Every finding on record at A Life Care Hospice Inc.

Upon patient record review, 4 of 14 (Patient #1,2,6,9) 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 12/11/24 Order for Triamcinolone cream states to "apply to affected area", no evidence of orders stating specific location. Corrected on site. Patient #2 Medication profile has orders for Acetaminophen RS, Oxycodone and Tylenol with no evidence of order containing instructions of "Not to exceed 4gm per 24 hour period". Corrected on site. Patient #6 8/7/24 order for Diclofenac 1% cream to be applied daily PRN without indication of specific location on medication profile. Corrected on site. Patient #9 1/4/25 order for Diclofenac 1% cream and Clotrimazole cream to be applied BID without indication of specific location on medication profile. 2/20/25 Methylprednisolone taper dose x6 days with no evidence of medication discontinued after the 6 days as ordered. Corrected on site.

Upon patient record review, 3 of 14 (Patient #1,6,9) 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 12/11/24 Order for Triamcinolone cream states to "apply to affected area", no evidence of orders stating specific location. Patient #6 8/7/24 order for Diclofenac 1% cream to be applied daily PRN without indication of specific location on medication profile. 8/7/24 order for wound care does not include specific wound care instructions including type of wound care and location of wound care. Corrected on site. Patient#9 1/4/25 order for Diclofenac 1% cream and Clotrimazole cream to be applied BID without indication of specific location on medication profile. 2/20/25 Methylprednisolone taper dose x6 days with no evidence of medication discontinued after the 6 days as ordered. Corrected on site.

Upon patient record review, 3 of 14 (Patient #1,2,7) 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 #1 12/16/24 Orders to monitor skin tear to left FA x14 days remains on the treatment profile. 1/10/25 orders to monitor and perform wound care to sacrum, left heel and right heel x14 days remains on treatment profile. Corrected on site. Patient #2 12/14/24 Order to monitor skin tear to left FA x14 days remains on the treatment profile. 12/16/24 Order to monitor skin tear to right FA x14 days remains on the treatment profile. 12/31/24 Order to monitor wound to heel x14 days remains on the treatment profile. 12/9/24 order to monitor bruising to left side of neck x14 days remains on treatment profile. Corrected on site. Patient #7 8/14/24 Order to monitor bruising on bilateral hands x14 days remains on the treatment profile. Corrected on site.

Upon patient record review, 8 of 14 (Patient #1,2,3,5,6,7,8,9) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1 Nursing visit frequencies ordered 12/11/24 for RN Q14 days and SN 1x/week, during the week of 1/5/25 visits were made on 1/7/25 and 1/10/25 by the LVN and on 1/10/25 by the RN. Visits were made 2/7/25, 2/14/25, 2/21/25 and 2/28/25 by the RN, no evidence of additional visits per ordered frequency were completed. Patient #2 Nursing visit frequency orders written 1/19/25 to increase visits to 2x/week, no evidence of 2 visits made the week of 2/2/25, 2/9/25, 2/16/25 and 2/23/25 and no orders to decrease frequency. Corrected on site. Patient #3 Nursing visit frequencies ordered 9/6/24 for RN Q14 days and SN 1x/week, visits were made 1/3/25, 1/10/25, 1/17/25, 1/24/25, 1/31/25, 2/7/25, 2/14/25 and 2/21/25, no evidence of additional visits per ordered frequency were completed. Patient #5 MSW frequency orders written 8/23/24 for 1x/month, no evidence of MSW visit since 11/8/24. Patient #6 Nursing visit frequencies ordered 8/7/24 for RN Q14 days and SN 1x/week, visits were made 1/17/25, 1/24/25, 1/31/25, 2/7/25, 2/14/25, 2/21/25 and 2/28/25, no evidence of additional visits per ordered frequency were completed. Patient #7 Nursing visit frequencies written 7/9/24 as follows: RN to perform initial visit, SN PRN x1, SN 1x/week and SN to visits 1x within 48 hours for a tuck-in visit. The only visits made the week of 7/9/24 were on 7/9/24 and 7/11/24, no evidence of additional visits per ordered frequency were completed. Corrected on site. Patient #8 MSW frequency orders written 6/27/24 for 1x/month with no evidence of visit made 11/2024. Corrected on site. Patient #9 MSW frequency orders written 1/4/25 for 1x/month with no evidence of visit made 2/2025. Corrected on site.

Upon patient record review 2 of 14 (Patient #7,9) 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 #7 1/21/25, aide did not complete the tasks for "Equipment per RN instructions" and "Companionship per RN instructions" as ordered. Patient #9 2/13/25, aide did not complete the tasks for "Non-Ambulatory", "Incontinent Care", "ROM/Exercise" and "Companionship" as ordered. 2/19/25 aide did not complete the task for "Toileting" as ordered.

Upon patient record review 2 of 14 (Patient #4,7) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient #4 Orders effective 1/29/25 for aide visits 2x/week which were completed by the aide, however no evidence of RN supervisory visit completed until 2/28/25. Patient #7 RN supervisory visit for aide was completed on 2/7/25 and next visit was made 2/28/25, no evidence of visit made by 2/21/25 to comply with 14 days.