Every finding on record at Malama Ola Health Services LLC

Upon patient record review, 6 of 19 records (Patient #5,#8,#10,#11,#12,#14) 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 #5: The medication profile contained Lactulose 20 Gms/30ml, 30 cc qd prn constipation and Bisacodyl 10 mg rectal supp, 1 daily prn constipation. There was not evidence of which medication to use first and under what conditions to administer the next medication. Corrected on site. Patient #8: The medication profile contained Bisacodyl 10 mg rectal supp, 1 daily prn constipation, and sennosides 8.6-Docusate 50 mg 1, po BID prn constipation. There was not evidence of which medication to use first and under what conditions to administer the next medication. Corrected on site. Patient #10: The medication profile contained Seroquel 100mg tab. Take 1 tab daily by mouth at bedtime. May take 0.5 tab (50 mg) by mouth x1 as needed for ongoing agitation. It was unclear if the second part was a 1x dose or prn and both dosages were combined into 1 order, making the entire medication unclear. Corrected on site. Patient #11: The hospice medication profile contained Lorazepam 1 mg po q6h as needed for agitation which was not included on the MAR at the facility. The hospice medication profile contained Albuterol l2.5mg solution for nebulization q2h prn SOB or wheezing while the facility MAR contained Albuterol inhalation aerosol, 2 puffs q12h as needed. Corrected on site. In addition, Bacitracin was on the facility MAR for a skin tear, and there was not evidence of this on the hospice medication profile. Patient #12: The nurse documentation dated 9/22/24 indicated that the patient/family was agreeable to using supplemental oxygen. There was not evidence that this was on the medication profile. Corrected on site. Patient #14: The hospice medication profile contained Meclizine and Dextromethorphan-Guaifenesin which were not on the facility MAR. Also, Salon Pas with lidocaine was on the facility MAR but not the hospice medication profile. Corrected on site.

Upon patient record review, 1 of 19 records (Patient #9) 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 #9: The record indicated that the patient was on Eliquis 2.5 mg BID. There was not evidence that bleeding precautions were addressed in the plan of care. Corrected on site.

Upon patient record review, 10 of 19 records (Patient #4,#5,#6,#7,#8,#10,#11,#12,#13,#14) 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 #4,#6,#7,#13,#14: The record indicated an order, 'Insert enema PR once daily as needed for constipation or if no BM for 3 days or Bisacodyl ineffective' without evidence of the type of enema. Corrected on site. Patient #5: The record contained orders for Lactulose 20 Gms/30ml, 30 cc qd prn constipation and Bisacodyl 10 mg rectal supp, 1 daily prn constipation. There was not evidence of which medication to use first and under what conditions to administer the next medication. Corrected on site. Patient #8: The record indicated an order, 'Insert enema PR once daily as needed for constipation or if no BM for 3 days or Bisacodyl ineffective' without evidence of the type of enema. Corrected on site. In addition, the record contained orders for Bisacodyl 10 mg rectal supp, 1 daily prn constipation, and sennosides 8.6-Docusate 50 mg 1, po BID prn constipation. There was not evidence of which medication to use first and under what conditions to administer the next medication. Corrected on site. Patient #10: The record indicated an order, 'Insert enema PR once daily as needed for constipation or if no BM for 3 days or Bisacodyl ineffective' without evidence of the type of enema. Corrected on site. Also Seroquel 100mg tab. Take 1 tab daily by mouth at bedtime. May take 0.5 tab (50 mg) by mouth x1 as needed for ongoing agitation. It was unclear if the second part of the order was a 1x dose or prn and both dosages were combined into 1 order, making the entire order unclear. Corrected on site. Patient #11: The record indicated an order, 'Insert enema PR once daily as needed for constipation or if no BM for 3 days or Bisacodyl ineffective' without evidence of the type of enema. Corrected on site. In addition, Bacitracin was on the facility MAR for a skin tear, and there was not evidence of an order in the hospice record. Corrected on site. Also, Salon Pas with lidocaine was on the Facility MAR but there was no evidence of an order on the hospice record. Corrected on site. Patient #12: The nurse documentation dated 9/22/24 indicated that the patient/family was agreeable to using supplemental oxygen. There was not evidence of an order. Corrected on site.

Upon patient record review, 5 of 19 records (Patient #1,#2,#7,#10,#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 #1: Nursing documentation indicated that the patient required a walker to ambulate. There was not evidence that a walker was in the plan of care. Corrected on site Patient #2: Nursing documentation from admission indicated that the patient was using a hospital bed. There was not evidence that this was in the plan of care. Corrected onsite. Patient #7: Documentation in the record indicated that the patient was ambulating with a walker. There was not evidence that a walker was in the plan of care. Corrected on site. Patient #10 The record indicated that the patient use a walker for ambulation. There was not evidence that a walker was in the plan of care. Corrected on site. Patient #12: The record indicated that the patient was receiving Albuterol through nebulization. The plan of care did not include nebulizer. Corrected on site.

Upon patient record review, 2 of 19 records (Patient #10,#11) 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 #10: Nurse documentation dated 10/9/24 indicated that the patient had blisters which had the appearance of Shingles and medication was ordered. There was not evidence of an update to the plan of care regarding infection/wounds/skin integrity. Patient #11: The facility MAR and treatment record indicated that the patient was receiving treatment for a skin tear. There was not evidence that the plan of care reflected skin issues related to the skin tear.

Upon patient record review, 1 of 19 records (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 social work visit frequency was 1 within every 4 weeks. There was not evidence of visits between 8/12/24 and 9/30/24.

Upon patient record review, 1 of 19 records (Patient #9) 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 that include alerts and precautions, 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 #9: The record indicated that the patient was on Eliquis 2.5 mg BID. There was not evidence of bleeding precautions on the aide plan of care. Corrected on site.

Upon patient record review, 9 of 13 (Patient #1, #2, #3, #4, #5, #6, #7, #8, #11) did not have evidence the plan of care included all services necessary for the palliation and management of the terminal illness and related conditions, including specific orders for all treatments. Patient #1, #2, #3. #4, #5, #6, #7, #8-Each of the records contained a standing order to Insert a 16 Fr catheter, 5 cc balloon for urinary retention or incontinence. Change as needed. Change as needed does not include indications for as needed. (Corrected on site) Patient #4-The POC dated 10/07/21 includes orders for the nurse to assess, monitor and ensure patency of the patients port a cath. Upon interview with leadership, this is an error on the plan of care as the patients port a cath is not in use and is not to be flushed/maintained. Patient #8- The patient was admitted with a G-J tube and the plan of care does not address management of the tube. On 06/10/21 the nurse documents the patient had a skin tear to the right clavicular area that was to be covered with a telfa and changed every three days. The plan of care was not updated with orders for the wound care. Patient #11-The 07/26/21 plan of care includes orders to provide Foley Catheter care once per day and as needed with routine perineal care. Orders are not specific for daily catheter care. The patient has a suprapubic catheter. (orders are not specific for management of the suprapubic catheter). The patient was admitted with an ostomy and the plan of care does not include orders for management of the ostomy.

Upon client record review, 6 of 13 (Patient #1, #4, #7, #8, #9,#11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1- The social worker visited the patient on 08/21/21. There are no orders on record for the social worker to visit. Patient #4-On 10/12/21 the nurse documents the patient is using Oxygen at 5 lpm. Oxygen is ordered at 1-4 LPM.(Corrected on site) Patient #7- On 09/10/21 and 09/16/21 the nurse documents the patient is using Oxygen at 5 lpm. Oxygen is ordered at 1-4 LPM. Patient #8- On 06/25/21 and 06/28/21 the nurse documents the patient is using Oxygen at 5 lpm. Oxygen is ordered at 1-4 LPM. Patient #9-The patient is receiving a volunteer for companionship. A written assignment is not on record. (corrected on site) Patient #11- On 08/06/21 the LPN documents changing the patients suprapubic catheter. There are no orders on record to change the catheter.

Upon patient record review, 10 of 13 (Patient #1, #2, #3, #4, #5, #6, #7, #8, #11, #12) did not have evidence that all entries are complete and accurate including credentials following signatures. (Credentials were entered on all employees. Corrected on site) Patient #1- The Social Worker visit dated 08/26/21 does not include credentials as part of the signature. The Social Worker signature on the 09/09/21 IDG documentation also does not include credentials. Patient #2- The Social Worker visit dated 10/02/21 does not include credentials as part of the signature. The Social Worker signature on the 10/07/21 IDG documentation also does not include credentials. Patient #3- The Social Worker visit dated 08/23/21 does not include credentials as part of the signature. The Social Worker signature on the 08/26/21 IDG documentation also does not include credentials. The Aide visit notes on record 08/25/21-10/07/21 do not include credentials as part of the signature. Patient #4-The Social Worker visits dated 08/09/21 and 08/23/21 does not include credentials as part of the signature. The Nursing visit notes dated 09/09/21-10/08/21 do not include credentials as part of the signature. Patient #5- The Social Worker visit dated 08/17/21 does not include credentials as part of the signature. Patient #6- The Social Worker visits dated 08/14/20-11/17/20 do not include credentials as part of the signature. Patient #7- On 09/18/21 the nurse documents administering Methadone via a syringe on the visit. The documentation does not include the dosage administered. Patient #8-The Social Worker visit dated 06/02/21 does not include credentials as part of the signature. Patient #11- The nursing visit note on 07/26/21 documents the patient does not have an ostomy. This is an error as all other nursing notes on record (07/29-08/10/21 indicate the patient does have an ostomy) Patient #12- The Aide visit notes on record 07/01/21-08/27/21 do not include credentials as part of the signature.