Every finding on record at Tinosa Hospice Inc

Upon patient record review, 1 of 13 (Patient #2) did not have evidence that the patient has received effective pain management and symptom control from the hospice for conditions related to the terminal illness. Patient #2 HSP POC dated 8/16/24 Pain is addressed as an issue ongoing from the Admission Comprehensive assessment. This patient reported pain to LPN rating "6-7/10" and LPN states "he says he uses OTC Advil as needed, but he hoped they would offer him something else". There were no pain medications on the HSP POC or med profile. The LPN stated she would contact the Case manager about pain management.

Upon patient record review, 2 of 13 (Patient #2,3) 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 Upon observation during home visits, 2 of 13 patients had inconsistent medications on profiles/POC and what was seen in home and stated as taken: Patient #2 (LPN translating) stated he takes "over the counter Advil at times for pain", this medication is not on HSP med profile or POC- RX bottle for Risperdal 0.5mg tablet instructs to take at noon and bedtime, HSP POC / med profile states once daily at bedtime-RX bottle in home for Loratadine 10mg take one tablet daily, not on HSP POC or med profile. Patient #3 (LPN translating for pt and family member) Medications in home being administered to pt per family member that are not included on HSP POC or med profile. Drisdol, Vit D2 1.25mg (50,000 U) orally once weekly, Meclizine 25mg take one by mouth daily for dizziness, Senna 8.6mg by mouth "as needed" per family member and LPN. The following medications are included on HSP POC and med profile and were not able to be produced in the home by the family: Vascepa 1g soft gel capsule oral twice a day, Donepezil Hydrochloride 5mg tablet, oral, daily, Carvedilol 6.25mg tablet oral daily, Bisacodyl 10mg Rectal suppository daily as needed for constipation, Albuterol Sulfate 1.25mg/3ml Solution for inhalation "every 4-6 hours as needed for COPD". Ibuprofen on HSP POC and med profile for 600mg oral every 8 hours prn pain and the RX bottle in the home is labeled 800mg tablets, one tablet oral, every 8 hours as needed for pain.

Upon patient record review, 1 of 13 (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 noted to be taking Plavix 75mg daily, Risk of bleeding not included on POC.

Upon patient record review, 3 of 13 (Patient #1,2,3) 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 #1 HSP POC dated 8/16/24 states "patient has significant right-sided weakness, necessitating the use of a cane and a walker. The DME section on POC is blank. Patient #2 HSP POC dated 8/16/24 states "patient has mobility issues and requires a walker for ambulation" pt answered door for home visit ambulating without assist of walker, with LPN translating, Surveyor asked to see his walker, LPN translated, "he said they haven't delivered it yet". DME section on POC is blank. This patient also reported pain to LPN rating "6-7/10" and LPN states "he says he uses OTC Advil as needed, but he hoped they would offer him something else". Patient #3 HSP POC dated 8/16/24 states pt is ambulatory and requires a walker, interventions even list "Ensure walker is properly adjusted and in good condition" The DME section on POC is blank. LPN translated for this pt and family , Surveyor asked about a walker being provided, the family was not able to produce a walker and after looking all over home, the LPN stated, "they think it is in the wife's car". The HSP POC also notes an Intervention for Respiratory symptom management stating Albuterol inhalation treatments per Nebulizer every 4-6 hours as needed to relieve acute symptoms and maintain airway patency. The family and the LPN were unable to produce the Medication or the actual Nebulizer machine. DME section on POC is blank. (note: agency staff provided the email order for the walker and Nebulizer sent 7/3/24 and the email verification of delivery of these items. The team will follow up with family to locate DME)

Upon personnel record review, 1 of 12 (Personnel #4 ) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(C) Shampoo, sink, tub, and bed Personnel #4 only demonstrated shampoo in shower. (agency will add Shampoo in Sink, tub and bed to competency)