Every finding on record at Symbol Healthcare Inc

Upon patient record review, 3 of 8 (Patients #4,#5,#6) 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 4: The medication profile contained cholestyramine oral powder with no instructions for a diluent, and miconazole nitrate topical powder with no defined affected areas for administration. Corrected on site. Patient 5: The medication profile contained oxygen with no delivery method identified for administration. Patient 6: The medication profile contained oxygen with no delivery method identified for administration.

Upon patient record review, 1 of 8 (Patient #1) 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: The medical record contained nursing documentation identifying patient issues with constipation 2/21/23. There was no evidence of problems, goals, and interventions related to constipation included care plan. Corrected on site.

Upon patient record review, 5 of 8 (Patients #1,#4,#5,#6,#8) 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 medical record contained an incomplete wound care order with no defined location. Corrected on site. Patient 4: The medical record contained orders for cholestyramine oral powder with no instructions for a diluent, and miconazole nitrate topical powder with no defined affected areas for administration. Corrected on site. Patient 5: The medical record contained an order for oxygen with no delivery method identified for administration. Patient 6: The medical record contained an order for oxygen with no delivery method identified for administration. Patient 8: The medical record contained incomplete wound orders 2/7/23 and 2/10/23 with no defined wound locations.

Upon patient record review, 2 of 8 (Patients #2,#5) 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 2: The medical record contained nursing documentation upon admission identifying patient use of a hospital bed. There was no evidence of the bed included as DME in the plan of care. Corrected on site. Patient 5: The medical record contained nursing documentation upon admission identifying patient use of a walker. There was no evidence of the walker included as DME in the plan of care.

Upon client record review, 2 of 8 (Patients #3,#8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 3: The medical record contained an order 2/22/23 to increase nursing visits to daily. The frequency was not met 2/23/23 and 2/25/23. Patient 8: The medical record contained an order for nursing frequencies to be completed once weekly. Two scheduled nursing visits were completed the week of 2/5/23.

Upon patient record review, 1 of 8 (Patient #7) 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 7: The aide care plan contained two bathing tasks of bed bath and shower each with frequencies of every visit.

Upon inpatient contract review, 2 of 4 (Orchard Park and Heartwood GIP/Respite contract) did not have evidence that the hospice patient's inpatient clinical record includes a record of all inpatient services furnished and events regarding care that occurred at the facility; that a copy of the discharge summary be provided to the hospice at the time of discharge; and that a copy of the inpatient clinical record is available to the hospice at the time of discharge.