Every finding on record at La Best Hospice Care

Upon patient record review, 2 of 14 (Patient 10 & 12) 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 10 medication profile includes "Miralax powder for solution 17g orally once daily as needed for constipation” with no strength and no diluent instructions. Patient 12 medication profile included "Nystatin 100,000u topical cream 2-4 gms apply to affected areas once daily” with no location identified.

Upon patient record review, 2 of 14 (Patient 10 & 12) 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 10 plan of care includes "Miralax powder for solution 17g orally once daily as needed for constipation” with no strength and no diluent instructions. Patient 12 plan of care included "Nystatin 100,000u topical cream 2-4 gms apply to affected areas once daily” with no location identified.

Upon patient record review, 1 of 14 (Patient 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 10 Aide care plan notes "check vital signs each visit" without parameters to notify RN.

Upon patient record review 1 of 14 (Patient 10) 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 10 HHA frequency ordered 2 x w, frequency not met week of 10/8/23-10/14/23; only 1 visit made.

Upon client record review, 2 of 14 (Patient 13 & 14) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patient 13 & 14 did not have evidence when patient revoked the election of hospice care, the hospice forwarded to the patient's attending physician a copy of the hospice discharge summary.