Every finding on record at Vistacare USA, LLC

Upon patient record review 1 of 19 (Patient #9) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #9 admitted on 10/19/23. The initial spiritual assessment was completed on 10/25/23.

Upon patient record review, 5 of 19 (Patient #1,8,10,12,13) 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 #1 Flonase 50mcg 1 spray at bedtime, did not include which nare(s). Patient #8 Care plan included DME for oxygen and oxygen present during surveyor visit. Med profile did not include oxygen dose/frequency/usage. Med profile included Propylene Glycol 1 drop four times daily. No evidence to include which eye(s) for the drops. Patient #10 RN visit on 6/15/24 documents oxygen 2-4 liters, nursing visit on 7/11/24 documents oxygen stored properly. Med profile did not include oxygen dose/frequency/usage. Patient #12 RN visit on 7/9/24 documents oxygen 2 liters nasal canula PRN. Med profile did not include oxygen dose/frequency/usage. Patient #13 Fluticasone 50mcg nasal spray 2 sprays daily, did not include which nare(s).

Upon patient record review, 5 of 19 (Patient #4,8,10,12,13) 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 #4 and 13 oxygen ordered, no evidence of a care plan to include oxygen and oxygen safety. Patient #8 oxygen DME ordered, no evidence of a care plan to include oxygen and oxygen safety. Patient #10 and 12 Nursing documentation of oxygen in use, no evidence of a care plan to include oxygen and oxygen safety.

Upon patient record review, 5 of 19 (Patient #1,8,10,12,13) 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 Flonase 50mcg 1 spray at bedtime, did not include which nare(s). Patient #8 Care plan included DME for oxygen and oxygen present during surveyor visit. No evidence of an order for oxygen dose/frequency/usage. Order for Propylene Glycol 1 drop four times daily. No evidence to include which eye(s) for the drops. Patient #10 RN visit on 6/15/24 documents oxygen 2-4 liters, nursing visit on 7/11/24 documents oxygen stored properly. No evidence of an order for oxygen dose/frequency/usage. Patient #12 RN visit on 7/9/24 documents oxygen 2 liters nasal canula PRN. No evidence of an order for oxygen dose/frequency/usage. Patient #13 Fluticasone 50mcg nasal spray 2 sprays daily, did not include which nare(s).

Upon patient record review, 3 of 19 (Patient #2,12,13) 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 #2,12,13 nursing documentation shows oxygen in the home. No evidence of oxygen order for DME.

Upon patient record review, 2 of 19 (Patient #11,14) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #11 order on 3/20/24 may crush meds for difficulty swallowing. No evidence of aspiration precautions on the updated POC. Patient #14 oxygen and Plavix added after admission. No evidence of oxygen and bleeding precautions on the POC.

Upon client record review, 7 of 19 (Patient #2,7,8,9,11,12,13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2 order on 4/25/24 for SW frequency effective 4/24/24 of 2M2 and 2 PRN. SW visit completed on 4/25/24, no evidence of a second visit for April or a refusal. SW visits completed on 6/17/24 and 6/25/24, no evidence of an order for these visits. Patient #7 order on 6/28/24 for volunteer frequency of 1x week, volunteer visit made 6/28/24 and no visits after that or refusal. Patient #8 order on 5/3/24 for SW frequency effective 5/1/24 of 1M3 and 2 PRN, SW visits completed on 5/3/24 and 5/16//24. Order on 4/30/24 for SC effective 4/29/24 of 1 every 2M2, 1M2 and 3 PRN, SC visits completed on 4/30/24 and 5/21/24. Patient #9 order on 6/5/24 for SW frequency effective 6/15 of 1m2 and 2prn. No evidence of SW visits or a refusal of a visit from 6/15-6/30. The 3/11/24 volunteer care plan included companionship, socialization, and respite 1x week. Order on 4/10/24 effective 4/16 ordered volunteer 1x month. Volunteer visits completed 4/18, 4/25. Volunteer visit completed on 4/25 documented companionship, visit on 5/23 documented haircut provided. Patient #11 order on 2/28/24 for SC frequency effective 2/28/24 of 2 every 2M2, 2M1,1M1, SC visits completed on 2/29/24, 3/8/24 and 3/22/24. Patient #12 order on 4/23/24 for SC frequency effective 4/22/24 of 2 every 2m2, 2m1, 1m1 and 3prn. SC visits completed on 4/23, 5/23, 5/30, 6/13. Order on 4/25/24 for SW frequency effective 4/22/24 of 2m2, 1m2 and 3prn. SW visits completed on 4/25, 5/14. No evidence of a refusal of visits. Patient #13order on 1/24/24 for SW frequency effective 1/24/24 of 1 every 2M2, 2M2, 1M2, SW visits completed on 1/25/24 and 2/1/24. Order on 1/24/24 for SC frequency effective 1/24/24 of 2 every 2M2, 2M1, 1M1, SC visits completed on 2/8/24 and 2/22/24.

Upon patient record review, 3 of 19 (Patient #12,13,14) 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 #12 and 13 care plan identified patient as high fall risk, no evidence of fall precautions on aide care plan. Patient #14 on Plavix, no evidence of bleeding precautions on the aide care plan.

Upon patient record review 4 of 19 (Patient #10,11,12, 14) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #10 Aide care plan included assist with feeding every visit and nail care weekly. Aide visits 7/11/24 and 7/13/24 documented nail care performed. Aide visit on 7/16/24 documented assist with feeding not needed per frequency. Patient #11 Aide care plan included shampoo every visit. Aide visits on 5/3/24 and 5/6/24 documented shampoo not needed per frequency. Patient #12 Order on 5/16/24 for aide frequency effective 5/19/24 of 1 every 2W2, 1W7. Aide visits completed on 5/21/24 and 5/28/24. Patient #14 aide care plan included shave and shampoo as every visit. Aide visits on 6/28/24 and 7/8/24 documented shave not needed per frequency, visits on 7/12/24 and 7/17/24 documented shave and shampoo not needed per frequency.

Upon client record review, 2 of 19 (Patient #1,10) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #1- There was order on 6/6/24 for SW frequency effective 6/23/24 of 2m2, 1m1 ,2prn. No evidence of SC visit or refusal from 6/23-6/30. Patient #10- There was an order on 6/18 for SC frequency effective 6/15/24 of 1every2m2, 1m1, and 3prn. SC visits completed on 6/18 and 7/15. Order on 6/18/24 for SW frequency effective 6/15/24 of 2m2 and 2prn. SW visit on 6/18, no evidence of a second visit in June or refusal.