Every finding on record at Nurture Care Hospice Inc

Upon patient record review, 1 of 14 (Patient #1) 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: During observation of the home visit and medication profile, the medication profile contained a discontinued Losartan. Corrected on site. The patient and the caregiver stated that he no longer took Losartan due to it causing constipation.

Upon patient record review, 1 of 14 (Patient #4) 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 #4: The active medication profile list Sertraline 100mg daily for depression. There was no evidence of depression management listed on the current plan of care. No evidence of problems, interventions, or goals added to address depression.

Upon patient record review, 2 of 14 (Patient #1,5) 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: During the home visit, the patient was using oxygen at 2L via simple face mask. The active medication list has an order for oxygen at 2L route was via nasal cannula. No evidence that an order was placed to change the route to simple face mask from nasal cannula. Patient 5: The RN documentation indicates that the patient was using oxygen at 3LNC. The active medication profile includes an order for oxygen at 2L via nasal cannula as needed. No evidence that an order was placed to change the flow rate of the oxygen.

Upon client record review, 1 of 14 (Patient #4) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient #4: IDG documentation dated 11/26/2024, 12/10/2024, and 12/24/2024 did not have evidence of Chaplain contribution to show collaboration with team to review and revise the plan of care. There was no evidence of the Chaplains signatures for attendance of those meetings.

Upon client record review, 1 of 14 (Patient #1) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: The current plan of care has the RN frequency as once a week. The medical record indicated that the LVN had completed visits at a frequency of once a week and the RN completed visits every 14 days since the time of admission. No evidence that an order was received to add LVN visits or to change the RN frequency to every 14 days.

Upon patient client record review, 1 of 14 (Patient #2) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient 2: The medical record indicated that the POA elected to receive the notice of Hospice non-covered items, services, and drugs. No evidence that a copy of the addendum was provided to the POA at the time of survey.

Upon patient record review, 1 of 5 (Patient # 1) 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. Patient #1: The terminal diagnosis was Cardiac. On the plan of care dated 3-15-22 cardiac goals and interventions were not included as part of the plan of care.