Every finding on record at Prohealth Home Care, Inc

Based on interview and record review, the Hospice Agency (HA) failed to document that education was provided to family for administration of Patient 1's medication, when Patient 1 received an incorrectly labeled narcotic pain medication (opioid pain medication used for severe pain) from the agency's contracted pharmacy and was given the incorrect dose. This failure resulted in Patient 1 receiving a dose of narcotic pain medication that was ten times the dosage ordered and placed the patient at risk for serious side effects including respiratory depression. --- A review of Patient 1's "Medpass Hospice Physician Plan of Treatment (POC)," for certification period 2/10/24 to 5/9/24, indicated Patient 1 had a start of care date with the HA on 2/10/24 for diagnosis of chronic kidney disease (kidneys unable to filter waste as well as they should). A review of Patient 1's POC indicated "...Orders for Skilled Nursing...SN [Skilled Nurse] visit frequency 2x [times]/week and 2 PRN [as needed] for changes in status...Implement and instruct Medication Regimen; including dosage, side effects, name, route, frequency, adverse reactions, and medication compliance/med set-up...Patient/caregiver may administer medications..." A review of Patient 1's "Hospice Medication Profile," dated 2/10/24, indicated "...Start Date...02/21/2024 Hospice Provided...Medication... Methadone HCL Intensol [narcotic pain medication used to treat severe pain]...Route...Oral...Dose/Amount...10 MG [milligrams]/ML[milliliter] (give 0.25 ML= 2.5MG) ...Frequency...Every 12 hours... Home Hospice Medication Policy and Procedure Review...Date: 02/10/2024... An assessment has been completed to assure that the patient, patient representative and/or family are competent to safely self-administer medications and may administer meds...Yes..." A review of Patient 1's "Hospice Nursing Clinical Note," dated 2/21/24, indicated "... patient had been complaining of increased pain located on his mid back. He used to be able to tolerate the pain, but now even with slight movement like lowering of the bed already triggers the pain..." Patient 1's "Hospice Nursing Clinical Note," dated 2/21/24, sections "Skilled Intervention/Treatment/Teaching/Pt [Patient]/Cg [Caregiver] Response" and "Coordination/ Plan" were not completed. A review of Patient 1's "Hospice Nursing Clinical Note," dated 2/23/24, indicated "...Patient was given 2.5 ml of Methadone at approximately 10:30 pm. family noted in early morning patient was very hard to arouse and non responsive [HA] was called at this time. SN found patient to be semi-comatose eyes are closed when open appears glossy with no tracking. No active movement or verbal response is noted to name or tactile [touch] stimuli...SN spoke with [name of HA pharmacy] to the Pharmacist who mislabeled medication, she is sending someone out with a new label to re label medication..." A review of Patient 1's "Care Coordination Note," dated 2/23/24, indicated "...Received a message from the patient's [name of Family Member] that the patient was administered Methadone conc. [concentrate] 10mg/ml, 2.5 ml last night because of severe pain. She reported that this morning he was "out of it" and seemed like he wanted to vomit but he couldn't...SN tried to clarify if it was 0.25 ml or 2.5 ml that was given and she stated that she followed what was written on the bottle. She took a picture of the bottle and it stated methadone 10mg/ml, Take 2.5 ML every 12 hours. The hospice order to [name of HA pharmacy] was rechecked and clearly written as Methadone 10mg/ml, take 2.5 mg (0.25ml) every 12 hours for pain management..." During an interview on 3/1/24 at 12:39 p.m. with the Director of Patient Care Services (DPCS), the DPCS stated that Patient 1's medication, Methadone, was delivered to the home on 2/22/24 and had been mislabeled by the pharmacy. The DPCS stated Patient 1's family member administered the medication on 2/22/24 according to label instructions on the bottle. Patient 1 received 2.5 ml instead of 0.25 ml that had been ordered. The DPCS stated that Patient 1 did not have a nursing visit after Methadone had been delivered to the home and before it was administered by the family on 2/22/24. Reviewed Patient 1's "Hospice Clinical Visit Note," dated 2/21/24, with the DPCS. The DPCS acknowledged that the note did not reflect family had been instructed in the administration of Methadone. The DPCS stated, "Teaching would have been documented in the nursing note, but the nurse did not complete her note because she had to leave the country." The DPCS further stated, "The policy is 48 hours to complete visit note. In this instance should have been completed the same day." During a telephone interview on 3/20/24 at 9:08 a.m. with SN 1, SN 1 stated she went to Patient 1's home on 2/23/24. SN 1 stated Patient 1 had been given, by a family member, the incorrect dosage of Methadone on 2/22/24 due to an incorrect medication label. SN 1 stated the Methadone bottle was labeled to give 2.5 ml instead of 0.25 ml. Patient 1's family member had given what the label instructed. SN 1 stated teaching is documented in the nursing visit note and needs to be charted within 48 hours of the visit. During a joint telephone interview with the HA Pharmacy Owner (OHAP) and the HA Pharmacist (PHM), OHAP stated methadone for Patient 1 was ordered on 2/21/24 by the HA and delivered to Patient 1's home on 2/22/24. The OHAP stated Patient 1's order for Methadone was labeled incorrectly because a pharmacy technician typed 2.5 ml instead of 2.5 mg. The OAH stated another pharmacy technician filled the medication and the PHM checked it off but did not catch the error. The OHAP stated, "It was our mistake." During a telephone interview on 3/20/24 at 12:38 p.m. with SN 2, SN 2 stated Patient 1 had severe back pain on 2/21/24 and Methadone 0.25 ml for 2.5 mg every 12 hours was ordered. It was delivered to the home and family administered it on 2/22/24. SN 2 received a picture of the bottle on 2/23/24 and observed it was incorrectly labeled. The family had administered 2.5 ml instead of 0.25 ml. SN 2 stated she checked the order which was correct. Reviewed Patient 1's "Hospice Nursing Clinical Note," dated 2/21/24, with SN 2. SN 2 acknowledged that she did not complete the visit note within 48 hours as she had to leave the country and education on Methadone administration was not documented. A review of the HA Policy and Procedure (P&P) titled "Identification of Medication for Administration," revised 11/20, indicated "...To provide general guidelines for the safe administration of medications in the home...Medications will be properly labeled with the patient's name, an additional patient identifier, name of drug, dosage...The nurse will review the medication label for name, additional patient identifier, drug, dosage, and prescription....The nurses will document medication teaching, side effects, administration, and other related information in the clinical record..." A review of the HA P&P titled "Medication Profile," revised 11/20, indicated "...the medication profile will be used as a care planning and teaching guide to ensure that the patient and family/caregiver...understand the medication regimen...Using the medication profile to teach drug purposes, dosages..." A review of the HA P&P titled "Entries into the Clinical Record," not dated, indicated "...A clinical record will be initiated and maintained for each patient...and will include at a minimum...Patient and family education...All entries into the clinical record will reflect the date care was provided...All visit notes must be completed within 24-48 hours..."

Based on interview and record review, the Hospice Agency (HA) failed to ensure that medications from their contracted pharmacy and delivered to Patient 1 were labeled and administered correctly, when Patient 1's narcotic pain medication (opioid pain medication used for severe pain) was administered by family caregiver with dosage of 2.5 milliliters (ml) instead of the correct dose of 0.25 ml. This failure had the potential to cause Patient 1 to experience adverse effects from receiving ten times the dose ordered. --- Findings: A review of Patient 1's "Medpass Hospice Physician Plan of Treatment (POC)," for certification period 2/10/24 to 5/9/24, indicated Patient 1 had a start of care date with the HA on 2/10/24 for diagnosis of chronic kidney disease (kidneys unable to filter waste as well as they should). A review of Patient 1's POC indicated "...Orders for Skilled Nursing...Implement and instruct Medication Regimen; including dosage, side effects, name, route, frequency, adverse reactions, and medication compliance/med set-up...Patient/caregiver may administer medications..." A review of Patient 1's "Hospice Medication Profile," dated 2/10/24, indicated "...Start Date...02/21/2024 Hospice Provided...Medication... Methadone HCL Intensol [narcotic pain medication used to treat severe pain] ...Route...Oral...Dose/Amount...10 MG [milligrams]/ML[milliliter] (give 0.25 ML= 2.5MG) ...Frequency...Every 12 hours..." A review of Patient 1's "Hospice Nursing Clinical Note," dated 2/21/24, indicated "... patient had been complaining of increased pain located on his mid back. He used to be able to tolerate the pain, but now even with slight movement like lowering of the bed already triggers the pain..." A review of Patient 1's "Hospice Nursing Clinical Note," dated 2/23/24, indicated "...Patient was given 2.5 ml of Methadone at approximately 10:30 pm. family noted in early morning patient was very hard to arouse and non responsive [HA] was called at this time. SN [Skilled Nurse] found patient to be semi-comatose eyes are closed when open appears glossy with no tracking. No active movement or verbal response is noted to name or tactile [touch] stimuli...SN spoke with [name of HA pharmacy] to the Pharmacist who mislabeled medication, she is sending someone out with a new label to re label medication..." A review of Patient 1's "Hospice Nursing Clinical Note," dated 2/24/24, indicated "...Upon arrival to visit SN was unable to obtain any vital signs auscultate [hear] heart sounds and noted patient to have ceased breathing..." A review of Patient 1's "Care Coordination Note," dated 2/23/24, indicated "...Received a message from the patient's [name of Family Member] that the patient was administered Methadone conc. [concentrate] 10mg/ml, 2.5 ml last night because of severe pain. She reported that this morning he was "out of it" and seemed like he wanted to vomit but he couldn't...SN tried to clarify if it was 0.25 ml or 2.5 ml that was given and she stated that she followed what was written on the bottle. She took a picture of the bottle and it stated methadone 10mg/ml, Take 2.5 ML every 12 hours. The hospice order to [name of HA pharmacy] was rechecked and clearly written as Methadone 10mg/ml, take 2.5 mg (0.25ml) every 12 hours for pain management..." During an interview on 3/1/24 at 12:39 p.m. with the Director of Patient Care Services (DPCS), the DPCS stated that Patient 1's medication, Methadone, was delivered to the home on 2/22/24 and had been mislabeled by the pharmacy. The DPCS stated Patient 1's family member administered the medication on 2/22/24 according to label instructions on the bottle. Patient 1 received 2.5 ml instead of 0.25 ml that had been ordered. The DPCS stated that Patient 1's family member contacted SN 2 on 2/23/24 and notified SN 2 that Patient 1 had received the wrong dose of Methadone. The HA pharmacy was contacted and sent a new corrected label to the home for the Methadone. During a telephone interview on 3/20/24 at 9:08 a.m. with SN 1, SN 1 stated she went to Patient 1's home on 2/23/24. SN 1 stated Patient 1 had been given, by a family member, the incorrect dosage of Methadone on 2/22/24 due to an incorrect medication label. SN 1 stated the Methadone bottle was labeled to give 2.5 ml instead of 0.25 ml. Patient 1's family member had given what the label instructed. SN 1 stated she contacted the HA Pharmacist and a new corrected label was sent to Patient 1's home. During a joint telephone interview with the HA Pharmacy Owner (OHAP) and the HA Pharmacist (PHM), OHAP stated methadone for Patient 1 was ordered on 2/21/24 by the HA and delivered to Patient 1's home on 2/22/24. The OHAP stated Patient 1's order for Methadone was labeled incorrectly because a pharmacy technician typed 2.5 ml instead of 2.5 mg. The OAH stated another pharmacy technician filled the medication and the PHM checked it off but did not catch the error. The OHAP stated, "It was our mistake." The PHM stated she was notified by the HA nurse on 2/23/24 that Patient 1's methadone was mislabeled and Patient 1 had received 25 mg of methadone instead of 2.5 mg. PHM contacted the OAH and a new label was sent to Patient 1's home. The OAH stated that the staff has been retrained to ensure labeling is correct. During a telephone interview on 3/20/24 at 12:38 p.m. with SN 2, SN 2 stated Patient 1 had severe back pain on 2/21/24 and Methadone 0.25 ml for 2.5 mg every 12 hours was ordered. It was delivered to the home and family administered it on 2/22/24. On 2/23/24, Patient 1's family member contacted her and reported Patient 1 was "out of it." SN 2 received a picture of the bottle and observed it was incorrectly labeled. The family had administered 2.5 ml instead of 0.25 ml. SN 2 stated she checked the order which was correct. A review of the HA Policy and Procedure (P&P) titled "Identification of Medication for Administration," revised 11/20, indicated "...To provide general guidelines for the safe administration of medications in the home...Medications will be properly labeled with the patient's name, an additional patient identifier, name of drug, dosage...The nurse will review the medication label for name, additional patient identifier, drug, dosage, and prescription....The nurses will document medication teaching, side effects, administration, and other related information in the clinical record..." A review of the HA P&P titled "Medication Profile," revised 11/20, indicated "...the medication profile will be used as a care planning and teaching guide to ensure that the patient and family/caregiver...understand the medication regimen...Using the medication profile to teach drug purposes, dosages..." A review of the HA P&P titled "Entries into the Clinical Record," not dated, indicated "...A clinical record will be initiated and maintained for each patient...and will include at a minimum...Patient and family education...All entries into the clinical record will reflect the date care was provided...All visit notes must be completed within 24-48 hours..."

Based on observation, interview, and record review, the Hospice Agency (HA) continuously failed to ensure that one of 11 sampled patients (Patient 2) had accurate medications since the Start of Care (SOC) in August 2022, when the medication profile did not reflect Patient 2's medications in the home. --- This failure caused Patient 2 to go out in the heat to obtain the medications and also had the potential to cause medication errors and cause adverse effects from taking over the counter medications in addition to current medications ordered by the Hospice doctor. A review of Patient 2s, clinical record, titled, ";Medpass Hospice Physician Plan of Treatment (POC)," for certification period 8/13/23-10/13/23, indicated that Patient 2 had a Start of Care (SOC) date with the HA on 8/18/22 and had multiple diagnoses that included Chronic Obstructive Pulmonary disease, unspecified (COPD- group of diseases that cause airflow blockage and breathing-related problems, Generalized anxiety disorder, Post-traumatic stress disorder and low back pain. During a concurrent observation and joint interview confirmed with Licensed nurse (LN) 1, Care Giver and Patient 2 on 8/23/23 at 9 a.m., they confirmed that medication profile did not indicate the following over the counter medication that Patient 2 was taking: 1. Ipratropium Bromide 0.02% solution, two times a day 2. Docusate Sodium 100 mg, takes two in the morning and 2 in the night. 3. Non-drowsy Allergy relief 25 mg, once a day 4. Breztri Aerosphere 160 mcg/9 mcg/4.8 mcg per inhalation, once a day During a concurrent observation and joint interview with LN 1, Care Giver, and Patient 2, on 8/23/23 at 9:30 a.m., confirmed that these 4 medications were not mentioned in Patients 2 medication profile. Patient 2 was taking these over-the-counter medications prior to starting hospice care. Patient 2 bought these medications from a Pharmacy. Care Giver stated that, ";...when hospice was started last year, hospice nurse who did the admission told us keep the Pharmacy medications and to continue to buy these medication from Pharmacy, the nurse said that it will be smoother to keep things as it is...". On further review of the medication profile and home medications on 8/23/23 at 9:30 a.m., it was found that medication Theo-24 ER 300 capsule, three times a day was included in the medication profile. Care Giver stated that, ";...for this medication, nurse who did admission told us keep this Pharmacy medication and to continue to buy this medication from pharmacy... But, it will be easy if we can get it from one place. In past few months it has been very hot, and Patient 2 has gone to the pharmacy to get it themselves...". Patient 2 stated, ";...I went on my scooter, it was very hot, and I went because I do not want to trouble anyone. When I went to pick up the medication, Pharmacists was asking me questions and I did not remember many things. It would be so convenient if we can just get it from one place...". On further review of the medication profile and home medication bottles on 8/23/23 at 9:30 a.m., it was found medication Gabapentin 100 mg, take 1 capsule by mouth three times day was present at home but was not mentioned in the medication profile of Patient 2. Care Giver stated, ";...we use this if he runs out of the Gabapentin 300mg, we have kept this just in case..". Patient 2 stated, ";...It has run out two times...". In an interview with LN1 at 10:18 a.m. on 8/23/23, LN1 stated, ";...I was aware that Patient 2 was taking the over-the-counter medications and getting it from a Pharmacy, but I never got to Hospice doctor to get order for it...I knew that there was Gabapentin 100 mg at home, Patient 2 had it even before hospice started, I was not aware that I had to get it discontinued, since Patient 2 was not taking it, it was kept just in case..". During an interview on 8/23/23 at 12:14 p.m. with the Director of Patient Care Services (DPCS), the DPCS stated, ";...my expectations are when the nurse visits patients, the nurses are supposed to do medication reconciliation on every visit to know what is in patients house and what is on our Medication list, they need to compare that at every visit. With regards to Patient 1 who has to go get their own medication, that is unacceptable to us. We take complete responsibility of this situation, medication reconciliation should have been done at the time of admission when it happened a year back...LN 1 has received training, is aware that they are supposed to go through medications on every visit. LN 1 should have followed up with the Hospice doctor and got an order for the medications that are not on the medication profile". A review of the HA policy and procedure (P&P) titled "Medication Management," revised November 2020, the P&P indicated "...Patients receiving medications administered by hospice will have a current, accurate medication profile in the clinical record...For accuracy and to completely reconcile medications across the continuum of care, the admitting organization will obtain and document a complete list of the patients current medications upon the patients entry to the organization..."

Based on interview and record review, the Hospice Agency (HA) failed to follow the Plan of Care (POC) for two of eleven sampled patients (Patient 4 and Patient 11) when Patient 4 and Patient 11 did not receive Home Health Aide (HHA) visits two times in one week as ordered. This failure resulted in Patient 4 and Patient 11 to not receive needed services. --- A review of Patient 4s POC for certification period 5/11/23 to 8/9/23, indicated Patient 4 had a Start of Care (SOC) date with the HA on 5/11/23 for diagnoses including heart failure [heart does not pump blood as well as it should], COPD [chronic obstructive pulmonary disease-lung disease that blocks airflow], and pulmonary hypertension [high blood pressure that affects arteries in the lungs]. The POC indicated Patient 4 had orders for ";Aide visit frequency 2x/ week [2 times a week] to assist w/ [with] personal care/ADLs [Activities of Daily Living] /light housekeeping as needed within 1 week period of time..." A review of Patient 4s ";Aide/Homemaker Care Plan," signed 5/12/23, indicated ";...Frequency 2 x/ week..." for tasks including complete bed bath, shampoo hair, comb hair, clean and file nails, perineal care, change linens, make bed and straighten room. A review of Patient 4s ";Patient Schedule," July 2023, indicated Patient 4 received one HHA visit on 7/5/23, the week of 7/2/23 to 7/8/23. A review of Patient 4s clinical record indicated HHA Progress Notes completed for 7/1/23, 7/5/23, and 7/12/23. There was no other HHA Progress Note for week 7/2/23 to 7/8/23 in the clinical record. During a concurrent interview and record review on 8/22/23 at 3:23 p.m. with the Director of Patient Care Services (DPCS), the DPCS confirmed that Patient 4s POC for certification period 5/11/23 to 8/9/23, indicated order frequency for HHA was two times a week. The DPCS acknowledged that Patient 4 had only one HHA visit the week of 7/2/23 to 7/8/23 and there was not a missed visit note. The DPCS stated that physicians are notified of missed visits, but there was no documentation the physician was notified of Patient 4s missed HHA visit week of 7/2/23 to 7/8/23. During an interview on 8/23/23 at 8:12 a.m. with HHA 1, HHA 1 stated that if a HHA visit was missed, a missed visit note was completed and sent to the office. The HHA stated if he is unable to make a visit, he contacts the office and they attempt to find someone else or reschedule the visit. During an interview on 8/24/23 at 9:35 a.m. with the DPCS, the DPCS stated that the physician is notified of a missed visit by phone. The DPCS stated the ";Missed Visit" note should indicate how the physician was notified. The DPCS further stated that if a HHA visit was missed, the HHA may contact the supervisor or notify the physician themselves. A review of the HAs policy and procedure (P&P) titled ";The Plan of Care," revised 11/20, indicated ";...A written individualized patient and family/caregiver plan of care will be established and maintained for each individual admitted to the hospice program. The care provided to the patient must be in accordance with the plan of care...The plan of care will identify the patients needs and services to meet those needs...It must state, in detail, the scope and frequency of services needed to meet the patients and family/caregivers needs...Care provided to the patient will be in accordance with the plan of care..." A review of the HAs P&P titled ";Missed Visits," revised 11/20, indicated ";...To ensure that missed visits are documented and does not affect the quality of patient care...Missed visits will be documented in the clinical record...If an aide visit is missed the aide will contact the case manager or clinical supervisor..." During a review of Patient 11's POC for certification period 1-10-23 to 4-9-23, indicated, "Aide visit frequency 2x/week effective week of 01/15/23 to assist w/personal care/ADLs/light housekeeping as needed with 1 week period of time." Patient 11 is bed bound and with diagnosis of Unspecified severe protein-calorie malnutrition, (reduced availability of nutrients in the body), abnormal weight loss adult failure to thrive (decreased appetite, poor nutrition), and Kidney disease. During a review of Patient 11's "AIDE/HOMEMAKER CARE PLAN," signed 1-10-23, indicated the HHA's tasks consist of complete bed bath, shampoo hair, comb hair, mouth care, assist with dressing, perineal care, apply lotion, make bed, change bed linens and straighten rooms. During a review of Patient 11's "Patient Schedule," dated January 2023, showed, patient did not receive HHA care from start of benefit period 1-10-23 to 1-17-23. During a concurrent interview and record review with the Director of Patient Care Services (DPCS) on 8-22-23 at 3:44 p.m., she confirmed Patient 11's schedule showed no visit from the HHA from 1-10-23 to 1-17-23. She further stated, these are missed visits, the HHA should have visited the patient. During a review of the facility's policy and procedure titled, "MISSED VISITS," revised on November 2020, indicated, "Missed visits will be communicated to the Interdisciplinary Group at the IDG Meeting. A missed visit will be rescheduled the same week if possible. Missed visits will be documented in the clinical record..."

Based on observation, interview, and record review, the Hospice Agency (HA) continuously failed to ensure that one of 11 sampled patients (Patient 2) had medical supplies for medical treatments since the Start of Care (SOC) in August 2022. --- This failure caused Patient 2 to buy his own medical supplies. A review of Patient 2s, clinical record, titled,"Medpass Hospice Physician Plan of Treatment (POC)," for certification period 8/13/23-10/13/23, indicated that Patient 2 had a Start of Care (SOC) date with the Hospice Agency (HA) on 8/18/22 and had multiple diagnoses that included Chronic Obstructive Pulmonary disease, unspecified (COPD- group of diseases that cause airflow blockage and breathing-related problems), Generalized anxiety disorder, post-traumatic stress disorder and low back pain. A review of Patient 2s medication profile and medications at home, showed that Patient 2 took the following medications through nebulizer (machine that administers respiratory medications): 1. Ipratropium Bromide 0.02% solution, two times a day; 2. Ipratropium Albuterol 0.5-2.5 (3) mg/3 ml 1 unit dose, every 4 hours for shortness of breath During a concurrent observation and joint interview confirmed with Caregiver and Patient 2, on 8/23/23 at 9:50 a.m., that Patient 2 was taking both these medications. When asked how often the nebulizer cup and tubing was changed, Caregiver replied that they change it every few months. She further stated that, "For nebulizer tubing I've asked the nurse from Hospice if they can bring the nebulizer tubing.... no one responded back to us, we have to order it online...". In an interview with Licensed Nurse (LN) 1 at 10:18 a.m. on 8/23/23, when asked LN 1, during the home visit if she assessed the nebulizer cup with tubing and who ordered the treatment supplies, LN 1 stated, ";...I have never looked at the nebulizer cup or tubing...Patient 2 and the Caregiver never communicated with me that they wanted me to order those items. We order oxygen through DME (durable medical equipment, which is an item or appliance that can withstand repeated use, is designed to serve a medical purpose) company. I have never ordered any tubing or equipment for Patient 2...I should check the nebulizer and the tubing on every visit...". On review of Patient 2s, clinical record, titled, ";Medpass Hospice Physician Plan of Treatment (POC), from the SOC starting certification period of 8/18/22-11/15/22 to latest certification period 8/13/23-10/13/23, indicated that there was no order for medical equipment/supplies and for duties involving cleaning of the medical equipment. In an interview on 8/23/23 at 12:14 p.m. with the Director of Patient Care Services (DPCS), the DPCS stated, ";...my expectations are from the nurse that they will check if the patient had all the necessary DME and medical supplies at every visit. Patients should not have to buy their medical supplies themselves, that is unacceptable to me...". When mentioned to DPCS that there is no order for medical supplies in the POC. The DPCS stated, ";...that is unacceptable, it should have been reconciled at the time of admission a year back. There should be an order from hospice doctor to order medical supplies required for treatments...". A review of the HA policy and procedure (P&P) titled "Durable Medical Equipment And Supplies", revised November 2020, the P&P indicated "...All durable medical equipment and supplies provided by hospice, as appropriate, will have an order from the patients physician and be included in the hospice plan of care. ...Those supplies required for optimal comfort, care, and management of the hospice patient will be obtained from the hospice stock supplies...".

Based on interview and record review, the hospice interdisciplinary group (IDG) failed to revise and document the individualized plan of care (POC) for 1 of 11 sampled patients (Patient 1) as frequently as the patient's condition requires. This failure had the potential for inaccurate care. --- Review of Patient 1s clinical record indicated he had an admission date of 3/5/23 and his diagnosis included cerebral atherosclerosis (buildup of plaque in the blood vessels of the brain) and dementia. During a concurrent interview and record review on 8/22/3 at 2:19 p.m. with Director of Patient Care Services (DPCS), Patient 1s "Hospice IDG Meeting/Care Plan Update" dated 7/11/23 and dated 7/25/23 were reviewed. The Care Plan contained an order for skilled nurse (SN) visit frequency of one time a week. The DPCS confirmed Patient 1 received 2 SN visits the weeks of 7/23/23, 7/30/23, 8/6/23 and 8/13/23, instead of one as ordered. The DPCS confirmed Patient 1s POC should have been updated. Review of the Hospice Agencys policy titled, ";The Plan of Care," revised November 2020 indicated, ";The care provided to the patient must be in accordance with the plan of care...The plan of care will be reviewed and revised as frequently as deemed necessary, but not less often than every 15 days...Any change in the patients condition must result in a change in the plan of care, prior to implementation of the new service. The policy indicated, ";The written plan of care will contain, but will not be limited to, the following: ...J. Frequency and type of services."