Every finding on record at Loving Peace Hospice, Inc.

Upon patient record review, 2 of 19 (Patient #2,7) 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 2: Duplicate drug therapy: Loperamide 2mg tab one every 24 hours PRN for diarrhea. Imodium PRN Q AM and as needed PRN. No evidence that a frequency was listed on when to give PRN dose for constipation. Patient 7: Duplicate drug therapy: Colace 100mg daily PRN for constipation and Miralax 17G mixed in 8oz of water daily PRN for constipation. No evidence that instructions were given on which medication should be given first for constipation.

Upon patient record review, 1 of 19 (Patient #14) 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 14: No evidence that the initial bereavement risk assessment was completed within 5 days. Admitted on 08/23/203, bereavement risk assessment completed on 11/08/2023.

Upon patient record review, 6 of 19 (Patient #1,2,3,7,10,12) 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 1: Wounds were inactivated on 02/14/2024. No evidence that wound care orders were removed from the active plan of care. Patient 2: Wounds were inactivated on 12/11/2023. No evidence that wound care orders were removed from the active plan of care. Patient 3: Patient identified as a risk for falls upon admit and ongoing via RN assessments. No evidence that risk for falls/safety was added to the plan of care. Patient 7: Patient identified as a risk for falls upon admit and ongoing via RN assessments. No evidence that risk for falls/safety was added to the plan of care. Patient 10: History of seizures. Currently takes Topamax 500mg daily for seizures, primidone 300mg at night and 100mg primidone in the morning for seizures. No evidence of risk for seizures was added to the plan of care. Patient 12: Patient identified as a risk for falls upon admit and ongoing via RN assessments. No evidence that risk for falls/safety was added to the plan of care.

Upon patient record review, 2 of 19 (Patient #2,7) 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: Duplicate drug therapy: Loperamide 2mg tab one every 24 hours PRN for diarrhea. Imodium PRN Q AM and as needed PRN. No evidence that a frequency was listed on when to give PRN dose for constipation. Patient 7: Duplicate drug therapy: Colace 100mg daily PRN for constipation and Miralax 17G mixed in 8oz of water daily PRN for constipation. No evidence that instructions were given on which medication should be given first for constipation.

Upon patient record review, 3 of 19 (Patient #2,6,12) 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 equipment and supply needs. Patient 2: Wound care supplies on current plan of care. Wound care discontinued on 12/11/2023. Patient 6: Wound care supplies on current plan of care. No evidence that the patient had wounds during his time on hospice services. Patient 12: Wound care supplies on current plan of care. Wounds were discontinued on 01/29/2024.

Upon client record review, 2 of 19 (Patient #9,13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 9: Plan of care has MSW frequency as once monthly. No evidence that the visit for the month of March occurred. No evidence of an order to change visits for that month or miss visit communications from the patient/caregiver to refuse the visit. Patient 13: Volunteer services started on 01/15/2024 for weekly tuck in calls. Last volunteer note uploaded has 02/12/2024 and 02/21/2024 dates. No evidence that patient received any tuck-in calls for the month of January or March. No missed visit note or other documentation present.

Upon patient record review 2 of 19 (Patient #5,12) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient 5: No evidence that the hospice aide received an on-site visit every 14 days. Patient received an on-site visit on 03/04/2024 and the next on-site visit was on 03/22/2024. 18 days occurred between on-site visits. Patient 12: No evidence that the hospice aide received an on-site visit every 14 days. Patient received an on-site visit on 02/22/2024 and the next on-site visit was on 03/19/2024. 26 days occurred between on-site visits.

Upon patient client record review, 1 of 19 (Patient #7) 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 7: No evidence that a signature date was placed by the medical director on the advanced directive/POST form that was uploaded to the chart.

Upon client record review, 2 of 19 (Patient #14,15) did not have evidence that the discharge summary includes all required information. Patient 14 and 15: No evidence that a discharge summary was completed.

Upon client record review, 1 of 19 (Patient #6) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 6: Plan of care has SN frequency ordered as "1 week one then 3 as needed for symptom management" Patient is currently receiving 2 SN visits per week.

A. Based on document review and staff interview, it was it was determined in 1 of 10 (Pt #1) Hospice patients records reviewed, the Hospice failed to ensure that palliative medication was available for patient use. This has the potential to affect all patients receiving care at the Hospice in a Nursing Home. Findings include: 1. Pt #1 SOC 2/10/2022 Diagnosis: Pneumonia due to COVID The clinical record was reviewed on 3/23/2022 at approximately 3:00 PM. Pt #1 was admitted to the Hospice Program on 2/10/2022 with a diagnosis of pneumonia due to COVID. The record contained an admission "Visit Note" written by Hospice Nurse (E #2) that indicated Pt #1 did not have pain and that the palliative pain medication would be ordered on 2/11/2022. Hospice failed to have palliative medication available at the Nursing Home for patient comfort from 2/11/22 to 2/15/22. Palliative medication was ordered 2/11/2022. 2. On 3/22/2022 at approximately 4:00 PM, the "Nursing Facility Hospice Services Agreement (effective 11/04/2020) was reviewed. It required, on page 5, "section 2.10 Provision of Hospice Services; Hospice Responsibilities. Hospice is responsible for providing, (c) furnishing medical supplies, durable medical equipment, and drugs necessary for the palliation of pain and symptoms associated a Resident Patient's terminal illness and related conditions ..." 3. On 3/22/2022 at approximately 3:00 PM an interview was conducted with E #2. E #2 stated "the patient did not have any pain or symptoms requiring palliative medication like morphine or lorazepam. I just entered the medications on the medication profile, and we have till 9:00 AM the next day to obtain a physician orders/prescription for the medication." 4. The "Client Coordination Notes" Report dated 2/12/2022 indicated the Hospice Nurse (E #3) called the Hospice Physician (MD #1) on 2/11/2022 requesting the palliative medication to be ordered : A. Morphine Concentrate 100 mg/5 ml (20 mg/ml) (milligrams/milliliters) oral solution 0.25 ml every hour as needed for moderate pain and shortness of breath B. Morphine Concentrate 100 mg/5 ml (20 mg/ml) oral solution 0.5 ml every hour as needed for severe pain and shortness of breath. C. Lorazepam 1 mg tablet every 2 hours as needed for anxiety, shortness of breath or nausea. 5. On 3/23/2022 at approximately 9:00 AM, an interview was conducted with E #3. E #3 stated, "MD #1 sent an electronic prescription for the palliative medications listed above to the Nursing Home Pharmacy and notified E #3 by text on 2/11/2022 that the prescription was sent to the Pharmacy." 6. On 3/23/2022 at approximately 10:00 AM, an interview was conducted with E #1. E #1 stated, "we do not have a policy regarding electronic prescriptions or a system in place to verify if the electronic prescription actually went to the pharmacy. We do not keep a copy of the electronic prescription/order in the patients chart. The electronic prescription was sent from MD#1's cell phone and goes directly to the pharmacy, therefore there is no paper documentation that verifies the prescription was sent to the pharmacy. MD #1 is currently on vacation therefore unable to confirm the 2/11/2022 prescriptions were sent to pharmacy. E #1 verbally confirmed Pt #1 did not have palliative medication available from 2/11/22 to 2/15/2022.