Every finding on record at Lighthouse Hospice - Coastal Bend, LLC

Upon patient record review, 4 of 14 (Patients #2,#3,#6,#10) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 2: During home visit medication reconciliation, the facility and hospice medication profiles did not match. The facility profile contained multiple medications not on the hospice profile including: scheduled Coenzyme Q-10, Cranberry tablets, Miralax, Omega-3 tablets, and Systane eye drops; and PRN Milk of Magnesia, Preparation H, and lactulose. Corrected on site with order clarification and update to profile. Patient 3: The medication profile contained duplicative listings of Tylenol PRN instructions. Corrected on site with update to profile. Patient 6: During home visit medication reconciliation, the facility and hospice medication profiles did not match. The facility profile contained scheduled calcium carbonate that was not on the hospice profile and did not contain scheduled Fosamax and Geri-Lanta that were on hospice profile. Also the dose of Vitamin D3 was 50 mcg per facility, 1250 mcg per hospice, facility route for hyoscyamine was sublingual not g-tube per hospice, facility dose of morphine was 5 mg, not 5-10mg per hospice, and multivitamin was Ocuvite Lutein not Women 50 Plus with Iron per hospice. Corrected on site with order clarification and update to profile. Patient 10: During home visit medication reconciliation, the facility and hospice medication profiles did not match. The facility profile contained senna PRN instead of scheduled per hospice. The medication profile also contained duplicative listings of acetaminophen tab PRN and supp PRN, Benadryl PRN, bisacodyl supp PRN, Claritin scheduled, famotidine scheduled, fentanyl patch, hydrocodone-acetaminophen PRN, hyoscyamine PRN, lorazepam PRN, losartan scheduled, magnesium oxide scheduled, naproxen PRN, pioglitazone scheduled, prochlorperazine PRN, senna scheduled, sertraline scheduled. Duplicative listings were corrected on site with update to profile. Facility discrepancy corrected on site with order clarification received and update to profile.

Upon patient record review, 3 of 14 (Patients #3,#4,#6) 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 3: The medical record contained nursing documentation upon admission identifying patient diagnoses of heart failure and atrial fibrillation. There was no evidence of problems, goals, and interventions related to cardiac dysfunction included in the plan of care. Corrected on site with plan of care update. Patient 4: The medical record contained nursing documentation upon admission identifying patient history of seizures and dysphagia requiring mechanical soft diet. There was no evidence of problems, goals, and interventions related to seizure precautions and dysphagia included in the plan of care. Corrected on site with plan of care update. Patient 6: The medical record contained nursing documentation upon admission identifying patient history of seizures. There was no evidence of problems, goals, and interventions related to seizure precautions included in the plan of care. Corrected on site with plan of care update.

Upon patient record review, 3 of 14 (Patients #2,#6,#10) 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: During home visit medication reconciliation, the facility and hospice medication orders did not match. The facility had multiple medication order that hospice did not have including: scheduled Coenzyme Q-10, Cranberry tablets, Miralax, Omega-3 tablets, and Systane eye drops; and PRN Milk of Magnesia, Preparation H, and lactulose. Corrected on site with order clarification. Patient 6: During home visit medication reconciliation, the facility and hospice medication orders did not match. The facility had orders for scheduled calcium carbonate that hospice did not have and did not have orders for scheduled Fosamax and Geri-Lanta that hospice had. Also the ordered dose of Vitamin D3 was 50 mcg per facility, 1250 mcg per hospice, facility route for hyoscyamine was sublingual not g-tube per hospice order, facility dose of morphine was 5 mg, not 5-10mg per hospice order, and multivitamin was Ocuvite Lutein not Women's 50 plus with Iron per hospice order. Corrected on site with order clarification. Patient 10: During home visit medication reconciliation, the facility and hospice medication orders did not match. The facility had an order for senna PRN instead of scheduled per hospice order. Corrected on site with order clarification.

Upon patient record review, 5 of 14 (Patients #1,#2,#4,#8,#9) 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 equipment and supply needs. Patient 1: The medical record contained nursing documentation upon recertification assessment 8/13/25 identifying patient use of a raised toilet seat. There was no evidence of an order for the DME included in the plan of care. Corrected on site with order received. Patient 2: The medical record contained nursing documentation upon recertification assessment 6/25/25 identifying patient use of a hospital bed and overbed table. There was no evidence of orders for the DME included in the plan of care. Corrected on site with order received. Patient 4: The medical record contained an aide care plan identifying patient use of a walker, and social worker documentation 9/11/25 identifying use of a wheelchair. There was no evidence of orders for the DME included in the plan of care. Corrected on site with order received. Patient 8: The medical record contained an aide care plan identifying patient use of a shower chair. There was no evidence of an order for the DME included in the plan of care. Corrected on site with order received. Patient 9: The medical record contained nursing documentation since admission identifying patient use of a shower chair. There was no evidence of an order for the DME included in the plan of care. Corrected on site with order received.

Upon patient record review, 1 of 14 (Patient #8) 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. Patient 8: The medical record contained an order to discontinue spiritual care visits 8/18/25. The current plan of care contained problems, goals, and interventions related to spiritual care to be completed by the chaplain. There was no evidence the plan of care was updated after services were discontinued. Corrected on site with plan of care update.

Upon patient record review, 2 of 14 (Patients #8,#10) did not have evidence in the patient record that hospice aide assignments and duties are specific to patient needs. Patient 8: The medical record contained nursing documentation since admission identifying patient requires a maximum assistance with transfers. There was no evidence of instructions for patient transport or ambulation included in the aide care plan. Corrected on site with update to aide care plan. Patient 10: The medical record contained nursing documentation since admission identifying patient requires two person assist with transfers and documentation 9/5/25 identifying patient's wound was healed. There was no evidence of instructions for patient transfers included in the aide care plan, and there were current instructions regarding management of wound bandage. Corrected on site with update to aide care plan.

Upon patient record review, 3 of 11 (Patient #6, #7, #8) 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 #6: The medication profile included Tylenol 650mg ER take one tablet every 8 hours PRN for mild pain and hydrocodone 7.5/325 take one tablet every 4 hours PRN for mod-severe pain without a maximum allowable limit. [corrected on site] Patient #7: The medication profile included Cortisone-10, 1% topical, apply 1" to affected areas twice daily however, affected areas were not listed. [corrected on site] Patient #8: The medication profile included Tylenol extra strength 500mg take one tablet every 6 hours PRN for mild pain, hydrocodone 5/325 take one tablet twice a day, and hydrocodone5/325 take on tablet every 6 hours PRN for mod-severe pain without a maximum allowable limit. [corrected on site]

Upon patient record review, 1 of 10 applicable (Patient #5) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #5: The patient admitted on 08/11/2022 however, the bereavement assessment was not performed until 08/17/2022.

Upon patient record review, 3 of 11 (Patient #6, #7, #8) 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 #6: The record contained orders for Tylenol 650mg ER take one tablet every 8 hours PRN for mild pain and hydrocodone 7.5/325 take one tablet every 4 hours PRN for mod-severe pain without a maximum allowable limit. [corrected on site] Patient #7: The record contained order for Cortisone-10, 1% topical, apply 1" to affected areas twice daily however, affected areas were not listed. [corrected on site] Patient #8: The record contained orders for Tylenol extra strength 500mg take one tablet every 6 hours PRN for mild pain, hydrocodone 5/325 take one tablet twice a day, and hydrocodone5/325 take on tablet every 6 hours PRN for mod-severe pain without a maximum allowable limit. [corrected on site]

Upon patient record review, 1 of 11 (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. Patient #5: The record indicated the patient transferred from home to a SNF however, the plan of care was not updated to include coordination of care with facility. [corrected on site]

Upon client record review, 1 of 7 applicable (Patient #10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #10: The record contained orders for social worker on 08/03/2022 for visits 1M1, 2M2, 2PRN however, there was evidence of two visits performed by social worker in August on 08/13 and 08/16/22.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Home visit #1: The CNA removed gloves twice while performing care of patient and was not observed washing hands before applying new gloves. Home visit #2: The RN removed gloves following full patient assessment and was not observed washing hands prior to applying new gloves to check medications.

Upon patient record review, 1 of 8 applicable (Patient #2) 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 #2: The aide plan of care included instructions to leave wound dressing in place however, the nurse documentation indicated the wound healed on 08/19/2022 and the plan of care was not updated. [corrected on site]

Upon patient client record review, 1 of 11 records (Patient #5) 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 #5: The aide note on 9/23/2022 indicated "patient continues with open area to right leg under butt cheek" and nurse notified however, no follow up assessment for wound was found. After researching, the clinical manager explained there was not an open area found by nurse which is why there was no assessment. [corrected on site]

Upon patient record review, 1 of 1 record (Patient #5) did not have evidence that the hospice provided the following information: • Names and contact information for hospice personnel involved in hospice care of each patient Patient #5: Upon observation on staff visit, the agency binder did not have evidence of hospice personnel involved in care. [corrected on site]