Every finding on record at Vistacare of Boston, LLC

Upon patient record review, 1 of 14 (Patient #10) 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 10: MAR has "Bisacodyl 10mg rectal supp every 24 hours prn for constipation" and "Milk of Magnesium 400 mg/5ml 30ml by mouth every 24 hours PRN for constipation". No instructions listed on either medication as to which medication for constipation to give first and which to use second.

Upon patient record review, 1 of 14 (Patient #7) 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 7#: No evidence of bereavement risk assessment being completed within the first 5 days. Patient admitted on 01/21/2023, bereavement risk assessment completed on 03/08/2023. SW completes bereavement risk assessments for this agency.

Upon patient record review, 1 of 14 (Patient #4) 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 #4: Patient had a wound that was identified, measured, and added to the POC by the nurse on 09/04/23. No measurements were obtained for the week of 09/11/2023. Agency policy is to measure wounds weekly/every 7 days.

Upon patient record review, 1 of 14 (Patient #10) 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 #10: MAR has "Bisacodyl 10mg rectal supp every 24 hours prn for constipation" and "Milk of Magnesium 400 mg/5ml 30ml by mouth every 24 hours PRN for constipation". No instructions listed on either medication as to which medication for constipation to give first and which to use second.

Upon personnel record review, 1 of 12 (Personnel #2 ) did not have evidence the alternate administrator's personnel record verifies that: • The employee has appropriate education and experience requirements • There is a signed job description for this role • The employee has been orientated to this role Personnel #2: No evidence of a signed job description or orientation checklist as the alternate administrator on file. Corrected on site.