Every finding on record at Stratford Enterprises, Inc

Upon patient record review, 8 of 19 (Patient #3,5,6,8,11,12,13,14) 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 3: On patient’s medication profile: fentanyl patch 25mcg/hr transdermal patch. Instructions read to apply one patch transdermal every 72 hours; rotate sites. There is no evidence of instructions to remove old patch when placing a new one. Patient 5: On patient’s medication profile: 1: biofreeze menthol 4 percent topical gel. Apply to affected area(s) as needed for mild to moderate pain. There is no evidence of application site. 2: Diclofenac 1 percent topical gel. Apply 4 grams to affected area 4 times daily. There is no evidence of application site. Patient 6: On patient’s medication profile: 1: Benadryl 2 percent topical gel. Apply one inch to affected area twice daily as needed for rash. There is no evidence of application site. 2: Trulicity 1.5mg/0.5mL subcutaneous injector. Inject 0.5mL once a week on Wednesday. There is no evidence of instruction to rotate injection sites. Patient 8,11,12: On patient’s medication profile: Miralax 17 grams/dose powder. Give 17 grams by mouth daily. There is no evidence of reconstitution instructions. Patient 13: On patient’s medication profile: Nystatin 100,000 units/gram topical powder. Apply to affected area 4 times daily as needed. There is no evidence of application site. Patient 14: On patient’s medication profile: Scopolamine patch 1mg. apply one patch transdermal every 72 hours as needed for nausea/vomiting. There is no evidence of instructions to remove old patch when placing a new one. There is no evidence of instruction to rotate application sites.

Upon patient record review, 4 of 19 (Patient #1,2,3,17) 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 1: Patient’s start of care date was 09/03/2023. There is no evidence of bereavement assessment until 12/01/2023. Patient 2: Patient’s start of care date was 01/31/2024. There is no evidence of bereavement assessment until 02/07/2024. Patient 3: Patient’s start of care date was 11/17/2023. There is no evidence of bereavement assessment until 11/28/2023. Patient 17: Patient’s start of care date was 11/17/2023. There is no evidence of bereavement assessment until 12/12/2023.

Upon patient record review, 8 of 19 (Patient #3,5,6,8,11,12,13,14) 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 3: In patient’s plan of care: fentanyl patch 25mcg/hr transdermal patch. Instructions read to apply one patch transdermal every 72 hours; rotate sites. There is no evidence of instructions to remove old patch when placing a new one. Patient 5: In patient’s plan of care: 1: biofreeze menthol 4 percent topical gel. Apply to affected area(s) as needed for mild to moderate pain. There is no evidence of application site. 2: Diclofenac 1 percent topical gel. Apply 4 grams to affected area 4 times daily. There is no evidence of application site. Patient 6: In patient’s plan of care: 1: Benadryl 2 percent topical gel. Apply one inch to affected area twice daily as needed for rash. 2: Trulicity 1.5mg/0.5mL subcutaneous injector. Inject 0.5mL once a week on Wednesday. There is no evidence of instruction to rotate injection sites. Patient 8,11,12: In patient’s plan of care: Miralax 17 grams/dose powder. Give 17 grams by mouth daily. There is no evidence of reconstitution instructions. Patient 13: In patient’s plan of care: Nystatin 100,000 units/gram topical powder. Apply to affected area 4 times daily as needed. There is no evidence of application site. Patient 14: In patient’s plan of care: Scopolamine patch 1mg. apply one patch transdermal every 72 hours as needed for nausea/vomiting. There is no evidence of instructions to remove old patch when placing a new one. There is no evidence of instruction to rotate application sites.

Upon patient record review, 3 of 19 (Patient #12,13,14) 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 equipment and supply needs. Patient 12, 13, 14: There is a physician’s order for oxygen. There is no evidence of oxygen in the DME plan of care.

Upon client record review, 2 of 19 (Patient #5,14) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 5: Ordered visit frequency for volunteer visits is twice monthly. There is evidence of volunteer visits made outside this frequency. Patient was seen by volunteer once in June 2024. Visit dates in July 2024 were 7/2, 7/8, 7/19, 7/26. Patient 14: Ordered visit frequency for volunteer visits is monthly. There is evidence of volunteer visits made outside this frequency. Patient was seen by volunteer twice in May 2024 and twice in July 2024. Visit dates: 5/28, 5/29, 7/30, 7/31.

Upon patient record review, 9 of 19 (Patient #1,2,3,4,5,6,7,12,14) 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: There is no evidence of oxygen, fall precautions on the aide care plan, despite both being on the plan of care. Patient 2: There is no evidence of wound precautions on the aide care plan, despite being on the plan of care. Shaving is an assigned task on the aide care plan. Frequency states every visit per caregiver request. There is no evidence of a statement that the caregiver has cognitive ability to make this choice. Patient 3: There is no evidence of fall, oxygen, aspiration precautions on the aide care plan, despite being on the plan of care. Patient 4: Assigned tasks on the aide care plan: transfer bed/chair, change linen, assist to bedside commode. Frequency states every visit per patient request. There is no evidence of a statement that the patient has cognitive ability to make this choice. Patient 5: There is no evidence of aspiration precautions on the aide care plan, despite being on the plan of care. Nail care, shampoo are assigned tasks on the aide care plan. Frequency states every visit per patient/caregiver request. There is no evidence of a statement that the patient/caregiver has cognitive ability to make this choice. Patient 6: There is no evidence of fall, aspiration, wound precautions on the aide care plan, despite being on the plan of care. Patient 7: Change linen, bed bath are assigned tasks on the aide care plan. Frequency states every visit per caregiver request. There is no evidence of a statement that the caregiver has cognitive ability to make this choice. Patient 12: There is no evidence of fall precautions on the aide care plan, despite being on the plan of care. Patient 14: There is no evidence of fall, aspiration precautions on the aide care plan, despite being on the plan of care.