Every finding on record at Tjs Management, LLC

Upon patient record review, 1 of 19 (Patient #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 Patient 3:The medical record contains nursing documentation on 9/1/23, 9/4/23 and 9/8/23 that patient had a bowel movement after using a coffee enema. There is no evidence of an entry for coffee enema on the medication profile. Corrected on site.

Upon patient record review, 1 of 19 (Patient #1) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient 1:The medical record contains documentation of a pain exacerbation on 10/6/23 and a subsequent order entry of Fentanyl Patch 12 mcg q 72 hours. There is no evidence that a reassessment was completed and documentation of the patient's response to the update to the plan of care.

Upon patient record review, 1 of 19 (Patient #11) 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 11:Upon admission, there is nursing documentation of a stage II to pressure ulcer to the right buttocks. There is no evidence of problems, goals and interventions on the plan of care related to skin integrity or wound care. Corrected on site.

Upon patient record review, 1 of 19 (Patient #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 medications and treatments. Patient 3: The medical record included nursing documentation on 9/1/23, 9/4/23 and 9/8/23 that patient had bowel movement after using coffee enema. There is no evidence of an order for a coffee enema on the plan of care. Corrected on site.

Upon patient record review, 1 of 19 (Patient #1) 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 aide plan of care dated 8/16/23 did not include aspiration precautions. Corrected on site.