Every finding on record at James River Home Health Care LLC

Upon patient record review, 3 of 19 (Patient #3,12,13) 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 #3: Facility med profile has Lorazepam concentrate 0.25 ml (of 2mg/ml solution) po q 4 hrs prn. The hospice Medication Profile had Lorazepam 0.5 mg tablet po every 4 hours. Patient #12, daughter reported patient taking Hydroxyzine 25 mg hs for itching, which is patient reported to be effective. The medication was not on the medication profile printed for surveyor. Patient #13: Hospice Rx profile included medications that were not list on facility Medication Profile. Aspirin 81 mg delayed release 1 tablet daily. CA Carbonate 400 mg/1000 units 1 tablet daily, Famotidine 20 mg tablet 1 daily GERD. Pepcid 20 mg 1 tablet 2 times daily. Prolia 60 mg/ml subcutaneous syringe subcutaneous daily every 6 months. Keppra 500 mg tablet 1 tablet 2 x daily is listed on the hospice profile, but the facility med profile lists solution rather than tablet. Ipratropium 0.5 mg Albuterol 3 mg (2.5 mg base/3 ml nebulization solution) every 6 hrs. (Note: There is a prn same dose every 4 hrs on both profiles for this medication)

Upon patient record review, 2 of 19 (Patient #5,6) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #5: SOC 1/26/24. MSW frequency initial POC is 1m3. There is no documented evidence that visit was made in March 2024. There is 3/12/24 order for SW freq. decreased to prn for the month of March at caregiver request. Patient #6: SOC 2/26/24. 2/27/24 order: SW frequency decreased for the month of Feb to prn at CG request.

Upon patient record review 1 of 19 (Patient #6) 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 #6: HA assignment included task to identify date of last BM completed: March 28th, April 4 and 11th, 2024 visits, the HA marked Y, but did not specify date.

Upon patient client record review, 1 of 19 (Patient #1) 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 #1: 3/23/24 PRN SN visit related to decreased output from Foley. Visit noted catheter changed however, documentation is not clear what size catheter was used, nor what size the balloon actually was.