidence that instructions were given on which medication to use first for moderate pain. Corrected on site. Patient 7: The current medication profile contains an order for polyethylene glycol 3350, 17gram oral powder 1 packet daily with no instructions to mix with a diluent. Corrected on site.

Upon patient record review, 1 of 14 (Patient #2) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient 2: No evidence that a bereavement risk assessment was completed within 5 days of the election of hospice. Patient admitted on 07/01/2024, assessment completed on 07/12/2024.

Upon patient record review, 2 of 14 (Patient #5,7) 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: The current medication profile contains an order Oxycodone 5mg every 4 hours PRN and Tramadol 50mg 1 tab every 6 hours PRN, both listed for moderate pain. No evidence that instructions were given stating which medication to use first for moderate pain. Corrected on site. Patient 7: The current medication profile contains an order for polyethylene glycol oral powder with no instructions to mix with a diluent. Corrected on site.

Upon patient record review, 3 of 14 (Patient #3,9,10) 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 3: The record indicates that patient had 2 wounds that were deactivated in the wound chapter on 09/09/2024 and 09/23/2024. No evidence that an order was received to take the wound care supplies off the current POC supply list. Corrected on site. Patient 9: The record indicates that patient had a wound at the time of admit that was deactivated in the wound chapter on 03/11/2024. No evidence that an order was received to take the wound care supplies off the current POC supply list. Corrected on site. Patient 10: The record indicates that patient had 2 wounds that were deactivated in the wound chapter on 01/29/2024 and 04/18/2024. No evidence that an order was received to take the wound care supplies off the current POC supply list. Corrected on site.

Upon patient record review 1 of 14 (Patient #3) 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 to start visiting the patient. Patient 3: Aide plan of care has orders for the aide to provide nail care and shampoo weekly. Aide documentation showed that those task were performed at every visit for the weeks of 12/16/24, 12/22, 12/29.

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. The documented annual usage for the year 2024 was 0.18%.

Upon patient record review, 3 of 13 (Patient #8,9,13) 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 #8 SN visit dated 8/14/2021 indicates patient taking Metformin. No evidence of Metformin on medication profile. Patient #9 Initial Nursing visit and visits in September and October documented that patient was on O2 3L N/C. No evidence of O2 on medication profile. Patient #13 SN visit dated 8/15/21 indicates patient taking Bisacodyl. No evidence of Bisacodyl on medication profile.

Upon patient record review, 1 of 13 (Patient #9) did not have evidence that each patient and family received education and training provided as appropriate to their responsibilities for the care and services identified in the plan of care. Patient #9 No evidence of teaching on the following medications: Lorazepam, Morphine, Nystatin, Ondansetron, Systane.

Upon patient record review, 3 of 13 (Patient #8,9,13) 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 #8 SN visit dated 8/14/2021 indicates patient taking Metformin. No evidence of an order. Patient #9 Initial Nursing visit and visits in September and October documented that patient was on O2 3L N/C. No evidence of orders. Patient #13 Patient admitted 8/14/21. Initial plan of care included 18 FR foley, but RN visit dated 8/14/21 documented 16 FR foley. The order was not clarified based on what the RN documented the patient already had. SN visit dated 8/15/21 indicates patient taking Bisacodyl. No evidence of orders. RN visits 8/14/21 and 8/15/21 document peripheral IV right foot, no evidence of order.

Upon patient record review, 1 of 13 (Patient #11) 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 #11 O2 2-5 L N/C was listed on medication profile, no evidence of O2 DME order.

Upon client record review, 6 of 13 (Patient #1,2,3,8,11,12) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1 Chaplain order dated 1/7/22 with frequency of 1mo1, 2mo2, 1mo4. Chaplain visits made on 1/11/22 and 1/24/22. Patient #2 Chaplain order dated 1/24/22 with effective date of 1/1/22 of 1mo1 plus 2 prns. Chaplain visit made on 2/1/22. Patient #3 SN ordered 2w13 on initial plan of care. SN performed visit on 12/20/21, no evidence of second visit or refusal. Patient #8 SN ordered 1w1, 3w2 on initial plan of care. SN visit on 8/27/21, documented refusal of visit on 8/24/2021. No evidence of 3rd visit or refusal. Patient #11 SN visit on 12/11/21 with evidence of performing wound care: cleanse with NS, apply steri-strips, wrap with Cling gauze. No evidence of order for this treatment. Patient #12 Volunteer care plan dated 7/14/21 included visit frequency of 2xmo and to provide companionship and errand running. Recertification order effective 1/4/22 stated Volunteer needed. Volunteer visits on 11/6/21, 11/21/21 and 12/11/21 documented companionship, emotional/spiritual support, socialization provided. Volunteer visits on 11/27/21 and 12/18/21 documented companionship, emotional/spiritual support, socialization, and food prep.

Upon patient record review, 2 of 12 applicable (Patient #3.10) 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 #3 Aide care plans dated 12/14/21 and 12/22/21 included shower every visit and dressing weekly with shower. Patient #10 Aide care plan dated 9/11/21 included bed bath and partial sponge bath every visit.

Upon patient record review 9 of 12 applicable (Patient #1,3,4,5,6,8,9,10,12) 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 #1 During home visit with surveyor on 2/1/22, Aide applied TED hose. No evidence of TED hose on Aide Care plan or in Aide documentation. Patient #3 Aide care plans dated 12/1/21 and 12/14/21 included shampoo every visit. Aide visits on 12/13/21 and 12/16/21 for shampoo documented not needed this visit. Aide care plan dated 12/22/21 included nail care every visit. Aide visit on 1/20/22 for nail care documented not needed. Patient #4 Aide care plan dated 1/25/22 included shaving weekly. Aide visits on 1/25/22 and 1/28/22 documented shaving performed. Patient #5 Aide care plan dated 11/30/21 included hair care weekly. Aide visits on 12/27/21 and 12/29/21 documented hair care performed. Aide visit frequency ordered on 12/8/21 effective 12/20/21 stated frequency of 2w13. Aide visit on 12/20/21 without evidence of 2nd visit during that week or refusal. Patient #6 Order dated 12/21/21 effective 12/26/21 stated aide frequency 2w12. Aide visit on 12/28/21 without evidence of 2nd visit that week or refusal. Patient #8 Initial plan of care stated aide frequency of 2wk13. Aide visit refusal documented for 8/27/21. No evidence of 2nd visit or refusal. Patient #9 Aide care plan dated 8/17/21 included nail care, skin care, weight and other-sweeper in living room frequency as weekly. Aide care plan dated 9/13/21 included bathing, skin care, dressing and nail care as weekly. Aide visits on 8/23/21, 8/25/21, 8/30/21, 9/3/21, 9/7/21, 9/9/21, 9/13/21 and 9/15/21 documented skin and nail care performed. Aide visits on 9/17/21, 9/20/21, 9/22/21 and 9/24/21 documented bathing, skin care and nail care performed. Aide visits on 9/28/21, 9/30/21, 10/2/21, 10/4/21, 10/6/21 and 10/7/21 documented bathing, dressing, skin care and nail care performed. Aide visit on 8/25/21 documented shampoo performed. No evidence of shampoo on care plan. Aide visit on 9/9/21 documented sponge bath performed. No sponge bath on care plan. Patient #10 Order dated 9/11/21 states Aide frequency 2w13. No evidence of aide visits during week of 9/11/21. Patient #12 Aide care plan dated 11/29/21 and 1/10/22 assigned shower, dressing and weight to be performed weekly. Aide care plan dated 1/12/22 assigns shower, dressing, shaving and weight weekly. Aide visits dated 1/10/22 and 1/12/22 documented weight. Aide visits dated 1/17/22 and 1/19/22 documented shower and dressing.

Upon client record review, 1 of 2 applicable (Patient #6) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #6 Initial plan of care denotes SN to assess O2 sat every visit. SN visits on 12/22/21, 12/30/21, 1/11/22, 1/17/22, and 1/20/22 does not have evidence assessing O2 saturation.