Every finding on record at Lester Dierksen Memorial Hospice, LLC

Upon patient record review, 1 of 19 (Patient #5) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. be proactive Patient #5 : SOC 10/10/24. SN received call from daughter 5/27/25 stating patient having increased depression and mood swings. Medication changes ordered after physician contact. There were no related updates to problems, goals and interventions.

Upon client record review, 1 of 19 (Patient #2) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2: SOC 5/19/25 with physician order for SC 2wk2. 6/6 and 7/18/25 IDG SC note entries say SC to continued 1/month and as needed. The only visit documented is 5/23/25.

Upon patient record review, 3 of 19 (Patient #1, 3, 6) 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 1, 3: Hospice Aide Care Plan Assignment says give complete bed bath or partial bed bath if patient unable or cannot tolerate shower. There is no reference that patient is cognitively able to make decisions or to refer to caregiver for decision. Patient #6: Patient has multiple diabetic medications prescribed and history of hypoglycemic reactions with glucagon documented to be in home for emergency. No related alerts or precautions on Hospice Aide Care Plan Assignment.

Upon patient client record review, 2 of 19 (Patient #12, 13) 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 #12: SN notes 6/23, 7/1/25 - Hospice Aide supervisory visit note section completed, although there was no Aide service provided. Patient #13: SN notes 6/12, 6/18, 7/9, 7/14/25 - Hospice Aide supervisory visit note section completed, although there was no Aide service provided.

Upon patient record review 2 of 13 (Patients #6 and #8) 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 #6: The patient was admitted on 4/22/2022. The Psychosocial assessment was not conducted until 4/28/2022 (Day 6). Patient #8: The patient was admitted on 9/28/2021. The Psychosocial assessment was not completed until 10/5/2021. (Day 7)

Upon patient record review, 5 of 13 (Patients #5, #7, #8, #10 and #11) did not have evidence that the plan of care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #5: The Medication Profile listed Colace, Prochlorperazine and Ipratropium-Albuterol as PRN medications. There was no indication for the PRN meds. Patient #7: The Medication Profile listed Hydrocodone, Atropine Sulfate and Lorazepam as PRN medications. There was no indication for the PRN meds. Patient #8: The Medication Profile listed Oxygen, Hydrocodone, Nystatin and Zofran as PRN medications. There was no indication for the PRN meds. Patient #10: The Medication Profile listed Lorazepam and Morphine as PRN medications. There was no indication for the PRN meds. Patient #11: The Medication Profile listed Atropine, Lorazepam and Morphine as PRN medications. There was no indication for the PRN meds.