Every finding on record at A-1 Hospice Care Center 4 U, Inc.

Upon patient record review 1 of 19 (Patient #3) did not have evidence that the hospice Registered Nurse must complete an initial assessment within 48 hours after the election of hospice care in accordance with §418.24 Patient #3: Election statement effective date is identified as 4/21/23. Document signatures have typed date for 4/19/23. Services began 4/19/23 with RN Comprehensive Assessment. SOC and Benefit period identified as 4/19-7/17/23. RN assessment completed prior to admission and not with 48 hours after admission according to election statement.

Upon patient record review, 4 of 19 (Patient #2, 5, 11, 14) 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 #2: 5/9/23 Tx /Rx order Left buttock stage 2 pressure sore: Cleanse with NSS, pat dry, apply triple antibiotic ointment; cover with dry dressing once daily OR as needed for soilage/loss of integrity until healed or further MD order. Patient #5: 4/20/23 Tx order to Start G-tube site care per MD order; remove old dressing; discard using double bag techniques; observe the site for s/sx of infection, irritation. Clean skin around the tube with NSS 0.9%; pat dry, cover with 4x4. split gauze pad slept around the tube and secure with tape daily or as needed if soiled. Patient #11: 4/1/23 Tx order: Rt. great toe diabetic wound. Clean with NS. Pat dry. Apply Medi-honey and collagen powder and cover with dry dressing once daily OR as needed for soilage, loss of integrity or wound healed. Right Buttock wound Stage 2 Clean with Normal Saline. Pat dry. Apply triple antibiotic ointment and cover with bordered dressing daily OR as needed for soilage, loss of integrity or wound healed. Patient #14: 5/29/23 MD Order lateral malleous ulcer wound treatment. Cleanse with Normal Saline solution, pat dry, apply Mupriocin ointment. cover with dry dressing once daily OR as needed until healed or further MD orders.

Upon patient record review, 1 of 19 (Patient #7) 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 #7: Foley catheter 20 fr 10 cc balloon inserted 5/5/23. The information was reported to IDG, but IDG POC not updated to include related interventions/goals

Upon patient client record review, 2 of 19 (Patient #3, 6) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #3: Election statement effective date is identified as 4/21/23. Document signatures have typed date for 4/19/23. Services began 4/19/23 with RN Comprehensive Assessment. SOC and Benefit period identified as 4/19-7/17/23. Patient #6: Election statement effective date is 4/6/23. Docs signed 4/6/23. Services began 4/7/23 with RN Initial Comprehensive Assessment, SOC and Benefit period identified as 4/7-7/5/23.

Upon patient client record review, 1 of 19 (Patient #2) 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 #2: MSW references G-Tube in 4/13/23 Initial Assessment: Patient has decreased appetite on G-Tube and increased sleep pattern." There is no other reference to G-Tube in RN assessment 4/11/23 or in IDG problem list. Interview with staff confirms this patient did not have G-Tube.