Every finding on record at James River Home Health Care LLC

Upon patient record review 5 of 19 (Patient #1,6,9,11,12) 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 1: SOC 10/27/21. SW initial visit completed after the first 5 days, completed on 11/28/2021. Patient 6: SOC 12/22/22 Spiritual Care assessment not completed until 01/13/23. Patient 9: SOC 12/16/22. Chaplain initial visit on 12/22/2022 Patient 11: SOC 1/31/23-SW completed on 02/16/2023. Chaplain initial visit completed on 02/16/2023. Patient 12: SOC 1/31/23 Chaplain initial visit completed on 02/08/23.

Upon patient record review 1 of 19 (Patient #3) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient 3: SOC 6/15/23. Chaplain had not done a spiritual assessment at the time of survey. Corrected during survey.

Upon patient record review, 3 of 19 (Patient #4,7,8) 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 4: MAR has Morphine order as "Morphine 10mg hourly by mouth for pain". POC order has "Morphine 10mg hourly PRN by mouth for pain" Corrected on site Patient 7: MAR has Morphine order as "Morphine 10mg hourly by mouth for pain". POC order has "Morphine 10mg hourly PRN by mouth for pain" POC order has 'oxygen continuous/prn 1-5L for shortness of breath'. MAR has 'oxygen 1-5L continuously'. Corrected on site. Patient 8: Miralax order does not have diluent listed. Corrected on site.

Upon patient record review, 4 of 19 (Patient #2, #4, #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 2: Patient had wounds at the time of admit, wounds were not measured between 5/4/23-6/11/23. Agency policy is to take measurements weekly/every 7 days. Patient 4: Patient had wounds at the time of admit. There was no evidence of wound measurements obtained between 5/16/23-6/20/23. Agency policy is to measure wounds weekly/every 7 days. Patient 5: Patient had wounds at the time of admit 01/27/23. Wounds were measured at that time by the admitting NP. No other wound measurements were taken during the 1st benefit period. Agency policy is to take measurements weekly/every 7 days. Patient 13: Patient had wounds that were added on 5/16/23. Wounds were measured at the time that they were found by the nurse. No other measurements were obtained between 5/16/23-6/20/23. Agency policy is to measure wounds weekly/every 7 days.

Upon patient record review, 3 of 19 (Patient #7, 8,9) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness Patient 7: POC order has 'oxygen continuous/prn 1-5L for shortness of breath'. MAR has 'oxygen 1-5L continuously'. Corrected on site. Patient 8: Miralax order does not have diluent listed. Corrected on site. Patient 9: MAR has wound care cleanser and Medihoney 80% topically, all wound care previously stopped and wound problems taken off the POC. Patient does not currently have a wound.

Upon client record review, 1 of 19 (Patient # 8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 8: Volunteer services declined at the time of admit. VC entered a coordination note stating that she evaluated the patient on 03/03/23. No order entered for volunteer to eval patient.