Every finding on record at Vnacare

Upon patient record review and direct observation during home visits, 4 of 19 (Patient #1, 7, 10, 12) 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 Patient 1: The patient's oxygen did not appear on the medication list. (corrected onsite) Patient: 7: The medication list indicated 8 hour pain reliever 650mg ER 1 tab po q 12 hrs PRN mild/moderate pain. This is an invalid medication entry as it does not specify a drug name, and subsequently drug efficacy and safety checks (such as side effects and interactions) cannot be performed. (corrected onsite) Patients 10, 12: The medication list indicated Miralax for PRN use, but did not contain instructions for reconstitution of this powdered medication. (corrected onsite)

Upon patient record review, 1 of 19 (Patient #8) 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 8: During the initial comprehensive assessment, it was identified that the patient requires a pureed diet with thickened liquids. It was also noted that this ALF resident requires assistance with ADLS, including feeding. However, no care plan was developed at that time or subsequently to address the patient's aspiration risk status to ensure while feeding. Of note, the admitting SN does note that the patient is an aspiration risk. (corrected onsite)

Upon patient record review, 3 of 19 (Patient #5, 6, 7) 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. Patients 5, 6: Patients utilize an indwelling Foley catheter for management of their terminal illness. However, the care plans were incomplete in that they did not contain evidence of the size of the Foley catheter, the balloon size, or the frequency of the catheter change. (corrected onsite) Patient: 7: The plan of care indicated 8 hour pain reliever 650mg ER 1 tab po q 12 hrs PRN mild/moderate pain. This is an invalid medication order as it does not specify a drug name, and subsequently drug efficacy and safety checks (such as side effects and interactions) cannot be performed. (corrected onsite)

Upon client record review, 1 of 19 (Patient #1) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: The plan of care indicates that the MSW will provide services 1 x monthly; however, there was no evidence that the MSW provided a visit during April 2024.

Upon patient record review, 15 of 19 (Patient #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 13, 14, 18, 19) did not have evidence in the patient record that hospice aide assignments and duties are: • 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 Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 13, 14, 18, 19: The hospice aides assignments indicated the frequency of the hospice aide visits to the patients homes, but did not indicate the frequency for each task to be performed by the aide. This was noted to be a process error for all records examined with a hospice aide assigned. (corrected onsite via the writing and implementation of a local policy)

Upon patient record review 1 of 19 (Patient #3) 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 3: The plan of care indicates that the HA will provide services 2 x weekly; however, during the week of 04.07.2024, there was only evidence of 1 HA visit performed on 04.07.2024.