Every finding on record at Reliable Hospice, LLC

Upon patient record review, 1 of 14 records reviewed (Patient #1) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #1: The record indicated the patient had a fall on 5/26/24, the on call nurse documented the details of the fall, no visit was made. Patient had bruising to her right lower leg and right buttocks. The next two visits made on 5/29/24 and 5/31/24 answered "no" on the nurse assessment regarding any recent falls. There was no evidence ensuring continuous assessment by the nurse.

Upon patient record review, 1 of 14 records reviewed (Patient #2) did not have evidence that the hospice assumes responsibility for professional management of the resident's hospice services in accordance with the hospice plan of care. The hospice is responsible for providing all hospice services including: • Ongoing assessment, care planning, monitoring, coordination and provision of care by the Hospice IDG • Assessment, coordination and provision of any needed general inpatient or continuous care • Consultation about the patient's care with facility staff • Coordination by the hospice RN for the implementation of the plan of care for the patient • Provision of hospice aide services, if these services are determined necessary by the IDG to supplement the nurse aide services provided by the facility • Provision, in a timely manner, of all supplies, medications, and DME needed for the palliation and management of the terminal illness and related conditions • Financial management responsibility for all medical supplies, appliances, medications and biologicals related to the terminal illness and related conditions • Determination of the appropriate level of care to be given to the patient (routine homecare, inpatient, or continuous care) • Arranging any necessary transfers from the facility, in consultation with the facility personnel Patient #2: The record indicated the patient is a resident in a contracted skilled nursing facility with the start of care for hospice on 06/21/24. There was no evidence the hospice assumed responsibility for professional management of the resident's hospice service in accordance with the hospice plan of care. There were no plan of care updates and or IDG meeting minutes on the facility chart. In addition, the facility record indicated an MD order for PT/OT and ST on 06/24/24. There was no evidence this had been coordinated, collaborated and or communicated between the hospice and or facility staff. COS.

Upon patient record review, 1 of 14 records reviewed (Patient #2) did not have evidence that the hospice provided the following information: • The most recent hospice plan of care specific to each patient • Hospice election form and any Advance Directives specific to each patient • Physician certification and recertification of the terminal illness specific to each patient • Names and contact information for hospice personnel involved in hospice care of each patient • Instructions on how to access the hospice's 24-hour on-call system • Hospice medication information specific to each patient • Hospice physician and attending physician (if any) orders specific to each patient Patient #2: The record indicated the patient is a resident at a contracted skilled nursing facility and was admitted to hospice on 6/21/24. The facility record did not show evidence of the hospice plan of care and or the most recent hospice plan of care, no hospice election form, no advance directives, no Certification, no names and contact information for the hospice's 24 hour on call system and no medications list were on the facility record. COS.

Upon patient record review, 9 of 11 records (Patients #1,#2,#3,#5,#6,#7,#8,#9,#10) 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. Patient 1: The medication profile contained miralax without a diluent and oxygen without instructions for a delivery method. Corrected on site. Patient 2: The medication profile contained oxygen without instructions for a delivery method. Santyl for wound that resolved 9-13-21, and duoneb with instructions for 5 days dated 5-19-21, were still active on the medication profile. Corrected on site. Patient 3: The medication profile contained Questran powder without a diluent. Corrected on site. Patient 5: The medication profile contained miralax without a diluent. Corrected on site. Patient 6, 9: The medication profile contained oxygen without instructions for a delivery method. Corrected on site. Patient 7: The medication list contained 3 orders for trazadone with instructions for 100 mg- 2 tabs at bedtime, 50 mg- 1 tab every PM, and 50 mg- 1/2 tab daily. Instructions were unclear if all doses given at bedtime or if different doses are accurate with different administration times. Corrected on site. The medication profile contained oxygen without instructions for a delivery method. Corrected on site. Patient 8: The medical record contained nursing documentation stating morphine and oxygen were ordered 3-9-21. There was no evidence of medications on the medication profile. Patient 10: The medication profile contained oxygen without instructions for a delivery method. The medical record contained nursing documentation dated 8-6-21 indicating duoneb called to pharmacy, 8-11-21 indicating caregiver applies calamine lotion to skin rash and Icy Hot applied to right knee for pain, 8-16-21 indicating new orders received for scopolamine. There was no evidence of medications on the medication profile.

Upon patient record review, 4 of 11 records (Patients #7,#9,#10,#11) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. Patient 7: The medical record contained nursing documentation identifying patient difficulty with swallowing 8-16-21. There was no evidence of problems, goals, and interventions related to dysphagia included on the plan of care. Patient 9: The medical record contained nursing documentation identifying issues with dyspnea and anemia 5-14-21. There was no evidence of problems, goals, and interventions related to cardiopulmonary or oxygen use included on the plan of care. Patient 10: The medical record contained nursing documentation identifying issues with skin impairment 6-22-21 and 8-11-21, difficulty swallowing and incontinence of bowel and bladder 6-9-21, multiple falls 8-18-21, and oxygen use 8-20-21. There was no evidence of problems, goals, and interventions related to dysphagia, incontinence, falls/safety, respiratory, and oxygen use included on the plan of care. Patient 11: The medical record contained contained nursing documentation 2-3-21 identifying patient use of oxygen. There was no evidence of problems, goals, and interventions related to respiratory deficit or oxygen use included on the plan of care. .

Upon patient record review, 2 of 11 records (Patients #8,#10) 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 8: The medical record contained nursing documentation dated 3-9-21 indicating oxygen was ordered for delivery. There was no evidence of an oxygen order in the medical record. Patient 10: The medical record contained nursing documentation dated 8-6-21 indicating duoneb called to pharmacy and 8-16-21 indicated new orders received for scopolamine. There was no evidence of medication orders included in the plan of care.

Upon patient record review, 1 of 11 records (Patients #10) 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 10: The medical record contained nursing documentation 8-16-21 stating education on suctioning provided. There was no evidence of suctioning supplies included on the plan of care.

Upon patient record review, 3 of 11 records (Patients #1,#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 1: The medical record contained nursing documentation dated 8-31-21 stating wound care provided to third finger on right hand and documentation dated 10-7-21 stating non-adhesive dressing applied to right lower extremity. There was no evidence of treatment orders for the wounds included in the plan of care. Corrected on site. Patient 9: The medical record contained nursing documentation dated 5-14-21 indicating family was instructed on zinc cream application to sacrum and buttocks. There was no evidence of a treatment order for the sacrum included in the plan of care. Patient 10: The medical record contained nursing documentation dated 6-22-21 indicating dermatitis noted to sacral area and zinc applied and 8-11-21 indicates caregiver applies calamine lotion to skin rash and Icy Hot applied to right knee pain. There was no evidence of a treatment orders included in the plan of care.

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. The agency could not provide information for 2019 to ensure compliance prior to the pandemic waiver. Information was not available due to change in ownership during 2020.