Every finding on record at Pathways Healthcare LLC

Upon patient record review, 4 of 11 (Patient #1,#2,#5,#9) 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:Upon admission, the patient's medication administration record with entry of MiraLAX powder 17 grams daily as needed. There was no evidence on the medication administration record of the type and amount of diluent needed for MiraLAX administration. Patient 2:Upon admission, the patient's medication administration record with entry of Oxygen at 3 liters per minute. There is no evidence on the medication administration record of a route for the delivery of oxygen. Patient 5:Upon admission, the patient's medication administration record with entry of MiraLAX powder 17 grams daily as needed. There was no evidence on the medication administration record of the type and amount of diluent needed for MiraLAX administration. Patient 9:Upon admission, the patient's medication administration record with entry of Oxygen at 2 liters per minute. There is no evidence on the medication administration record of a route for the delivery of oxygen.

Upon patient record review, 1 of 11 (Patient #3) did not have evidence that each patient and family received education and training provided as appropriate to their responsibilities for the care and services identified in the plan of care. Patient 3:The patient's medical record included medications of aspirin, losartan, Magnesium, oxybutynin, pantoprazole, Imodium, and Menthol profiled on the patient's medication administration record. There is no evidence that the patient and family received education and training on these medications to include purpose, instructions for use and side effects.

Upon patient record review, 3 of 11 (Patient #3,#5,#6) 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 3:The patients medical record contained nursing documentation upon admission of a primary diagnosis of Liver Cancer with noted ascites and change in mental status. There is no evidence of care plan problems with goals and interventions related to the management of liver disease and cancer. Patient 5:The patients medical record contained nursing documentation upon admission of a primary diagnosis of Heart Failure to include a cardiac diet with fluid restrictions of 1500ml per day. There is no evidence of care plan problems with goals and interventions related to the management of a cardiac diet with fluid restrictions. Patient 6:The patients medical record contains nursing documentation on 6/8/23 that the patient now required continuous oxygen via nasal cannula at 2 liters per minute. There is no evidence of care plan problems with goals and interventions related to management of oxygen use.

Upon patient record review, 4 of 11 (Patient #1,#2,#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 medications and treatments. Patient 1:The patient's plan of care includes order for MiraLAX powder 17 grams daily as needed. There is no evidence of the type and amount of diluent. Corrected on site Patient 2:The patient's plan of care includes order for oxygen at 3 liters per minute. There is no evidence of delivery route. Corrected on site. Patient 5:The patient's plan of care includes order for MiraLAX powder 17 grams daily as needed. There is no evidence of the type and amount of diluent. Corrected on site Patient 9:The patient's plan of care includes order for oxygen at 2 liters per minute. There is no evidence of delivery route. Corrected on site.

Upon patient record review, 2 of 14 (Patient #1,#4) 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 1:The patient's medical record includes anticoagulation therapy in use and nursing documentation that the patient is at risk for falls. The aide plan of care includes the assignment of a shower every visit with no evidence of the inclusion of bleeding precautions or fall risk precautions. Patient 4:The patient's aide plan of care includes the assignment of bed bath and shower. The frequency of provision for both assignments is every visit.

Upon patient record review 2 of 11 (Patient #2,#4) 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: The patient's medical record contains an ordered frequency for aide visits of 3 visits per week for 11 weeks effective 6/4/23. There is no evidence of visits completed or missed visits documented by the aide prior to 6/21/23. Patient 4: The patient's medical record contains an ordered frequency for aide visits of 3 visits per week for 11 weeks effective 6/25/23. There is no evidence of visits completed or missed visits documented by the aide prior to 7/7/23.

Upon patient record review, 1 of 11 (Patient #10) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient's life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination: • The primary terminal condition • Related diagnosis • Current subjective and objective medical findings • Current medication and treatment orders • Information about the medical management of any of the patient's conditions unrelated to the terminal illness Patient 10:The patient's medical record includes a written certification by the medical director that it is anticipated that the patient's life expectancy is 6 months or less. There is no evidence that the physician's written certification included documentation to include the primary diagnosis, related diagnoses and any subjective and objective medical findings.