Every finding on record at Residential Hospice of Carlisle LLC

Upon patient record review, 1 of 23 (Patient #12) 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 #12 - Medication profile contained Benzox Lotion 10% and Cavilon Barrier Cream apply PRN per instructions. No application site listed and no indication of when to apply PRN.

Upon patient record review, 1 of 23 (Patient #11) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #11 - The SOC was 12/19/24 - initial bereavement was completed on 12/26/24 - 7 days after SOC.

Upon patient record review, 2 of 23 (Patient #12, 17) 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 #12 - POC 11/14/24 contained Benzox Lotion 10% and Cavilon Barrier Cream apply PRN per instructions. No application site or indication of when to apply PRN on POC. Patient #17 - POC 10/17/24 wound care contained "clean with, apply medihoney, cover with foam border dressing 2 x week and PRN for soilage", order did not indicate what to clean wound with.

Upon patient record review 2 of 23 (Patient #8, 10) 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 #8 - During the visit with the home health aide she provided a bed bath but shower is on the aide care plan for every visit. Patient #10 - During the home visit the wife stated patient gets a chair bath every visit patient can not get in shower because shower is upstairs and patient unable to get upstairs - the aide documented a shower bath every visit and a shower bath is on the aide care plan.

Upon patient record review, 3 of 13 (Patients #7, #10 and #13) did not have evidence that 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 #7: Physician orders for wound care were dated 12/2/2021, 12/6/2021, 12/10/2021, and 12/15/2021. The patient lived in an assisted living facility but the Physician order did not indicate who was responsible for providing the wound care. Patient #10: A Physician order dated 1/6/2021 revealed wound care orders. The order did not indicate who was responsible for providing the wound care. Patient #13: A Physician order dated 5/24/2021 revealed wound care orders. The order did not indicate who was responsible for providing the wound care.

Upon patient record review, 3 of 11 applicable (Patients #1, #8 and #10) did not have evidence in the patient record that the hospice aide assignments and duties include the tasks to be provided and the frequency of those tasks. Patient #1: On the SOC dated 11/26/2021, the RN documented patient having difficulty swallowing. There was no aspiration precautions listed on the Aide Care Plan. RN directed the Aide to give a patient a bed bath if they are physically unable to shower. Assessing the patient's physical limitations is outside of the Aide's scope of practice. Patient #8: On the Aide Care Plan, tasks were documented that included Partial sponge on last visit of the week and bed bath on first visit of the week. On 1/4/2021, a Physician order was obtained to increase the Aide visits to 3x week. The Aide Care Plan was not updated to include what type of care was to be provided on the third visit. Patient #10: On the Aide Care Plan dated 12/17/2021, the RN directed the Aide to shower 2x week, but may give bed bath if unable to shower due to weakness. It is out of the Aide's scope to assess the patient to determine weakness.

Upon patient client record review, 3 of 13 (Patients #1, #4 and #5) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. A Policy titled Program/Service Operations (Section 6) stated Entries into the clinical/service record will be made and completed, at point of care, on the day care/service is provided to the patient. Patient #1: An LPN conducted visits on 11/29/2021 and 12/2/2021. The documentation was not completed until 12/8/2021. Patient #4: The Social Worker conducted an evaluation on 12/16/2021. The documentation was not completed until 12/25/2021. An RN conducted a visit on 12/23/2021. The documentation was not completed until 12/28/2021. Patient #5: The RN conducted a visit on 12/22/2021. The documentation was not completed until 12/27/2021.