Every finding on record at Life Choice Hospice of Ohio, LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current: prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by clinical record review, interview, and observation. In 3 of 14 (21%) clinical records reviewed, the hospice did not ensure that the Registered Nurse reviewed and updated the drug profile at the time of each comprehensive assessment. Clinical Record 1/Home Visit 1: The patient elected hospice care on 12/30/2024 with a diagnosis of chronic diastolic (congestive) heart failure. The patient resided in an assisted living facility (ALF). During the home visit with the Registered Nurse (RN) [Personnel Record 5] on 05/28/2025, the hospice medication profile, dated 05/27/2025, and the ALF medication profile were reviewed. The ALF medication profile documented oxycodone 5mg, take one (1) every 12 hours as needed for moderate pain (04/11/2025), and Fleet enema, one (1) enema rectally daily as needed for constipation not relieved by suppository (01/01/2025). The hospice medication profile reviewed on 05/27/2025 documented Neomycin and Losartan as active medications. The ALF medication profile documented Neomycin as a discontinued medication (01/29/2025-02/17/2025). The facility wellness nurse reviewed the medication profile and history of physician orders and stated that the Losartan had not been on the facility's medication list from 01/01/2025 through 05/27/2025. The hospice medication profile did not document the oxycodone and Fleet enema, and was not updated to reflect the discontinuation of the Neomycin and Losartan. There was no evidence that the hospice medication profile was updated with these medications at the time of the comprehensive assessment. During the home visit, the RN [Personnel Record 5] stated, "I don't see them updated on our medication list. I am not sure what happened. I need to get help from my supervisor on entering and discontinuing medications properly. These should be updated every visit, but it looks like these were not." Clinical Record 4/Home Visit 2: The patient elected hospice care on 06/21/2024 with a diagnosis of senile degeneration of the brain. The patient resided in a skilled nursing facility (SNF). During the home visit with the Social Worker [Personnel Record 6] on 05/28/2025, the hospice medication profile, dated 05/27/2025, and the SNF medication profile were reviewed. The SNF medication profile documented, mineral oil enema, one (1) enema rectally every 24 hours as needed for constipation if no bowel movement 8 hours after receiving suppository (03/30/2025), and Mylanta max strength suspension 400-40mg/5ml, give 30ml by mouth every 4 hours as needed for gerd (03/14/2025). The hospice medication profile did not document the mineral oil enema and Mylanta Max Strength. There was no evidence that the hospice medication profile was updated with these medications at the time of the comprehensive assessment. Clinical Record 5/Home Visit 3: The patient elected hospice care on 06/21/2024 with a diagnosis of chronic combined systolic and diastolic heart failure. The patient resided in an ALF. During the home visit with the Hospice Aide (HA) [Personnel Record 8] on 05/28/2025, the hospice medication profile, dated 05/27/2025, and the ALF medication profile were reviewed. The ALF medication profile documented, acetaminophen 325mg, take two (2) tablets (650mg) every 4 hours as needed for fever/temp above 99F (10/21/2024), acetaminophen 325mg, take two (2) tablets (650mg) every 4 hours as needed for mild pain (10/21/2024), Geri Lanta antacid, take 20ml every 4 hours as needed for gastric distress (10/21/2024), and Geri-Tussin 100mg/5ml syrup, give 15ml every 6 hours as needed for cough/congestion (10/21/2024). The hospice medication profile did not document the acetaminophen, Geri Lanta, and Geri-Tussin. There was no evidence that the hospice medication profile was updated with these medications at the time of the comprehensive assessment. During a joint record review and interview on 05/29/2025, the Director of Clinical Services agreed there was no documented evidence that the hospice medication profile was updated at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. Additionally, the Director of Clinical Services stated, "These should be updated at every comprehensive visit. I will be discussing this with the nurses as I can see these were not updated."

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 2 of 13 (15%) clinical records reviewed of patients that received Hospice Aide (HA) services, the hospice did not ensure that the Hospice Aide received written patient care instructions to meet the patient's needs. Clinical Record 3: The patient elected hospice care on 12/30/2024 and resided in an assisted living facility (ALF). The Registered Nurse documentation dated 11/05/2024 to 05/27/2025 revealed wound care being provided and active wounds. Physician orders for wound care dated 11/05/2024 and 03/07/2025 revealed active wound care orders. The HA care plan dated 04/02/2025 did not provide notification or instructions related to the wound. The HA care plan dated 11/05/2024 to 05/27/2025 did not provide the HA with notification or instructions related to the wound.. Clinical Record 9: The patient elected hospice care on 04/07/2025 with the diagnosis of squamous cell carcinoma of skin, unspecified part of face. The patient resided in a skilled nursing facility (SNF). The assessment completed by the Registered Nurse (RN) dated 04/07/2025 documented a facial tumor protruding out of the patient's left temple, and boils/nodules all over the patient's body. The HA care plan dated 04/07/2025 did not provide the HA instructions related to the patient's facial tumor, and boils/nodules all over the patient's body. On 05/12/2025, the physician ordered wound care for the facial tumor. The HA care plan provided the HA no notification of the wound care or update to the care between 04/07/2025 through 05/28/2025. During a joint record review and interview on 05/29/2025, the Director of Clinical Services agreed there was no documented evidence that the HA was provided with specific written instructions relating to the wounds, facial tumor, and boils/nodules all over the body. Additionally, the Director of Clinical Services stated, "We have a new performance improvement plan (PIP) and started training, but we will be adding more training." The record review revealed a physician's order dated 01/04/2023 that included wound care with a wound dressing for a wound to the sacrum. The aide care plan dated 01/06/2023 lacked instructions related to the wound dressing.

It is required that hospice aides are assigned to a specific patient by a Registered Nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by a review of clinical records, observation, and interview. 2 of 11 (18%) clinical records reviewed receiving aide services, the agency did not ensure that aide care plans were complete and included the appropriate information to support the aide working within the scope of practice and meeting patient needs. Clinical Record 0: RN assessment completed on 8/5/2022 indicates that the patient is on oxygen at 2L/min per nasal canal. Observed patient on oxygen via concentrator on 8/16/2022 during home visit. The patient also receiving feeding via peg tub according to Skilled Nursing assessment, orders written on 8/5/2022, and observation. The aide care plan written on 8/5/2022 and updated on 8/10/2022 does not mention oxygen use or the peg tube, leaving the aide without specific instruction. Clinical Record 10: RN assessment completed 5/20/22 documents the presence of a pressure wound on the patient's buttocks. Orders written on 5/25/2022 state in part, irrigate wound on coccyx with NS apply Triad and then foam dressing. Aide care plan is written on 5/20/2022 and updated on 5/21/22 orders an aide to provide bed bath and perineal care every visit but does not mention the patient's wound. There are no updates to the aide care plan addressing wound care orders or how to manage dressing area. Interview with Regional Director of Operations on 8/17/2022 stated in part, "the aide care plans should be clearer. It makes sense that oxygen, wounds, etc., should be on the care plan to give direction to the aide." 2 of 11 (18%) of records with aide care plans revealed that agency did not ensure that aide care plans were complete and included the appropriate information to support the aide working within scope of practice and meeting patient needs.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group, included in the plan of care. This standard was not met as evidenced by a review of clinical records and interviews. 1 of 11 (9%) clinical records for patients receiving aide services reviewed, the agency did not ensure that the hospice aide plan of care was followed as ordered. Clinical Record 0: Aide plan of care effective date 8/5/2022 includes an order for an aide to "transfer to/from bed to chair- mechanical lift every visit." Aide visit dated 8/9/2022 indicates that transfer to/from bed to the chair was not completed due to "not necessary during this visit." The Task list also contains a note - Did you communication with other disciplines? If so, whom? Aide documented "Y" with no documentation of what or to whom information communicated. Interview with Regional Director of Operations on 8/17/2022, she stated, "understood that the aide care plan was unclear and the documentation from the aide was insufficient." Additionally, that she would meet with IDG to clarify and revise aide care plan and provide aide with education related to following care plan and /or contacting nurse for clarification. 1 of 11 (9%) records with aide services revealed that the agency did not ensure that the hospice plan of care was followed as ordered.

It is required that the designated IDG member provides the SNF/NF or ICF/IDF with physician certification and recertification of the terminal illness for each patient/resident. This standard was not met as evidenced by a review of clinical records, interviews, and observations. 2 of 3 (66%) observations during home visits for patients residing in a skilled facility (SNF), the agency did not ensure that the SNF had a copy of the physician certification of the terminal illness. Home Visit 0: During home visit #3, Patient #4, on 8/16/2022, a patient residing in a long-term care facility, in the review of facility record, there was no physician certification of terminal illness (CTI) present. Interview with Social Worker, on 8/16/2022, the Social Worker revealed that she could not find the CTI in the facility file but would work to ensure a copy was included in the facility record. Home Visit 2: During home visit #1 (Clinical Record #9) on 8/16/2022, in the review of the facility record, there was no physician certification of a terminal illness. In an interview on 8/16/2022, the RN stated during a home visit that she could not find CTI in the facility chart. RN said she would get a copy into the patient facility record. 2 of 3 (66%) of relevant clinical records, the agency did not ensure that the SNF had a copy of the physician certification of the terminal illness.