Every finding on record at Proactive Home Care LLC

Based on record review, policy review and interview the hospice failed to ensure licensed professionals included written interventions and goals to manage pain and symptoms in the plan of care for 1 (Patient 2) of 3 patients reviewed. Failure to ensure inclusion of written interventions and goals in the plan of care has the potential for unmet patient and family care and expectations. --- Findings Include: Review of a document titled, “Interdisciplinary Group Roles and Responsibilities, PC.40,” last reviewed 09/01/24, showed, “the IDG/IDT, in collaboration with the attending physician (if any), will prepare a written Plan of Care (POC) for each patient and family, which specifies the care and services necessary to meet the patient and/or family’s specific needs identified in the comprehensive assessment, as those needs relate to the terminal illness and related conditions. The IDG/IDT, in its entirety, will supervise the care and services including Interventions to manage pain and symptoms . . . measurable outcomes anticipated from implementing the POC.” Patient 2 Review of Patient 2's record titled, “RN Initial Assessment,” dated 04/29/25 (admission), showed, “Upon assessment pt(patient) is with minimal conversation and confused. She became restless at end of visit and calmed with lorazepam 0.25ml (antianxiety medication).” The document showed, “Tramadol (opioid pain medication) Prn (as needed) ordered as she was taking it at rehab.” The same record showed Patient 2 had "1" dose of "breakthrough pain medication" in the prior 24-hour period. Review of Patient 2's record titled, “RN Skilled Nursing Visit,” dated 04/30/25, showed, “Pt is restless. . . New order to increase lorazepam dose.” Review of Patient 2's document titled, “Plan of Care Order,” dated 04/29/25, showed the RN/CM (Registered Nurse/Case Manager) to "assess disease prognosis/decline, sx (symptom) management, education /collaboration with pt/family/staff, dev (development) of POC (Plan of Care)." Further review of the document showed opioid and non-opioid analgesics (medications for pain), and anxiolytics (medications for anxiety) were ordered for the patient.   The POC failed to include written problems, interventions and goals related to symptom management for the patient that included anxiety, restlessness and pain. During an interview on 06/26/25 at 10:45 AM, Staff A, Regional Executive Director, confirmed the Plan of Care did not contain written problems, interventions and goals, specific to the management of anxiety and pain for the patient.

Based on interview and review of the Emergency Preparedness Plan (EPP), the Hospice Agency failed to develop and maintain an emergency preparedness plan (EPP) that is based on and includes a documented, facility-based and community-based risk assessment; utilizing an all-hazards approach that included strategies for addressing emergency events identified by the risk assessment. This deficient practice has the potential to place patients at risk for harm or injury during an emergency situation. --- Findings Include: Review of the EPP revealed that the Hospice agency failed to develop the EPP based on a facility-based and community-based risk assessment. During an interview conducted on 11/16/23 between 10:00 AM and 11:30 AM, the Administrator stated that there was no Risk Assessment for the Emergency Preparedness Plan that was based on both the facility and community but only one assessment based on the community.

Based on document review and interview, the above-named Hospice agency failed to include information addressing the process for cooperation and collaboration with local, regional, state and federal emergency preparedness officials in their Emergency Preparedness Plan (EPP). This failure affected all patients and could result in a delayed response to an emergency situation. --- Findings Include: On 11/16/23 between 10:00 AM and 11:30 AM, while reviewing the EPP, it was determined that the agency did not have evidence of a process for cooperation and collaboration with local, regional, state and federal emergency preparedness officials. The Administrator confirmed that there was currently no process in place for cooperation and collaboration.