Every finding on record at 24-7 Quality Hospice Care, Inc.

Upon patient record review, 14 of 14 (Patient 1,2,3,4,5,6,7,8,9,10,11,12,13,14) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death.

Upon patient record review, 11 of 14 (Patient 1,2,3,4,5,6,7,10,11,12,13) 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: Patient 1: The medication profile 05/27/23 contains Famotidine,hydralazine, albuterol with no route. Corrected on site. Patient 2: The medication profile 07/05/23 contains V-D3 5000units daily with no route. Corrected on site. Patient 3: The medication profile 04/21/23 contains Oxygen 2-5 liters/min with no route. Corrected on site. Patient 4: The POC 07/01/22 contains oxygen 2-5 liters per NC, the medication profile contains Oxygen 2 Liters as needed. Patient 5: The medication profile 07/23/22 contains Prochlorperazine 25mg with no route. Patient 6: The POC 10/10/22 contains an order for Morphine 20mg/ml 0.25ml Q2 hours prn. The medication profile contains Morphine 20mg/ml 0.5ml Q2 hours prn. The POC 10/10/22 contains an order for oxygen 2-3 liters prn, the medication profile contains Oxygen 2-5 liters prn. Patient 7: The POC 02/14/23 contains an order for Morphine 20mg/ml 0.25ml Q3 hours prn, the medication profile contains Morphine 20mg/ml 0.5ml Q2 hours prn. Patient 10: The POC 11/10/22 contains Tylenol every 8 hours, the medication profile contains Tylenol every 6 hours. The medication profile contains levothyroxine, ferrous, calcium with no route. The POC contains Tramadol twice daily for pain, the medication profile contains Tramadol BID prn. Patient 11: The POC 08/19/22 contains Levothyroxine 25mcg daily. The medication profile contains Levothyroxine 25mg daily. The POC contains Pantoprazole 40mg 2 daily, the medication profile contains Pantoprazole 40mg 1 tab daily. The POC contains Metformin 500mg 1 BID. The medication profile contains Metformin 500mg daily. Patient 12: The medication profile 07/03/22 has Oxycodone 5mg Q4 hours prn, there is no evidence of an order on the POC. Patient 13: The medication profile 06/03/21 contains Tylenol 500mg Q6 hours prn, there is no evidence of an order for Tylenol on the POC.

Upon patient record review, 14 of 14 (Patient 1,2,3,4,5,6,7,8,9,10,11,12,13,14) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: Patients 1,2,3,4,5,6,7,8,9,10,11,12,13,14: The agency uses a prepopulated POC where they fill in the visit orders (SN 2 times a week). After the visit order is filled in "and PRN" is prepopulated. There is no number of PRN's in the order for frequency. The orders just say "and PRN". This is for all disciplines.

Upon patient record review, 7 of 14 (Patient 1,2,3,10,11,12,13) 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: The POC 02/27/23 contains Famotidine with no frequency, Furosemide with no frequency, Oxygen with no route. Corrected on site. Patient 2: The POC 07/05/23 contains Gabapentin with no route, V-D3 with no route. Corrected on site. Patient 3: The POC 04/21/23 contains Tylenol 500mg Q6 hours, the medication is taken PRN. Oxygen 2-5 liters/min with no route. Corrected on site. Patient 10: The POC 11/10/22 contains an order for Tylenol, Tramadol, and docusate sodium with no routes. Patient 11: The POC 02/17/22 contains Metformin with no route. Patient 12: The POC 09/03/22 contains hydrocodone/acetaminophen with no route or reason, Xopenex Q6 hours prn with no dose, route or reason. Patient 13: The POC 06/03/22 contains HCTZ, Oxygen and Quetiapine with no route.

Upon patient record review, 2 of 14 (Patient 1,3) 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: Upon home visit finding the patient was wearing heel protectors and has suction. There is no evidence of them being listed on the POC. Patient 3: Upon home visit finding the patient was wearing heel protectors and there is no evidence of them being listed on the POC.

Upon client record review, 5 of 14 (Patient 2,6,10,13,14) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 2: The POC contains an order for SN daily for 10 days and reassess. There is evidence the patient was seen on 04/03/23, 04/06/23, 04/10/23, 04/13/23, 04/17/23. There is not evidence of an order to discontinue the daily visits and no evidence in the documentation that the daily visits were no longer needed. The POC contains an order for MSW once a month, there is no evidence the MSW saw the patient in April 2023. There is no missed visit documentation. Patient 6: The nurse documents on 10/12/22 @12:00 Oxygen increased to 4 liters. There is evidence the POC order is for Oxygen 2-3 liters prn. Patient 10: The POC on 11/10/22 contains an order for nursing 3 times a week. There is evidence the patient was only seen twice (Nov. 10 & 12) by the nurse the week of Nov 6-12. Patient 13: On 06/13/22 the nurse documented "SN administered morphine SL 0.5ml". There is evidence in the POC the Morphine order is for 0.25ml. Patient 14: The POC contains an order for SN twice weekly. The nurse did not see the patient after admission until 06/04/23. There is no missed visit documentation.

Upon patient record review 4 of 14 (Patient 2,4,12,13) did not have evidence documentation in the patient record that a hospice aide provides services that are: Patient 2: The POC 04/04/23 contains an order for an aide twice weekly. The aide made the first visit this certification period on 04/14/23 and saw the patient once weekly there after. There is no evidence of missed visit documentation or an order to decrease visits to once weekly. Patient 4: The POC 07/01/22 contains an order for an aide twice weekly. The aide's first visit to the pt was 07/08/22. There is evidence the aide saw the patient once weekly until discharge. There is no evidence of missed visit documentation or an order to decrease visits to once weekly. Patient 12: The POC 07/05/22 contains an order for an aide twice weekly. The aide's first visit to the pt was 07/07/22 and then pt was seen by the aide once weekly, there were no missed visit documentations and no evidence of an order to decrease the aide visits to once weekly. Patient 13: The POC 03/03/22 contains an order for an aide 2 times per week. The aide did not see the patient until 03/10/22 and then saw once a week until she passed away. There was no evidence of missed visit documentation and no order to decrease visits to once weekly.

Upon patient client record review, 1 of 14 (Patient 8) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 8: The nurse documented her Comprehensive assessment was completed on 02/09/23 from 18:00-19:30. She then adds a second nursing visit note 02/09/23 from 19:15-20:00. These times overlap for the two visits.

Upon client record review, 3 of 14 (Patient 4,11,12) did not have evidence that the discharge summary includes all required information. Patients 4,11,12: The patient record did not contain evidence of a discharge summary that included: A summary of the patient's stay, including treatments, symptoms and pain management, The patient's current plan of care, The patient's latest physician orders, Any other documentation that will assist in post-discharge continuity of care or that is requested by the attending physician or receiving facility.