Every finding on record at Shrine Hospice Care Inc

Upon patient record review, 1 of 14 (Patient #9) 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 Patient 9: The patient was admitted for hospice services on 02.27.2023. On 04.28.2023, the caregiver called to report the patient had canker sores and requested medication due to the patient's oral chemotherapy. There is no evidence, at any time, of an oral chemotherapy agent on the medication list.

Upon patient record review, 1 of 14 (Patient #10) 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 10: The POST form indicates the patient's code status is full treatment/perform CPR. The patient was admitted for hospice services on 04.29.2023, and this full treatment status was noted at that time. There is no evidence in the patient record of any discussion with the patient & family, or among the IDT, since the time of admission related to the patient's code status or lack of advance directives. There is no evidence in the patient record of end of life planning, or the patient & family's preferences related to the patient's decline.

Upon patient record review, 14 of 14 (Patient #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14) 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, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14: For all patients, social work and chaplain visits were scheduled as 1 PRN visit for support to patient and family. (corrected onsite for all active patients)

Upon patient record review, 1 of 14 (Patient #9) 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 9: The patient was admitted for hospice services on 02.27.2023. On 04.28.2023, the caregiver called to report the patient had canker sores and requested medication due to the patient's oral chemotherapy. There is no evidence, at any time, of a physician's order for an oral chemotherapy agent.

Upon patient record review, 5 of 14 (Patient #1, 2, 3, 9, 10) 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 hospice aide care plan indicates that the patient requires a bath using the shower chair, a shampoo, and brushing the teeth, but does not specify the frequency for the performance of the tasks. (corrected onsite) Patient 2: The hospice aide care plan indicates that the patient requires a shower, a shampoo, and brushing the teeth, but does not specify the frequency for the performance of the tasks. (corrected onsite) Patient 3: The hospice aide care plan indicates that the patient requires a bed bath, a shampoo, and brushing the teeth, but does not specify the frequency for the performance of the tasks. (corrected onsite) Patient 9: The hospice aide care plan indicates that the patient requires a shower, a shampoo, and brushing the teeth, but does not specify the frequency for the performance of the tasks. (corrected onsite) Patient 10: The hospice aide care plan indicates that the patient requires a bath using the shower chair, a shampoo, and brushing the teeth, but does not specify the frequency for the performance of the tasks. (corrected onsite)