Every finding on record at A-One Hospice Providers, Inc

Upon patient record review, 1 of 14 (Patient #4) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #4 election of benefit section to elect attending physician was blank.

Upon patient record review, 10 of 14 (Patient #1,2,3,4,5,6,7,8,9,10) 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 #1,2,3,4,5,6,7,9,10 Oxygen was ordered and not included on the medication profile. Patient #8 order for oxygen is 2-5lpm per nasal cannula PRN. The medication profile included oxygen 2lpm nasal cannula.

Upon patient record review, 1 of 14 (Patient #4) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #4 No evidence of an initial bereavement risk assessment.

Upon patient record review, 2 of 14 (Patient #1,6) 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 1 had spiritual care involved, no evidence of a care plan to include problems goals and interventions for spiritual care. Patient 6 taking aspirin as a blood thinner, no evidence of bleeding precautions.

Upon patient record review, 1 of 14 (Patient #6) did not have evidence that the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions which including interventions to manage pain and symptoms. Patient 6 prescribed Tylenol, Morphine and Ativan, no evidence of a care plan for pain or anxiety to include identified problems, goals, and interventions.

Upon patient record review, 5 of 14 (Patient #2,3,4,7,8) 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: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #2 Order on 3/12/24 for aide 4xw and 2 prn; can not have aide prn orders on plan of care. Patient #3 Order on 1/12/24 for SW prn for psychosocial support; no evidence of routine frequency and quantity for prn. Patient #4 Order on 6/27/24 for SW initial eval plus prn visits per cert period, SC initial assessment once per month and prn, SN 1xw plus prn; no evidence of quantity for prn. Patient #7 Order on 1/15/24 for SW prn; no evidence of routine frequency and no quantity for prn. Patient #8 Order on 1/14/24 for SC once per month/every recert; no evidence of a specific frequency for visits.

Upon patient record review, 1 of 14 (Patient #1) 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 Admission nursing note 10/19/23 documented the use of hoyer lift and shower chair. No evidence of an order for the DME.

Upon patient record review, 1 of 14 (Patient #6) 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 6 spiritual care currently seeing patient monthly, on 5/17/24 the spiritual care plan was documented as resolved and no longer included an active care plan for spiritual care.

Upon client record review, 4 of 14 (Patient #1,3,6,8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1 order for SW 1x month, no evidence of visits for February, March, April, June or July. Patient 3 nursing visit on 1/12/24 documented completed a urine dip stick, no evidence of an order. Patient 6 order on 1/15/24 for SW every recert and 1prn. Routine SW visit completed on 5/14/24 without an order, recert visits were completed on 1/15, 4/5 and 7/5. Patient 8 order on 1/14/24 for SC monthly/every recert, no order for a prn visit. SC prn visit completed on 7/29/24

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient 1 during the home visit with SC, the employee placed the notebook on the patient's bed with no barrier.

Upon patient record review, 5 of 14 (Patient #1,2,3,7,8) 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 #1is on oxygen and using hoyer lift. No evidence of oxygen precautions or hoyer lift on Aide POC. Aide care plan included street clothes. No evidence of a frequency for changing street clothes. Patient #2 Aide care plan included street clothes. No evidence of a frequency for changing street clothes. Patient #3 Aide care plan included turn/reposition, pajamas and linen. No evidence of a frequency for these tasks. Patient on ASA, oxygen and seizure medication. No evidence of precautions on the Aide care plan. Patient #7 Aide care plan included turn/reposition, pajamas and linen. No evidence of a frequency for these tasks. Patient using hoyer lift. No evidence of hoyer lift on aide care plan. Patient #8 Aide care plan included turn/reposition, street clothes and linen. No evidence of a frequency for these.

Upon patient client record review, 14 of 14 (Patient #1,2,3,4,5,6,7,8,9,10,11,12,13,14) 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 #1,2,3,4,5,6,7,8,9,10,11,12,13,14 Consents did not contain the BFCC- QIO information and how to contact Livanta. There was no documentation that supported that the agency discussed the addendum/notice of non-covered items. Patient #4 election of benefit section to elect attending physician was blank.