Every finding on record at Livingston Healthcare

Based on interview and record review, the agency failed to revise and document the individualized plan of care updates, when new medication orders were received for 4 (#s 5, 6, 11, and 13) of 14 sampled patients. Findings include: --- 1. Patient #5Review of patient #5's Hospice Medication Profile, as of 10/22/25, showed the addition of the following order:- acetaminophen 500 mg, 2 tablets to be taken three times a day, start date of 10/1/25, and- melatonin 5 mg, 1 tablet to be taken every night at bedtime, start date of 10/1/25.Review of patient #5's plan of care, as of 10/21/25, showed an acetaminophen order for 500 mg, 2 tablets every six hours as needed for pain. Patient #5's plan of care did not reflect the current medication orders.2. Patient #6Review of patient #6's Hospice Medication Profile, as of 10/22/25, showed the addition of the following order:- acetaminophen 500 mg tablet, one tablet to be administered three times a day, start date of 10/17/25.Review of patient #6's plan of care, as of 10/21/25, did not show the new order for acetaminophen, which began on 10/17/25.3. Patient #11Review of patient #11's Hospice Medication Profile, as of 10/22/25, showed the following order:- fentanyl 75 mcg/hr transdermal patch, change patch in 2-3 days, start date of 10/15/25, and discontinued date of 10/20/25.Review of patient #11's plan of care, date 10/17/25 included the new order of fentanyl 75 mcg from 10/15/25, but the plan of care was not updated on 10/20/25 with the discontinuation of fentanyl 75 mcg. Patient #11's plan of care was not reviewed/revised with new medication orders until the interdisciplinary team meeting on 10/22/25.4. Patient #13Review of patient #13's Hospice Medication Profile, on 10/22/25 at 11:06 a.m., showed the following medication order changes after the 9/17/25 admission:- quetiapine fumarate 50 mg tablet at bedtime, start date of 9/17/25, discontinued date of 10/16/25,- fluconazole 100 mg tablet, two tablets administered on 10/10/25, one time order discontinued on 10/10/25,- fluconazole 100 mg tablet, once daily, start date of 10/11/25, order to be discontinued on 10/24/25, and- quetiapine fumarate 100 mg tablet at bedtime, start date of 10/16/25.Review of patient #13's plan of care, last revised on 10/14/25, did not show the two new orders for fluconazole, which began on 10/10/25 and 10/11/25.No updated plan of care was completed to include the discontinuation of quetiapine fumarate 50 mg on 10/16/25 and the addition of quetiapine fumarate 100 mg on 10/16/25, as of 10/22/25 at 7:30 a.m.During an interview on 10/22/25 at 8:35 a.m., staff member D stated when a medication order was changed, the nurse assigned to the patient was to notify the quality nurse so updates/changes could be made in the plan of care timely. Staff member D stated the plan of care should be changed each time there were changes to medication(s).During an interview on 10/23/25 at 8:00 a.m., staff member A stated when a nurse processed medication order changes, the system changes the orders in the medication profile listing only. The nurse completing the medication changes must communicate the information to the office personnel for the plan of care to be updated.

Based on interview and record review, the facility failed to provide detailed information of the frequency and duration of services necessary to meet specific patient and family needs on the care plans for volunteer services for 2 (#s 6 and 9) of 12 sampled patients. Findings include: --- 2. Review of patient #6s current Plan of Care dated, 11/29/22, showed she had a discontinued order for volunteer services from 5/2/22 to 6/25/22 which had a frequency of once a week for the duration of eight weeks. There were no updated orders on the Plan of Care for a duration or frequency of visits for volunteer services. In the section, Goals/Interventions, it showed, ";volunteer to assist pt out with sorting through belongings." [sic] During an interview on 12/6/22 at 1:56 p.m., staff member B stated the expectation was to ensure the ordered volunteer services had both a frequency and duration for ordered services. She stated their new EMR system would not allow for them to enter the volunteer services. Staff member B stated although this was an issues which had been identified by the agency, they were continuing to work on a process to fix the issue. A review of the facilitys policy and procedure titled, Hospice Volunteer Policy, with a revision date of 3/17/22, showed, ";...The RN or MSW will submit a referral, request MD orders and develop at Plan of Care for the volunteer when it is determined that services are needed." 1. Review of patient #9's Plan of Care, with the start date of 11/7/22, showed physician orders for volunteer services weekly to start effective 11/7/22. The order for volunteer services failed to establish a duration for the ordered volunteer services.

Based on interview, and record review, the agency failed to ensure the coordination of volunteer services reflected the physician orders and IDG established services for 1 (#9) of 12 sampled patients. Findings include: --- 2. Review of the agency form, Volunteer Referral Form, provided on 12/7/22 for patient #6 showed none of the content filled out and the form was not dated. A handwritten last name of patient #6 and a circled ";no" were written in the upper righthand corner of the form. Review of patient #6s volunteer service visit documentation uploaded into the electronic medical record showed, there were volunteer visits after the original volunteer order was discontinued. Volunteer visits were documented three times in July 2022, three times in August 2022, twice in September 2022, three times in October 2022, and one time in November 2022. A review of the agencys policy and procedure titled, Hospice Volunteer Policy, with a revision date of 3/17/22, showed: ";...All volunteers assigned to the hospice patient/family will: ...Be given information and support as needed to carry out their assignments." 1. Review of patient #9s Physician Order, dated 11/7/22, showed, volunteer services ordered for one time a week for 13 weeks. During an interview on 12/6/22 at 1:56 p.m., staff member B stated the expectation was to ensure the ordered volunteer services were entered on the Volunteer Referral Form, so the volunteers would know what services to provide, including the frequency and duration of visits. Review of patient #9s Volunteer Referral Form, dated 11/7/22, failed to include the volunteers assigned duration and frequency of services to be provided.