Every finding on record at Residential Hospice, LLC

Upon patient record review, 2 of 14 (Patient #4,#6) 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 4 and 6:The medication profile includes entries for Acetaminophen 325 mg po q 6 hours as needed and Acetaminophen 650 mg suppository as needed q 4 hours. There is no evidence that the medication profile includes instructions on a maximum daily dosage of acetaminophen 4000mg daily. COS

Upon patient record review, 1 of 14 (Patient #6) 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 6:The medical record includes nursing documentation on 7/22/24 and 7/17/24 of patient's pain level of 6 and 9 respectively. There is no documented evidence of a follow up assessment of the patient's pain level.

Upon patient record review, 1 of 14 (Patient #8) 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 8:The medical record includes documentation that the patient uses oxygen 2 liters per minute as needed for shortness of breath. There is no evidence that the plan of care includes active problems, goals and interventions for the management and safety of oxygen.

Upon patient record review, 3 of 14 (Patient #2,#4,#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 2:The plan of care includes an order dated 6/18/24 for boost orally 2 times daily as supplemental nutrition. There is no evidence that the order includes an amount of boost to be provided to the patient. COS Patient 4:The plan of care includes an order for oxygen to be used at 3 liters per minute via nasal cannula as needed for shortness of breath. There is nursing documentation that on 6/17/24 the oxygen is being delivered at 2.5 liters per minute and on 6/21/24, 6/26/24 and 6/28/24 the oxygen is being delivered at 2 liters per minute. Patient 10:The plan of care includes an order dated 7/12/24 for wound care to left toe and foot noting clean gently with soap and water, pat dry, apply band aid during the day and remove band aid and sock and leave open to air at night. There is no evidence that the order includes who is to perform the treatment. COS

Upon patient record review, 3 of 14 (Patient #1,#2,#9) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient 1 and 2: The medical record contains documentation of the discontinuation of visits by the music therapist. There is no evidence of an update to the plan of care to remove problem, goals and interventions for music therapy. COS Patient 9:The medical record contains nursing documentation on 5/19/24 of a rash noted to the right lower back, not crossing midline, collaboration with the physician and a subsequent order for Valtrex to treatment suspected shingles. There is no evidence of an update to plan of care to include problems, goals and interventions for skin integrity or active infection/droplet precautions.

Upon patient record review, 4 of 14 (Patient #1,#3,#7,#9) 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 medical record includes documentation that the patient is at risk for seizures. There is no evidence that the aide plan of care includes seizure precautions. COS Patient 3:The aide plan of care includes task of mechanical lift transfer with the frequency of as needed. COS Patient 7:The medical record includes documentation that the patient is a high fall risk. There is no evidence that the aide plan of care includes fall precautions. COS Patient 9: The medical record includes documentation that on 5/27/24 Valtrex was ordered for treatment of shingles. There is no evidence that the aide plan of care was updated with droplet precautions.

Upon patient record review 2 of 14 (Patient #5,#8) 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 5:The aide plan of care included the task of shaving assigned weekly. The aide visit notes include documentation that task was performed on 6/18/24 and 6/20/24; 7/16/24 and 7/18/24, twice weekly. Patient 8:The aide plan of care included the task of shampoo hair assigned weekly. The aide visit notes include documentation that task was performed on 7/16/24 and 7/18/24, twice within the week.

Upon client record review, 1 of 14 (Patient #4) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 4:The plan of care includes an order for oxygen to be used at 3 liters per minute via nasal cannula as needed for shortness of breath. There is nursing documentation that on 6/17/24 the oxygen is being delivered at 2.5 liters per minute and on 6/21/24, 6/26/24 and 6/28/24 the oxygen is being delivered at 2 liters per minute.