Every finding on record at Nuera Hospice Inc

Upon patient record review, 6 of 14 (Patients #2,#4,#5,#7,#8,#10) 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 2: The medication profile contained lidocaine topical patch with no area defined for administration. During interview of the patient's daughter, oxygen and Robitussin were still inappropriately active on the medication profile, but not in the home or in use. Corrected on site. Patient 4: The medication profile contained diclofenac topical gel with no area defined for administration and Miralax oral powder with no instructions for a diluent. Corrected on site. Patient 5: The medication profile contained lidocaine topical patch with no area defined for administration. Corrected on site. Patient 7: The medication profile contained Miralax oral powder with no instructions for a diluent. Corrected on site. Patient 8: The medication profile contained duplicative listings of omega 3 with differing doses of 2000mg and 200mg daily, and duplicative listings with same doses for DHEA dehydroepiandrosterone, vitamin D3, and vitamin B12. Corrected on site. Patient 10: The medication profile contained Salonpas topical patch with no area defined for administration. Corrected on site.

Upon patient record review, 1 of 14 (Patient #13) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual's attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient's progress toward desired outcomes • Reassessment of the patient's response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient 13: There was no evidence of an RN comprehensive assessments from 3/27/24 to discharge for extended prognosis 4/17/24.

Upon patient record review, 6 of 14 (Patients #1,#2,#4,#5,#6,#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 1: The medical record contained nursing documentation since admission identifying patient had a high risk for skin impairment and falls. There was no evidence of problems, goals, and interventions related to skin and fall safety. Corrected on site. Patient 2: The medical record contained nursing documentation since admission identifying patient had dysphagia. Corrected Patient 4: The medical record contained nursing documentation since admission identifying patient was a high risk for falls and issues with dysphagia. There was no evidence of problems, goals, and interventions related to fall safety and dysphagia. Corrected on site. Patient 5,6,9: The medical record contained nursing documentation since admission identifying patient was a high risk for falls. There was no evidence of problems, goals, and interventions related to fall safety. Corrected on site.

Upon patient record review, 5 of 14 (Patients #2,#4,#5,#7,#10) 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 2,5: The medical records contained orders for lidocaine topical patches with no areas defined for administration. Corrected on site. Patient 4: The medical records contained orders for diclofenac topical gel with no area defined for administration, and Miralax oral powder with no instructions for a diluent. Corrected on site. Patient 7: The medical record contained an order for Miralax oral powder with no instructions for a diluent. Corrected on site. Patient 10: The medical record contained an order for Salonpas topical patch with no area defined for administration. Corrected on site.

Upon patient record review, 5 of 14 (Patients #2,#3,#4,#5,#9) 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 2: The medical record contained nursing documentation identifying patient use of a wheelchair since admission. There was no evidence of an order for the wheelchair included in the plan of care. Corrected on site. Patient 3: The medical record contained nursing documentation identifying patient use of a walker and commode since admission. There was no evidence of orders for the DME included in the plan of care. Corrected on site. Patient 4: The medical record contained nursing documentation identifying patient use of a hospital bed, wheelchair, and shower chair since admission. There was no evidence of orders for the DME included in the plan of care. Corrected on site. Patient 5: The medical record contained nursing documentation identifying patient use of a wheelchair and shower chair. There was no evidence of orders for the DME included in the plan of care. Corrected on site. Patient 9: The medical record contained nursing documentation identifying patient use of a wheelchair, shower chair, and commode. There was no evidence of orders for the DME included in the plan of care. Corrected on site.

Upon client record review, 8 of 14 (Patients #1,#2,#4,#5,#6,#9,#10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1,4,5,8: There was evidence of spiritual visits completed without an order for scheduled spiritual care included in the plan of care. Patient 2: The medical record contained an order for nursing visits twice weekly. There was no evidence of second visits completed the weeks of 7/21/24, 7/28/24, 8/4/24, and 8/11/24. Patient 6: The medical record contained an order for nursing visits twice weekly. There was no evidence of second visits completed the weeks of 7/7/24, 7/14/24, 7/28/24. There was also evidence of a spiritual visit completed 6/10/24 without an order. Patient 9: The medical record contained an order for LVN visits twice weekly. There was no evidence of second visits completed the weeks of 8/4/24 and 8/11/24. Patient 10: The medical record contained an order for nursing visits one to two times weekly. There was evidence of three visits completed the week of 8/4/24, and a spiritual visit completed 8/15/24 without an order.

Upon patient record review, 2 of 14 (Patients #1,#3) did not have evidence in the patient record that hospice aide assignments and duties are individualized to the patients' needs. Patient 1: The aide care plan contained a task to complete foley care, but the patient did not have an indwelling catheter. Corrected on site. Patient 3: The aide care plan contained a task to obtain vital signs. There was no evidence of parameters to outline when appropriate notification of the RN would be necessary. Corrected on site.

Upon patient record review 3 of 14 (Patients #3,#8,#9) 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 aide care plan contained a task to obtain vital signs every visit. There was no evidence the aide completed the task at each of the three visits completed. Patient 8: The medical record contained an order for aide visits twice weekly. The aide was completing three visits weekly consistently. Patient 9: The medical record contained an order for aide visits three times weekly. There was no evidence of visits completed in August.

Upon personnel record review, 1 of 14 (Personnel #11) did not have evidence the hospice employees and contract employees have received orientation on the hospice philosophy. Personnel 11: Upon request, the agency was unable to provide a personnel file for a PT that had provided an evaluation on a patient per their coordination. Corrected on site.

Upon personnel record review, 1 of 14 (Personnel #11) did not have evidence that the hospice employees have received orientation on their specific job requirements. Personnel 11: Upon request, the agency was unable to provide a personnel file for a PT that had provided an evaluation on a patient per their coordination. Corrected on site.

Upon personnel record review, 1 of 14 (Personnel #11) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel 11: Upon request, the agency was unable to provide a personnel file for a PT that had provided an evaluation on a patient per their coordination. Corrected on site.

Upon personnel record review, 1 of 14 (Personnel #11) did not have evidence that personnel credentialing activities are conducted to verify qualifications of all credentialed/licensed personnel in the positions they hold at the time of hire, at renewal or in accordance with specific state practice act requirements. Personnel 11: Upon request, the agency was unable to provide a personnel file for a PT that had provided an evaluation on a patient per their coordination. Corrected on site.

Upon personnel record review, 1 of 14 (Personnel #11) did not have evidence all Physical Therapy Services are provided by a qualified licensed Physical Therapist (PT) in accordance with the state's Physical Therapy Practice Act and the hospice's policies and procedures and/or job descriptions. Personnel 11: Upon request, the agency was unable to provide a personnel file for a PT that had provided an evaluation on a patient per their coordination. Corrected on site.

Upon personnel record review, 1 of 14 (Personnel #11) 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 11: Upon request, the agency was unable to provide a personnel file for a PT that had provided an evaluation on a patient per their coordination. Corrected on site.