Every finding on record at Rose Desert Hospice

Upon patient record review, 2 of 5 (Patient #1,#2) 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#1: The medication profile indicated Acetaminophen 500mg 1 caplet PO every 6 hours pain/fever. There was no parameters for fever listed. Also, the medication profile indicated duplicate orders of Docusate Sodium 250mg 1 caplet PO BID and Senna Plus 8.6/50mg Daily. No order as to what to give first then second. Patient#2: The medication profile indicated Mupirocin 2% topical cream daily and as needed to surgical wound for soiling/loss of integrity until healed and further MD order. There was no evidence of the surgical wound location as where to apply ointment.

Upon patient record review, 3 of 5 (Patient #1,#2,#3) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient#1:An order dated 1/10/24, indicated SW and SC "May conduct telehealth visits if it is feasible and appropriate to do so." There was not an indication of the quantity of visits. Patient#2:An order dated 1/03/24, indicated SW and SC "May conduct telehealth visits if it is feasible and appropriate to do so." There was not an indication of the quantity of visits. Patient#3:An order dated 1/10/24, indicated SW and SC "May conduct telehealth visits if it is feasible and appropriate to do so." There was not an indication of the quantity of visits.

Upon patient record review, 2 of 5 (Patient #1,#2) 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#1: The record indicated Acetaminophen 500mg PO 1 capsule every 6 hours PRN pain/fever. There was no parameters for fever listed. Patient#2: The record indicated Mupirocin 2% topical cream daily and as needed to surgical wound for soiling/loss of integrity until healed and further MD order. The order did not identify the location of the surgical wound.

Upon patient record review, 2 of 5 (Patient #4,#5) 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. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient#4: There was no evidence of a follow up 2 month phone call to the bereaved, or documentation to support why phone call was not made. Patient#5: There was no evidence of a bereavement care plan or documentation supporting that the bereaved refused follow up. Corrected onsite.

Upon personnel record review, 1 of 10 (Personnel #5) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel#5: There is no evidence of supervisor's signature on initial orientation competency checklist to confirm competency.

Upon patient client record review, 3 of 5 (Patient #1,#2,#3) did not have evidence that each patient record contains Advance Directives. Patient#1,Patient#2,Patient#3: All records indicated patients were DNR. There was not evidence of advanced directives in chart. Corrected onsite.

Upon personnel record review, 1 of 10 (Personnel #10) did not have evidence that all Speech Therapy Services are provided by a qualified licensed Speech-Language Pathologist (SLP) or Audiologist in accordance with the state's Speech-Language Pathology Practice Act and the hospice's policies and procedures and/or job descriptions. Agency was unable to provide personnel files.

Upon personnel record review, 1 of 10 (Personnel #9) did not have evidence all Occupational Therapy Services are provided by a qualified licensed Occupational Therapist (OT) in accordance with the state's Occupational Therapy Practice Act and the hospice's policies and procedures and/or job descriptions. Agency was unable to provide personnel files.

Upon personnel record review, 1 of 10 (Personnel #8 ) did not have evidence all Physical Therapy Services are provided by a qualified licensed Physical Therapist (PT) in accordance with the state's Physical Therapy Practice Act and the hospice's policies and procedures and/or job descriptions. Agency was unable to provide personnel files.