Every finding on record at Odyssey Healthcare Operating B, LP

Upon patient record review, 4 of 23 (Patient #2, 11, 12, 13) 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 medication profile included Nitroglycerin SL q5min and did not include a max for dosing. Patient 11 medication profile included Oxygen 3LPM NC prn, LPN visit 6/13/24 documented oxygen at 2LPM. Patient 12 medication profile included Oxygen 6LPM NC, nursing visit 7/5/24 documented oxygen at 5.5LPM and nursing visit on 7/8/24 documented oxygen at 3LPM. Patient 13 medication profile included Miralax and did not include instructions for how to dilute.

Upon patient record review, 2 of 23 (Patient #4, 14) 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 currently on Levetiracetam for seizures, no evidence of seizure precautions. Patient 14 identified as high risk for aspiration with nectar thick liquids, soft mechanical diet, no evidence of aspiration precautions.

Upon patient record review, 4 of 23 (Patient #2, 11, 12, 13) 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 Nitroglycerin SL q5min ordered and did not include a max for dosing. Patient 11 order for Oxygen 3LPM NC prn, LPN visit 6/13/24 documented oxygen at 2LPM. Patient 12 order for Oxygen 6LPM NC, nursing visit 7/5/24 documented oxygen at 5.5LPM and nursing visit on 7/8/24 documented oxygen at 3LPM. Nursing visit 7/3/24 documented patient stopped using BiPAP 2 weeks ago, nursing visit 7/10/24 documented patient starting using BiPAP again yesterday. No evidence of an order for the BiPAP. Patient 13 order for Miralax did not include instructions for how to dilute.

Upon patient record review, 2 of 23 (Patient #2, 14) 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 and 14 with Oxygen in the home and no evidence of an order for oxygen DME.

Upon patient record review, 1 of 23 (Patient #8) 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 8 initially accepted SC services, then SC services discontinued on 4/30/24. Plan of care continued with an active care plan problems for SC after recertification on 5/20 and remains current active.

Upon client record review, 6 of 23 (Patient #2, 3, 6, 7, 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 2 order on 5/8/24 for SW frequency effective 5/7/24 of 1every2m2, and 2prn. SW routine visits completed on 5/8/24 and 6/7/24. Order on 5/8/24 for SC frequency effective 5/7/24 of 1m2, and 2prn. SC routine visits completed on 5/8/24 and 5/21/24. Nursing visits document the presence of a foley (some document 16fr and some 18fr) and the nursing visit on 6/14/24 and 6/24/24 documented the foley was changed. No evidence of an order for the foley size and details of care. Patient 3 order on 5/8 for SW frequency effective 5/7/24 1m1, 2m2, and 2prn. SW routine visits completed on 5/8 and 5/22. Order on 5/29 for SC frequency effective 5/7 of 1every2m2, 1m1, 2prn. SC routine visits completed on 5/8 and 6/6. Patient 6 order on 2/26/24 for SW frequency effective 2/23 of 1every2m2, 1m2, and 2prn. SW routine visits completed on 2/26 and 3/28. Patient 7 order on 3/15/24 for SW frequency effective 3/13 of 1m3 and 2prn. SW routine visits completed on 3/15 and 3/29. Patient 9 order on 6/6/24 for SW to assess and order on 6/7 for SW frequency effective 7/1 of 2x month and 2prn. SW visits completed on 6/7 and 6/13, no evidence of an order for the 6/13 visit. Patient 10 order on 4/5/24 for SW frequency effective 4/3 of monthly visits and 2 prn. SW routine visits completed on 4/5 and 4/29.

Upon patient record review, 1 of 23 (Patient #19) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient 19 the 13 month letter was due to sent 5/19/24 and has not been sent yet.

Upon patient record review, 3 of 23 (Patient #3, 6, 14) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient 3 identified as high risk for aspiration and on blood thinners, no evidence of aspiration or bleeding precautions. Patient 6 identified as high risk for seizures, no evidence of seizure precautions on the aide care plan. Patient 14 on Aspirin and is high risk for aspiration, no evidence of aspiration or bleeding precautions on the aide care plan.

Upon patient record review 6 of 23 (Patient #1, 4, 5, 6, 8, 14) 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 1 aide care plan included change linen every Tuesday. Linens were documented as changed on 6/6/24, 6/13, and 6/20. Aide care plan included walker and wheelchair every visit. Aide visits on 6/6 and 6/11 documented not needed, and aide visit on 6/27 documented wheelchair not needed this visit. Patient 4 aide care plan included shampoo Monday, Wednesday, and Friday. Aide care plan included hoyer and transfer bed/chair on Tuesday and Thursday. Aide visit on 7/6/24 provided shampoo, hoyer and transfer. Aide visit on 7/8/24 documented shampoo not needed this visit per frequency. Patient 5 aide care plan included shampoo Monday and Fridays. Aide visits on 6/25/24 and 7/3 documented shampoo performed. Patient 6 aide care plan 6/17/24 included bed bath and shower both as every other visit. Consecutive aide visits on 6/24/24, 6/26, 6/28, 7/1, 7/8 all documented bed bath given, no shower provided. Aide visit on 6/21/24 documented both shower and bed bath given. Aide visit on 6/26/24 documented transfer not needed and it is every visit on the aide care plan. Patient 8 aide care plan included shave weekly, aide visits on 6/11/24, 6/13, 6/18, 6/20 shave was completed. Patient 14 aide care plan included shampoo weekly. Aide completed shampoo on 6/25/24, 6/26, 6/27, 6/28, 7/1, 7/2, 7/3, 7/5, 7/8, 7/9, 7/10.

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. Volunteer hours for 2023 were 1.77%.

Upon client record review, 1 of 23 (Patient #5) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care Patient 5 order on 2/26/24 for SC frequency effective 2/23/24 of 1every2m2, 1m2, and 2prn. SC completed visits on 2/26/24 and 3/15/24.

Upon patient record review, 2 of 5 (Patient #1, 5) 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 on Aspirin, no evidence of bleeding precautions on the care plan. Patient 5 spiritual care services discontinued on 4/30/24, the spiritual care plan remained active at the time of survey.

Upon client record review, 2 of 5 (Patient #4, 5) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 4 order on 3/15/24 for SW frequency effective 3/13/24 of 1m3 and 2prn. Routine SW visits completed on 3/15 and 3/29. Patient 5 order on 2/23/24 for SW frequency effective 2/20/24 of 2x month and 2prn. SW visit on 3/7/24 completed, a missed visit note entered on 3/31 stated no answer at the door/phone, no documentation of a visit refusal for the second visit for March.

Upon patient record review 2 of 5 (Patient #2, 5) 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 2 aide care plan included linen change every visit. Aide visits on 6/12/24, 6/14, and 6/17 documented linen not needed per visit frequency. Patient 5 aide care plan included shave weekly and bath as every visit. Aide visits on 6/4/24, 6/13, 6/18, and 6/20 documented shave performed. Aide visits on 5/21/24 and 5/28/24 documented bath was not needed.