Every finding on record at Solace Hospice Care LLC

Upon patient record review, 4 of 19 (Patient #1,2,8,9) 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 • Drug therapy currently associated with laboratory monitoring Patient 1: Upon home visit to facility there is noted inconsistencies between Agency and Facility medication list including Lidocaine patch apply once daily to right knee noted on agency medication profile with no dose or instructions of when to remove patch. Facility order specifies that lidocaine patch is to be removed daily at bedtime. In addition, the facility medication profile is missing the following medications Cholecalciferol 125mcg 2 tabs daily, Lasix 20mg once daily, and Milk of Magnesia 8% oral suspension 30 ml every 24 hours PRN which are listed on the hospice agency medication profile. Corrected on site with med reconciliation completed by agency nurse visit at facility on 6/19/25. Patient 2: Upon home visit to facility updated hospice agency medication list on 6/17/25 contains orders for hydroxychloroquine 200 mg tabs twice daily and Levothyroxine 125 mcg po daily that are not on facility medication profile. Corrected on site with medication reconciliation completed by agency nurse 6/19/25. Patient 8: There is evidence in the patient record 6/5/25 contains an order for diphenhydramine zinc topical cream ordered PRN without dose or specifics on location to apply cream. Corrected on site with updated order with dose and location of application. Patient 9: There is evidence in the patient record review 3/25/25 contains an order for clotrimazole-betamethasone 1% topical lotion apply to affected area twice daily with no evidence of dose amount or location to apply. Corrected on site with an updated order with dose and location of application.

Upon patient record review, 3 of 19 (Patient #1,2,7) 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 1: Patient is taking Eliquis with no evidence of risk of bleeding addressed on the POC. SN 6/19/25 POC updated to address risk for bleeding. Corrected on site with updated POC. Patient 2: The POC indicates patient is taking Xarelto with no evidence that POC includes risk for bleeding. Corrected on site with updated POC. Patient 7: Patient is on Xarelto with no evidence of POC addressing risk for bleeding. Corrected on site with new POC addressing bleeding risk and goals have been updated to include specific timeframes.

Upon patient record review, 2 of 19 (Patient #8,9) 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 8: Initial POC 4/4/25-5/19/25 and updated POC 6/5/25 contains an order for Diphenhydramine zinc topical cream ordered PRN without dose or application location. Corrected on site with an updated POC. Patient 9: The POC 3/25/25 contains an order for Clotrimazole-betamethasone 1% topical lotion apply to affected area twice daily with no dose amount or application location. Corrected on site with an updated order received and updated POC.

Upon patient record review, 2 of 19 (Patient #7,8) 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 7: Updated POC on 6/13/25 states "Pt will maintain optimal swallowing and patient/caregiver understands risk during care w/in ______ period of time." Corrected on site with new POC addressing goals have been updated to include specific timeframes. Patient 8: Updated POC 6/5/25 contains an intervention and goal stating "Caregiver will verbalize knowledge of s/s of aspiration and aspiration precautions. Promote optimal nutrition/hydration during care within ____ period of time." There is documentation patient has difficult swallowing and dysphagia. There is no evidence goal was updated and individualized with specific timeframe for goal/interventions. Corrected on site with updated POC with specific goal and timeframe.

Upon patient record review, 2 of 19 (Patient #1,2) 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 1: Upon home visit in the facility, the documentation in the facility on the initial and updated POC for brace to rt hand on in am, brace to remain on at lunch and only off at night, this is not on the hospice agency POC. Patient 2: The facility record contains an order for elevate left lower extremity and apply ice prn for pain/edema that is not on the hospice agency POC.

Upon patient record review, 1 of 13 (Patient #5) 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.

Upon patient record review, 1 of 13 (Patient #5) did not have evidence that the IDG documents the sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement. The SOC was 05/18/2022. The SW documented a phone call with the patient's son on 05/20/2022, wherein the son stated the patient was feeling overwhelmed with all of the Hospice clinician visits, and did not want a SW visit at this time. The MSW documents she will get back with the son on Monday 05/23/22 with some funeral planning information. There is no documentation that the patient/family are refusing ongoing MSW visits. The IDG POC dated 06/08/22 did not include a frequency nor scope of care/services to be provided the the Hospice SW. On this POC the SW writes, "SW did not visit the patient during this IDG period." There is no inclusion of the planned visit frequency, nor the scope of SW services to be provided, to include funeral planning.

Upon patient record review, 4 of 13 (Patients #1, 3, 5, and 7) did not contain evidence that the Hospice Aide Plan of Care/assignments and duties indicated what tasks were to be done by the Aide, the frequency of these tasks, and/or any indicated details of such tasks. For each of these records, the Aide POC assigned the following, "Apply Barrier Cream to _______", with this area of needed detail not included.

Upon patient record review, 2 of 13 (Patients #2 and 10) did not contain evidence that the Interdisciplinary Group, as part of the review of the Plan of Care, had determined the ability of the patient/family/caregiver to safely self-administer drugs and biologicals to the patient in his or her home. If the patient and/or family are not capable of safely administering drugs and biologicals in the home, the Hospice must address this issue in the patient's Plan of Care.

Upon SNF contract review, 1 of 1 applicable (Garden View Care Center/SNF/GIP/RIP) did not contain evidence of a provision stating that the Hospice assumes responsibility for determining the appropriate course of Hospice care; specifically to include: The determination to change the Level of Care and services to be provided.

Upon SNF contract review, 1 of 1 applicable (Garden View Care Center/SNF/GIP/RIP) did not contain a provision listing a delineation of all of the Hospice's responsibilities/services, which include but are not limited to the following: Social Work services.

Upon SNF contract review, 1 of 1 applicable (Garden View Care Center/SNF/GIP/RIP) did not contain a provision that the Hospice may use the SNF nursing personnel, where permitted by state law and as specified by the SNF, to assist in the administration of prescribed therapies included in the Hospice Plan of Care; only to the extent that the Hospice would routinely use the services of a Hospice patient's family in implementing the Plan of Care.

Upon personnel record review, 1 of 8 applicable (Personnel #8) did not contain evidence of a state Criminal Background Check (CBC) having been obtained in accordance with Missouri State requirement: (Section 660.315). Missouri Hospice Agencies must demonstrate documented evidence of a Missouri State Criminal Background Check having been obtained prior to any contact with a patient. Personnel #8's DOH was 04/06/2022. Her Missouri CBC was not obtained until 06/09/2022.