Every finding on record at Miracle Touch Hospice

Upon patient record review, 3 of 4 (Patient #1,2,4) 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 1: Polyethylene Glycol 3350 17G powder once daily as needed. No evidence that a dosage and a diluent was added to the active medication profile. Patient 2: Miralax Powder 17g twice a day. No evidence that a dosage and a diluent was added to the active medication profile. O2 sat 2-3LPM via nasal cannula PRN for SOB, wheezing, or O2 sat below 92%. No evidence that oxygen was on the active medication profile. COS Patient 4: Treatment order for oxygen 2L via nasal cannula PRN or continuous for SOB. Titrate by 1L/min in 5 minute increments to keep O2 sat below 92%. No evidence that oxygen was added to the active medication profile.

Upon patient record review, 2 of 4 (Patient #1,2) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient 1&2: Initial orders for spiritual coordinator written as "1 as needed and recert". No evidence that a routine visit frequency was ordered nor quantity for visits to be completed per recert period. COS

Upon patient record review, 3 of 4 (Patient #1,2,4) 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 medications and treatments. Patient 1: Polyethylene Glycol 3350 17G powder once daily as needed. No evidence that a dosage or a diluent was added to the POC order. Patient 2: Miralax Powder 17g twice a day. No evidence that a dosage and a diluent was on the POC order. Patient 4: Treatment order for oxygen 2L via nasal cannula PRN or continuous for SOB. Titrate by 1L/min in 5 minute increments to keep O2 sat below 92%. No evidence of a POC order for the oxygen.

Upon client record review, 1 of 4 (Patient #3) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 3: The plan of care has orders for one RN visit weekly. No evidence that a RN visit was completed for the week of 01/07-1/13/2024. No evidence that an order was obtained to change the frequency. No evidence that the visit was declined by the patient/family. POC has orders for one LVN visit weekly. No evidence that an LVN completed visits between 01/01/2024 and 01/14/2024. No evidence that a physician order was placed to discontinue those visits or that those visits were declined by the patient/family. LVN saw the patient twice on 01/15/2024, twice on 01/16, and once on 01/17/2024. No evidence that an order was received to increase visits.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. Reports show Volunteer hour total for 2023 were 0.64%, less than the needed 5%.

Upon personnel record review, 3 of 12 (Personnel #10,11,12 ) did not have evidence the hospice obtained a criminal background check on all contracted individuals who have direct patient care and access to patient records. Personnel #10,11,12: No evidence that the hospice obtained a criminal background check at the time of survey.