Every finding on record at Melarith Hospice and Palliative Care LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. This standard was not met as evidenced by clinical record review, document review, interview and observation. 2 of 3 (67%) home visits conducted where medication reconciliations were completed revealed the hospice did not ensure that medication profiles were updated accurately compared to the patient's current regimen. Document 1: Policy# PC.17, titled Medication list and monitoring (revised 050110) sub-section one (1), stated in part, "Agency will maintain a current, accurate list of all prescription and over-the-counter (OTCO medications taken by the patient. (medication Profile) Home Visit 1: A home visit was conducted in the presence of the Director of Nursing (staff 2) on 8/30/2023 for a patient with a hospice benefit election date of 7/5/2023 (record 1). A medication reconciliation was performed, comparing the hospice agency's medication profile to the patient's medication regime. The hospice agency medication profile stated, "Donepezil five (5) milligrams (mg). Take one (1) tablet daily. The patient's medication bottle said, "Donepezil ten (10) milligrams (mg). Take one (1) tablet daily. The caregiver confirmed the hospice patient was taking Donepezil ten (10) milligrams (mg). Take one (1) tablet daily. A joint record review and interview with the Director of Nursing (staff 2) confirmed the hospice agency medication profile did not match the patient's medication regime. Home Visit 3: A home visit was conducted in the presence of the Director of Nursing (staff 2) on 8/30/2023 for a patient with a hospice benefit election date of 7/5/2023 (record 3). A medication reconciliation was performed, comparing the hospice agency's medication profile to the patient's medication regime. The hospice agency medication profile stated, "Soma three-hundred fifty (350) milligram (mg). Take one (1) tablet two (2) times daily (BID).". The medication bottle stated, "Soma three-hundred fifty (350) milligram (mg). Take one (1) tablet one (1) time daily at bedtime. The patient confirmed they took Soma three-hundred fifty (350) milligrams (mg). Take one (1) tablet one (1) time daily at bedtime. A joint record review and interview with the Director of Nursing (staff 2) confirmed the hospice agency medication profile did not match the patient's medication regime.

It is required that drugs and biologicals are labeled and stored in accordance with state law and regulation, as well as accepted standards of practice. (L693) At a minimum, labels include: the patient’s full name; generic, trade, or brand name of the medication, as well as amount dispensed; directions for use, including route, rate, frequency, and method of administration; prescriber’s name; expiration date; and cautionary instructions. This standard was not met as evidenced by interview and observation. The supply cabinet was inspected on 8/30/2023 in the presence of the Director of Nursing. The following supplies were expired: four (4) mouthwashes with an expiration date of 7/2023, twenty (20) N-95 masks with an expiration date of 7/8/2022, and one (1) case of twelve (12) chocolate ensure with an expiration date of 10/30/2022. The Director of Nursing (staff 2) confirmed the supplies were expired. They reported another hospice agency donated some of the supplies, and the current agency doesn't use those supplies regularly. However, the supplies were all housed in the same cabinet on the same shelves mixed in with the current supplies used for the existing patients. Document 2: Policy# EC.10 titled Maintenance of Supplies (reviewed 110197) sub-section (A) four (4) stated in part, "Supplies will be checked for expiration date prior to use. If out of date, the vendor shall be notified to remove them." An interview with the Administrator on 8/30/2023 confirmed the supplies were expired. The Administrator said, "I know the mouthwash was expired. I saw that last week and was going to throw them away, but then I thought I didn't need to because we don't use mouthwash for our patients." The supply cabinet was inspected on 8/30/2023 in the presence of the Director of Nursing. The following supplies were expired: four (4) mouthwashes with an expiration date of 7/2023, twenty (20) N-95 masks with an expiration date of 7/8/2022, and one (1) case of twelve (12) chocolate ensure with an expiration date of 10/30/2022. The Director of Nursing (staff 2) confirmed the supplies were expired. They reported another hospice agency donated some of the supplies, and the current agency doesn't use those supplies regularly. However, the supplies were all housed in the same cabinet on the same shelves mixed in with the current supplies used for the existing patients.