Every finding on record at Nineveh Home Health Services LLC

Upon patient record review, 1 of 5 (Patient #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 #4: 2/4/25 order for Dextrose 5% and 0.9% sodium chloride intravenous solution - 1 liter subcutaneous one time. Infuse 1 liter subcutaneous one time @50 ml/hr - may titrate. The medication profile does not include specific parameters for titration.

Upon patient record review, 3 of 5 (Patient #1, 2, 3) 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, 3: SN frequency order includes 10 prn visits for decline in condition.

Upon patient record review, 1 of 5 (Patient #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 #4: 2/4/25 Order Dextrose 5% and 0.9% sodium chloride intravenous solution - 1 liter subcutaneous one time. Infuse 1 liter subcutaneous one time @50 ml/hr - may titrate. Order does not include specific parameters for titration.

Upon patient record review, 1 of 5 (Patient #4) 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 #4: Patient admitted 12/20/24. On 1/24/25 order for Nystatin for oral thrush. Also had order for subcutaneous infusion 2/4/25 for hydration. There were no updates to problems, goals, interventions for either.

Upon patient record review, 1 of 5 (Patient #4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #4: 2/4/25 Order Dextrose 5% and 0.9% sodium chloride intravenous solution - 1 liter subcutaneous one time. Infuse 1 liter subcutaneous one time @50 ml/hr - may titrate. There was no documentation that infusion was provided upon surveyor's initial record review. Administrator/DPCS made late entry, but documentation did not include specifics of procedure; the patient is deceased, unable to make corrections.

Upon patient record review 1 of 5 (Patient #3) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient #3: A volunteer request/assessment was documented 4/4/25, but no documentation of service provided. Upon interview with staff and interview with patient caregiver during home visit, it was verified that patient/caregiver decided against volunteer related to patient confusion with multiple visitors and adequate support available. Hospice staff failed to document update to patient/caregiver acceptance/desire for service.

Upon personnel record review, 1 of 13 (Personnel #4) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient according to Missouri 19 CSR 30-35.010. (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel #4: The Missouri Home Health Aide/Hospice Aide competency evaluation form does not include shampoo and/or types.