Every finding on record at James River Home Health Care LLC

Upon patient record review, 1 of 14 (Patient #2) 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 medication profile contained MiraLax oral powder daily for constipation. There was no evidence of a diluent to be added. This was corrected onsite. The profile was updated onsite.

Upon patient record review, 5 of 14 (Patient #2,3,6,7,12) 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 #2 - Upon record review, noted the nursing comprehensive dated 09/03/24, noted patient is experiencing uncontrolled pain. The medication profile noted patient was utilizing a Fentanyl patch and oxycodone for pain control. The plan of care interventions did not The plan of care did not contain interventions to address pain. Patient's medication profile also included Eliquis as a blood thinner. There was no evidence of problems, goals or interventions related to risk of bleeding. This was updated onsite. Patient #3 - The medical record showed a diagnosis of degenerative senile dementia with behaviors. The medication profile noted Seroquel, trazadone, and Depakote to control these behaviors. The plan of care did not contain interventions to address neuro behaviors. This was updated onsite. Patient #6 - The medication profile showed patient was utilizing a DuoNeb via nebulizer. There was no evidence of problems, goals or interventions related to respiratory issues. The medication profile also included Jardiance for treatment of diabetes. There was no evidence of problems, goals or interventions related to the endocrine system. The medical record contained an order for cephalexin 250 mg three times a day for ten days. There was no evidence of problems, goals, interventions related to infection. This was updated onsite. Patient #7 - The medical record showed patient has a primary diagnosis of Parkinson's Disease along with a related diagnosis of diabetes. There was no evidence of problems, goals, or interventions related to the endocrine or neuro systems. There was a physician order dated 07/28/25 for Keflex for treatment of a UTI. There was no problems, goals, or interventions related to infection. These were all updated onsite. Patient #12 - The medication profile showed patient was taking Eliquis as a blood thinner. There was no evidence of problems, goals or interventions related to the bleeding risk. This was updated onsite.

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 - The medical record contained a physician order for MiraLax 17gm daily for constipation. There was no order for a diluent for this medication. This was corrected onsite with an updated physician order.

Upon client record review, 1 of 14 (Patient #1) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient #1 - Upon record review, noted that the IDG console had an IDG meeting dated 10/10/24 with a missing signature. Upon review of this IDG update, the signature of attendance from the Medical Director was left blank therefore, no evidence of this discipline's participation to review/revise individual POC.

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. Upon review of the 2024 annual report, the volunteer percentage was noted at 3.62%.