Every finding on record at Progressive Home Health & Hospice LLC

Upon observation, there was no evidence of contracts/agreements with other facilities/agencies/hospices to receive patients in the event the hospice cannot provide care to their patients during an emergency. Corrected on site.

Upon patient record review, 3 of 14 records (Patient #2,#3,#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: Documentation by the nurse dated 3/31/23 indicated that the patient was prescribed topical ointment Triamcinolone. There was not evidence that this medication was a part of the medication profile. Corrected on site. Patient #3: The record indicated Miralax 17 Gm powder, 1 scoop daily prn. There was not evidence of a diluent. Corrected on site. Patient #13: Nurse documentation dated 1/19/23 indicated that the patient was on oxygen. There was not evidence that this was a part of the medication profile.

Upon patient record review, 6 of 14 records (Patient #2,#4,#5,#10,#13,#14) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient that reflects 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 #2,#4,#5,#13: The patient was admitted with a diagnosis of senile degeneration of the brain. There was not evidence that the plan of care reflected patient/family goals and interventions based on the patient's neurological problems. All corrected on site. Patient #10: The record indicated that the patient was on Keflex for a UTI, dates 1/12/23 and 2/18/23. Also had been started on 2 medications for C-diff on 3/29/23. There was not evidence that infections were a part of the care plan with goals and interventions. Corrected on site. Patient #14: The record indicated that the patient had a G-tube. There was not evidence that the plan of care reflected patient/family goals and interventions related to the G-tube.

Upon patient record review, 3 of 14 records (Patient #2,#3,#13) did not have evidence the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #2: Documentation by the nurse dated 3/31/23 indicated that the patient was prescribed topical ointment Triamcinolone. There was not evidence of an order. Corrected on site, Patient #3: The record indicated Miralax 17 Gm powder, 1 scoop daily prn. There was not evidence of a diluent. Corrected on site. Patient #13: Nurse documentation dated 1/19/23 indicated that the patient was on oxygen. There was not evidence of an order.

Upon patient record review, 3 of 14 records (Patient #3,#10,#13) did not have evidence the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient #3: The record indicated that the patient uses a walker for ambulation. There was not evidence that a walker was part of the plan of care. Corrected on site. Patient #10: The record indicated that the patient had a bed, overbed table, walker, wheelchair, shower chair and a bedside commode. Thee was not evidence that the plan of care included this equipment. Corrected on site. Patient #13: The record indicated that the patient had a hospital bed, wheelchair, bedside commode, suction machine, oxygen concentrator, and E-tanks. There was not evidence that the plan of care included this equipment.

Upon client record review, 1 of 14 records (Patient #11) 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 #11: The patient was discharged for extended prognosis on 1/23/23. There was not evidence that the IDG discussed discharge on this patient at the IDG dated 1/10/23 prior to discharge or at any other time prior to discharge (including the last skilled nurse visit on 1/19/23).

Upon client record review, 5 of 14 records (Patient #1,#2,#10,#13,#14) 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 visit frequency for the skilled nurse was 1x/week at the start of care (2/22/23). The record indicated that routine visits were conducted on 2/22/23, 2/23/23, and 2/25/23. In addition, the visit frequency for the social worker was for 1x/month. There was not evidence of a visit for the month of March. Corrected on site. Patient #2: The visit frequency for the skilled nurse was 1x/week The record indicated 3 visits for the week of 2/12/23-2/18/23, 2 visits for the week of 2/26/23-3/4/23, 3 visits for the week of 3/5/23-3/11/23 and 2 visits for the week of 3/26/23-4/1/23. Patient #10 The record indicated that the patient had a Foley catheter which was changed on 3/20/23. There was not evidence that the care plan specified a Foley catheter change. Corrected on site. Patient #13: Nurse documentation dated 1/19/23 indicated that the patient had a Foley catheter. There was not evidence that a Foley catheter was in accordance with the plan of care. In addition, the skilled nurse visit frequency was 1x/week. Visits were conducted on 1/19/23, 1/20/23, 1/22/23, and 1/23/23. Patient #14:The visit frequency for the skilled nurse was 1x/week. The record indicated that the skilled nurse conducted 2 visits per week. In addition, The record indicated that PT conducted 4 visits while the patient was on hospice. There was not evidence of an order

Upon patient record review, 1 of 14 records (Patient #14) 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. • Ensuring that bereavement services reflect the needs of the bereaved Patient #14: The patient lived with her spouse, was married for 31 years, he worked from home and was her primary caregiver. There was not evidence that the patient's spouse was receiving bereavement support. The record indicated that the patient's daughter (who lived out of state) was the only person receiving bereavement support.

Upon patient record review 6 of 14 records (Patient #2,#6,#7,#9,#10,#13) 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 Patient #2: The aide visit frequency was 2x/week. For the week of 3/5/23-3/11/23, the record indicated only 1 visit on 3/6/23. Patient #6: The aide visit frequency was 1x/week. For the week of 3/26/23-4/1/23, the record indicated 2 visits (3/27/23 and 3/29/23). There was also no evidence of visits for the weeks of 4/2/23-4/8/23 and 4/9/23-4/15/23. Corrected on site. Patient #7: The aide visit frequency was 2x/week For the week of 3/26/23-4/1/23, the record indicated only 1 missed visit (refusal). For the week of 4/2/23-4/8/23, only 1 visit was conducted on 4/5/23 and for the week of 4/9/23-4/15/23, there was not evidence of a visit. Corrected on site. Patient #9: The aide visit frequency was 2x/week from admission until 3/20/23, when aide services were discontinued. The last documented aide visit was 11/25/22. Corrected on site. Patient #10: The aide visit frequency was 2x/week. For the weeks of 3/26/23-4/1/23, 4/2/23-4/8/23, and 4/9/23-4/15/23, the record indicated only 1 visit each of these weeks. Corrected on site. Patient #13: The aide visit frequency was 2x/week. The patient was on hospice from 12/30/22-1/23/23. The record indicated only 1 aide visit on 1/17/23.

Upon patient record review, 4 of 14 records (Patient #2,#8,#10,#11) 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. There was not evidence that the physician considered the following when making this determination: The narrative statement/form did not contain evidence of • 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 Patients 2, 8, 10, 11 There was no evidence of a date that the physician completed the initial CTI.

Upon patient client record review, 3 of 14 records (Patient #7,#9,#10) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #7,#9,#10: The area on the benefit election form indicating if the patient/representative would like to receive or declines the “Patient Notification of Hospice Non-Covered Items, Services, and Drugs” had both areas checked. It was not clear if they wished to receive the document or if they declined the document.

Upon patient client record review, 1 of 14 records (Patient #11) did not evidence that each patient record contains physician orders. Patient #11: The patient was discharged for extended prognosis. There was not evidence of a discharge order from the medical director.

Upon client record review, 2 of 14 records (Patient #11,#12) did not have evidence that the discharge summary includes all required information. Patient #11,#12: There was not evidence of the following in the discharge summary: • The patient's current plan of care • The patient's latest physician orders • Any other documentation that will assist in post-discharge continuity of care • Any instructions or referral information given to the patient or family • Significant health history • Discharge orders, instructions, medication profile and allergies, if discharge is other than patient death • Presence of Advance Directives • End of life decisions