Every finding on record at Mar Hospice Care

Upon patient record review, 1 of 14 (Patient #10) did not have evidence that the patient has received effective pain management and symptom control from the hospice for conditions related to the terminal illness. Patient #10: Patient Admitted with Cancer of retroperitoneum and peritoneum on 06/10/24. Patient self identified pain threshold was 2. His pain management included Hydrocodone/Acetaminophen 7.5/325 mg one tablet every 6 hours as needed. On 06/12/24, patient complained of pain at a 5, nurse documented advised him to take his ordered medication, no follow up phone call or patient visit for 7 days. On 06/19/24 patient complained of pain of 3, nurse documented pain was controlled with current medications. On 07/10/24, patient complained of a pain of a level 6. Nurse documented pain managed with current medication, no call to doctor, no visit or follow up call for 7 days. On 07/17/24, patient complained of a pain level of 7. They did give first dose of Morphine, however, no visit or follow up phone call made for 5 days. On 07/22/25, patient complained of level 6 pain, nurse wrote pain managed with current medications.

Upon patient record review, 2 of 14 (Patient #3,#10) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #3: Patient had documentation of wounds on the L great toe and Right foot. Later it was documented as R great toe and L and right leg. There is no evidence in the record of a full wound assessment being completed with wound type, drainage type or measurements at ant time. Patient #10: Patient Admitted with Cancer of retroperitoneum and peritoneum on 06/10/24. Patient self identified pain threshold was 2. His pain management included Hydrocodone/Acetaminophen 7.5/325 mg one tablet every 6 hours as needed. On 06/12/24, patient complained of pain at a 5, nurse documented advised him to take his ordered medication, no follow up phone call or patient visit for 7 days. On 06/19/24 patient complained of pain of 3, nurse documented pain was controlled with current medications. On 07/10/24, patient complained of a pain of a level 6. Nurse documented pain managed with current medication, no call to doctor, no visit or follow up call for 7 days. On 07/17/24, patient complained of a pain level of 7. They did give first dose of Morphine, however, no visit or follow up phone call made for 5 days. On 07/22/25, patient complained of level 6 pain, nurse wrote pain managed with current medications.

Upon patient record review, 2 of 14 (Patients #1, 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 #1: The patient was using a nebulizer. there are no interventions or goals in the POC for nebulizer use. Patient #6: The patient was on service for lung cancer, however, there are no interventions or goals related to primary diagnosis of cancer on the POC.

Upon patient record review, 1 of 14 (Patient #3) 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 #3: The record has orders for wound care that state the following: "Apply Betadine swab to right great toe every 2-3 days prn wound care" The order does not state who will do wound care or what the indication for prn would be. The next order states, "Silvadene 1% apply topically to affected area (right great toe and foot) every dressing change. The order does not state who will change the dressing or the frequency of dressing changes. The next order reads, "Santyl 250g, apply topically to affected areas ( right and left leg) once daily with every dressing change for wound care. It does not clarify who will change the dressing.

Upon patient record review, 6 of 14 (Patient #2, 8, 10, 11, 12, 13) 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 #2: Patient started on Macrobid 100mg twice daily for 7 days for UTI. No infection interventions or goals updated to plan of care. Patient #8: Patient was started on continuous care on 12/04/24. There was no interventions or goals added for change of level of care to continuous care. There were no interventions or goals added for imminently dying. Patient #10: Patient was started on continuous care on 08/18/24. There was no interventions or goals added for change of level of care to continuous care. There were no interventions or goals added for imminently dying. Patient #11: Patient was started on continuous care on 05/13/24. There was no interventions or goals added for change of level of care to continuous care. There were no interventions or goals added for imminently dying. Patient #12: Patient was started on continuous care on 05/07/24. There was no interventions or goals added for change of level of care to continuous care. There were no interventions or goals added for imminently dying. Patient #13: Patient was started on continuous care on 01/17/24. There was no interventions or goals added for change of level of care to continuous care. There were no interventions or goals added for imminently dying.

Upon patient record review, 1 of 14 (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: Hospice aide POC states patient is incontinent of urine. The patient has an indwelling foley catheter, however, this is not indicated on the hospice aide plan of care. The patient is on anticoagulants, yet bleeding precautions are not selected.

Upon patient record review 1 of 14 (Patient #3) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #3: The patient had hospice aides ordered for once weekly visits. There were no aide visits the week of 04/20/25 or the week of 04/27/25. There was no evidence of an order to hold aide visits for those weeks. There was no evidence of documentation of why the visits were missed.

Upon patient record review, 3 of 5 (Patient #1, #3 and #4) 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 record reflected that this patient had a nebulizer machine. This item was not included on Plan of Care. Patient #3: The record reflected that this patient had a walker. This item was not included on Plan of Care. Patient #4: The record reflected that this patient had a walker. This item was not included on Plan of Care.

Upon patient client record review, 3 of 5 (Patients #2, #4 and #5) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #2: The Election of Benefit (EOB) Effective Date for benefits to begin was not filled out in the space provided on the form. Patient's #4 and #5: The Election of Benefit (EOB) form had two items that were not completed. (1) The right to request "Patient Notification of Hospice Non Covered Items" choice was not checked to "elect" or "decline" notification. (2) Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) did not have the Livanta name or number included in space provided.