Every finding on record at A Path of Care Hospice II, LLC

Based on record review and interview, the hospice failed to ensure the emergency preparedness communication plan included contact information for the current staff for 18 patients and all staff. --- Findings: A review of emergency preparedness records showed the communication plan included contact information for staff no longer with the hospice and did not include contact information for current staff of the hospice. On 08/27/25 at 11:30 a.m., Staff A stated the communication plan was not updated to reflect contact information of current staff for the hospice.

Based on record review and interview, the hospice failed to ensure development of a bereavement POC at the time of initial assessment for eight (Patients #2, 4, 7, 8, 11, 12, 13 and #14) of 14 patients. --- Findings: Patient #2A review of the clinical record showed an initial bereavement assessment dated 02/11/25 with IDG updates on 07/02/25, 07/16/25, 07/24/25, 08/07/25 and 08/21/25. The clinical record showed no bereavement POC and showed no bereavement interventions and goals in the overall POC dated 08/05/25 to 10/03/25. The clinical record showed no patient or caregiver refusal of a bereavement POC since the bereavement assessment dated 02/11/25.  On 08/27/25 at 12:00 p.m., Staff A stated:1.    The patient had no bereavement POC and showed no bereavement interventions and goals in the overall POC.2.    A bereavement POC is put into place at the time of a patient’s death. Patient #4A review of the clinical record showed an initial bereavement assessment dated 04/17/25 with IDG updates on 07/10/25, 07/24/25, 08/07/25 and 08/21/25. The clinical record showed no bereavement POC and showed no bereavement interventions and goals in the overall POC dated 07/15/25 to 10/12/25. The clinical record showed no patient or caregiver refusal of a bereavement POC since the bereavement assessment dated 04/17/25.  On 08/27/25 at 12:15 p.m., Staff A stated:1.    The patient had no bereavement POC and showed no bereavement interventions and goals in the overall POC.2.    A bereavement POC is put into place at the time of a patient’s death.  Patient #7A review of the clinical record showed an initial bereavement assessment dated 08/18/25 with IDG update on 08/21/25. The clinical record showed no bereavement POC and showed no bereavement interventions and goals in the overall POC dated 08/16/25 to 11/13/25. The clinical record showed no patient or caregiver refusal of a bereavement POC since the bereavement assessment dated 08/18/25.  On 08/27/25 at 12:30 p.m., Staff A stated:1.    The patient had no bereavement POC and showed no bereavement interventions and goals in the overall POC.2.    A bereavement POC is put into place at the time of a patient’s death.  Patient #8A review of the clinical record showed an initial bereavement assessment dated 07/28/25 with IDG updates on 07/28/25, 08/07/25 and 08/21/25. The clinical record showed no bereavement POC and showed no bereavement interventions and goals in the overall POC dated 07/25/25 to 10/22/25. The clinical record showed no patient or caregiver refusal of a bereavement POC since the bereavement assessment dated 07/28/25.  On 08/27/25 at 12:35 p.m., Staff A stated:1.    The patient had no bereavement POC and showed no bereavement interventions and goals in the overall POC.2.    A bereavement POC is put into place at the time of a patient’s death.  Patient #11A review of the clinical record showed an initial bereavement assessment dated 02/05/25 with IDG update on 02/12/25 and 02/16/25. The clinical record showed no bereavement POC until after the patient’s death on 02/13/25 and showed no bereavement interventions and goals in the overall POC dated 02/01/25 to 05/01/25. The clinical record showed no patient or caregiver refusal of a bereavement POC from the bereavement assessment dated 02/05/25.  On 08/27/25 at 12:42 p.m., Staff A stated the patient had no bereavement POC until the patient’s death on 02/13/25.  Patient #12A review of the clinical record showed an initial bereavement assessment dated 01/23/25 with IDG update on 01/02/25, 01/15/25, 01/29/25 and 02/12/25. The clinical record showed no bereavement POC until after the patient’s death on 01/29/25 and showed no bereavement interventions and goals in the overall POC dated 01/21/25 to 03/21/25. The clinical record showed no patient or caregiver refusal of a bereavement POC from the bereavement assessment dated 01/23/25.  On 08/27/25 at 12:45 p.m., Staff A stated the patient had no bereavement POC until the patient’s death on 01/29/25.  Patient #13A review of the clinical record showed an initial bereavement assessment dated 05/02/25 with IDG updates on 06/04/25, 06/18/25, 07/02/25, 07/16/25, 07/24/25, 08/07/25 and 08/21/25. The clinical record showed no bereavement POC and showed no bereavement interventions and goals in the overall POC dated 06/28/25 to 08/26/25. The clinical record showed no patient or caregiver refusal of a bereavement POC from the bereavement assessment dated 05/02/25 to the patient’s discharge from the hospice on 08/16/25.  On 08/27/25 at 12:47 p.m., Staff A stated:1.    The patient had no bereavement POC and showed no bereavement interventions and goals in the overall POC.2.    A bereavement POC is put into place at the time of a patient’s death.  Patient #14A review of the clinical record showed an initial bereavement assessment dated 01/17/25 with IDG updates on 01/29/25, 02/12/25, 02/20/25, 03/06/25, 03/19/25 and 03/31/25. The clinical record showed no bereavement POC and showed no bereavement interventions and goals in the overall POC dated 01/16/25 to 04/16/25. The clinical record showed no patient or caregiver refusal of a bereavement POC from the bereavement assessment dated 01/17/25 to the patient’s discharge from the hospice on 03/31/25.  On 08/27/25 at 1:00 p.m., Staff A stated:1.    The patient had no bereavement POC and showed no bereavement interventions and goals in the overall POC.2.    A bereavement POC is put into place at the time of a patient’s death.

Based on record review and interview, the hospice failed to ensure POCs included:  1.    Interventions and goals related to MSW services for two (Patients #2 and #8) of 14 patients.2.    Interventions and goals related to Chaplain services for one (Patient #7) of 14 patients.3.    Identified a wound site location for wound care interventions for one (Patient #7) of 14 patients.4.    Interventions and goals related to wound site care for four (Patients #4, 6, 13 and #14) of 14 patients. --- Findings: Patient #2A review of the plan of care dated 07/25/25 to 10/22/25 with IDGs dated 07/16/25, 07/24/25, 08/07/25 and 08/21/25 showed no interventions and goals for MSW services for visits conducted on 07/28/25 and 08/20/25. On 08/27/25 at 12:00 p.m., Staff A stated the plan of care should have included interventions and goals for MSW services.  Patient #4A review of the plan of care dated 07/15/25 to 10/12/25 with IDGs dated 07/24/25, 08/07/25 and 08/21/25 showed no interventions and goals for wound site care to the left heel for visits conducted:·      07/15/25 ·      07/18/25·      07/21/25·      07/24/25·      07/28/25·      07/31/25·      08/05/25·      08/12/25·      08/15/25·      08/19/25·      08/22/25 On 08/27/25 at 12:00 p.m., Staff A stated the plan of care should have included interventions and goals for wound site care. Patient #6A review of the plan of care dated 07/24/25 to 10/21/25 with IDGs dated 08/07/25 and 08/21/25 showed no goals for wound site care to the left upper extremity ordered on 07/25/25 for visits conducted:·      07/25/25·      07/28/25·      07/31/25·      08/05/25·      08/07/25·      08/12/25·      08/14/25·      08/18/25·      08/20/25 On 08/27/25 at 12:15 p.m., Staff A stated the plan of care should have included goals for wound site care. Patient #7A review of the plan of care dated 08/16/25 to 11/13/25 with IDG dated 08/21/25 showed no interventions and goals for chaplain services for a visit conducted on 08/18/25. A review of a POC update dated 08/19/25 ordered wound care interventions of wound cleanser, packing with normal saline and ABD dressing. The POC update showed no identified wound site location, no frequency the SN was to conduct the wound site interventions and no goals for the wound site care interventions for visits conducted on:·      08/19/25·      08/20/25·      08/22/25 On 08/27/25 at 12:00 p.m., Staff A stated:1.    The plan of care should have included interventions and goals for MSW services.2.    Should have included wound site location, a frequency the SN was to conduct the wound site interventions and goals for the wound site care interventions. Patient #8A review of the plan of care dated 08/05/25 to 10/03/25 showed no interventions and goals for MSW services for visits conducted on 08/05/25 and 08/12/25. On 08/27/25 at 12:35 p.m., Staff A stated the plan of care should have included interventions and goals for MSW services.  Patient #13A review of the plan of care dated 06/28/25 to 08/26/25 with IDG dated 08/07/25 showed POC updates dated:1.    08/01/25 for wound care interventions to the right upper buttock of cleanse site with normal saline, apply Medi-honey and silicon dressing. The POC update showed no frequency the SN was to conduct the wound site care and showed no wound site care goals. 2.    08/05/25 for wound care interventions to the left leg of cleanse site with wound wash, apply Silvasorb and collagen, cover with petroleum dressing and gauze, secure with Kerlex. The POC update showed no frequency the SN was to conduct the wound site care and showed no wound site care goals.  For visits conducted on:·      08/05/25·      08/08/25·      08/12/25·      08/15/25 On 08/27/25 at 12:47 p.m., Staff A stated the plan of care should have included a SN frequency to conduct the wound care and goals for the wound site care interventions. Patient #14A review of the plan of care dated 01/16/25 to 04/15/25 with IDGs dated 01/25/25, 02/12/25, 02/20/25, 03/06/25, 03/19/25 and 03/31/25 showed a POC update dated 01/17/25 for wound care interventions to the right heel of cleansing site with normal saline, apply Xeroform and ABD dressing. The POC update showed no frequency the SN was to conduct the wound site care and showed no wound site care goals for visits conducted on:·      01/27/25·      01/31/25·      02/04/25·      02/07/25·      02/12/25·      02/17/25 ·      02/20/25·      02/21/25·      02/28/25·      03/04/25·      03/07/25·      03/12/25·      03/14/25·      03/17/25·      03/21/25·      03/25/25·      03/27/25 On 08/27/25 at 1:00 p.m., Staff A stated the plan of care should have included a SN frequency to conduct the wound site care and goals for the wound site care interventions.

Based on record review and interview, the hospice failed to ensure review and update of hospice aide care plans for three (Patients #4, 9 and #13) of 14 patients. --- Findings: Patient #4A review of the plan of care dated 07/15/25 to 10/12/25 and IDG plan of care updates dated 07/24/25, 08/07/25 and 08/21/25 ordered hospice aide visits two times a week for one week, then three times a week. POC orders dated 07/11/25 and again on 07/15/25 showed the patient required two hospice aides’ to be present on every visit. The POC showed no update to the hospice aide care plan last dated 07/28/25. On 08/27/25 at 12:15 p.m., Staff A stated the hospice aide care plan was not reviewed and updated. Patient #9A review of the plan of care dated 06/04/25 to 09/01/25 and IDG plan of care updates dated 06/18/25, 07/02/25, 07/16/25, 07/24/25, 08/09/25 and 08/21/25 ordered hospice aide visits one time a week for one week, three times a week for 12 weeks, then one time a week for one week. POC orders dated 06/10/25 and again on 07/02/25 showed the patient required two hospice aides’ to be present on every visit. The POC showed no update to the hospice aide care plan last dated 06/04/25. On 08/27/25 at 12:38 p.m., Staff A stated the hospice aide care plan was not reviewed and updated. Patient #13A review of the plan of care dated 06/28/25 to 08/26/25 and IDG plan of care updates dated 07/02/25, 07/16/25, 07/24/25, 08/09/25 and 08/21/25 ordered hospice aide visits two times a week for eight weeks, then one time a week for one week. POC order dated 07/02/25 showed the patient required two hospice aides’ to be present on every visit. The POC showed no update to the hospice aide care plan last dated 04/29/25. On 08/27/25 at 12:47 p.m., Staff A stated the hospice aide care plan was not reviewed and updated.

Based on record reviews and interviews, the hospice failed to ensure POCs included hospice aide visit interventions and goals for 14 (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 and #14) of 14 patients. --- Findings: Patient #1A review of a plan of care dated 07/27/25 to 09/24/25 showed no interventions and goals for hospice aide services for visits conducted:·      07/29/25·      07/31/25·      08/05/25·      08/12/25·      08/14/25·      08/19/25·      08/21/25  On 08/27/25 at 11:48 a.m., Staff A stated the plan of care did not include interventions and goals for hospice aide services.  Patient #2A review of a plan of care dated 08/05/25 to 10/03/25 showed no interventions and goals for hospice aide services for visits conducted:·      08/12/25·      08/14/25·      08/19/25·      08/21/25  On 08/27/25 at 12:00 p.m., Staff A stated the plan of care did not include interventions and goals for hospice aide services.  Patient #3A review of a plan of care dated 07/20/25 to 09/17/25 showed no interventions and goals for hospice aide services for visits conducted:·      07/21/25·      07/23/25·      07/25/25·      07/29/25·      07/30/25·      08/01/25·      08/04/25·      08/06/25·      08/08/25·      08/11/25·      08/14/25·      08/15/25·      08/18/25·      08/19/25·      08/21/25  On 08/27/25 at 12:14 p.m., Staff A stated the plan of care did not include interventions and goals for hospice aide services.  Patient #4A review of a plan of care dated 07/15/25 to 10/12/25 showed no interventions and goals for hospice aide services for visits conducted:·      07/22/25·      07/24/25·      07/25/25·      07/28/25·      07/30/25·      08/01/25·      08/04/25·      08/07/25·      08/08/25·      08/10/25·      08/12/25·      08/15/25·      08/18/25·      08/20/25·      08/22/25  On 08/27/25 at 12:15 p.m., Staff A stated the plan of care did not include interventions and goals for hospice aide services.  Patient #5A review of a plan of care dated 07/28/25 to 09/25/25 showed no interventions and goals for hospice aide services for visits conducted:·      07/28/25·      07/29/25 ·      07/30/25·      07/31/25·      08/04/25·      08/05/25·      08/06/25·      08/07/25·      08/08/25·      08/11/25·      08/12/25·      08/13/25·      08/14/25·      08/18/25·      08/19/25·      08/20/25·      08/21/25·      08/22/25  On 08/27/25 at 12:22 p.m., Staff A stated the plan of care did not include interventions and goals for hospice aide services. Patient #6A review of a plan of care dated 07/24/25 to 10/21/25 showed no interventions and goals for hospice aide services for visits conducted:·      07/28/25·      07/30/25·      08/01/25·      08/05/25·      08/06/25·      08/07/25·      08/11/25·      08/12/25·      08/14/25·      08/18/25·      08/19/25·      08/21/25 On 08/27/25 at 12:25 p.m., Staff A stated the plan of care did not include interventions and goals for hospice aide services. Patient #7A review of a plan of care dated 08/16/25 to 11/13/25 showed no interventions and goals for hospice aide services for visits conducted:·      08/19/25·      08/22/25 On 08/27/25 at 12:30 p.m., Staff A stated the plan of care did not include interventions and goals for hospice aide services. Patient #8A review of a plan of care dated 07/25/25 to 10/22/25 showed no interventions and goals for hospice aide services for visits conducted:·      08/07/25·      08/13/25·      08/20/25 On 08/27/25 at 12:35 p.m., Staff A stated the plan of care did not include interventions and goals for hospice aide services. Patient #9A review of a plan of care dated 06/04/25 to 09/01/25 showed no interventions and goals for hospice aide services for visits conducted:·      06/05/25·      06/09/25·      06/11/25·      06/13/25·      06/16/25·      06/18/25·      06/20/25·      06/23/25·      06/25/25·      06/27/25·      06/30/25·      07/02/25·      07/03/25 ·      07/07/25·      07/09/25·      07/11/25·      07/14/25·      07/16/25·      07/18/25·      07/21/25·      07/23/25·      07/24/25·      07/28/25·      07/30/25·      08/01/25·      08/04/25·      08/06/25·      08/08/25·      08/11/25·      08/13/25·      08/15/25·      08/18/25·      08/20/25·      08/22/25 On 08/27/25 at 12:38 p.m., Staff A stated the plan of care did not include interventions and goals for hospice aide services. Patient #10A review of a plan of care dated 05/18/25 to 08/15/25 showed no interventions and goals for hospice aide services for visits conducted:·      05/19/25·      05/21/25·      05/23/25·      05/27/25·      05/28/25·      05/30/25·      06/03/25·      06/05/25·      06/09/25·      06/11/25·      06/13/25·      06/16/25·      06/18/25·      06/20/25·      06/23/25·      06/25/25·      06/27/25·      06/30/25·      07/02/25·      07/03/25·      07/07/25·      07/09/25·      07/11/25·      07/14/25·      07/16/25·      07/18/25·      07/21/25·      07/23/25·      07/25/25·      07/28/25·      07/30/25·      08/01/25·      08/04/25·      08/06/25·      08/08/25·      08/11/25·      08/13/25·      08/14/25 On 08/27/25 at 12:40 p.m., Staff A stated the plan of care did not include interventions and goals for hospice aide services.Patient #11A review of a plan of care dated 02/01/25 to 05/01/25 showed no interventions and goals for hospice aide services for visits conducted:·      02/03/25·      02/05/25·      02/06/25·      02/10/25·      02/11/25 On 08/27/25 at 12:42 p.m., Staff A stated the plan of care did not include interventions and goals for hospice aide services.  Patient #12A review of a plan of care dated 01/21/25 to 03/21/25 showed no interventions and goals for hospice aide services for visits conducted:·      01/23/25·      01/29/25 On 08/27/25 at 12:45 p.m., Staff A stated the plan of care did not include interventions and goals for hospice aide services. Patient #13A review of a plan of care dated 06/28/25 to 08/26/25 showed no interventions and goals for hospice aide services for visits conducted:·      07/01/25·      07/03/25·      07/08/25·      07/11/25·      07/15/25·      07/18/25·      07/22/25·      07/25/25·      07/29/25·      08/01/25·      08/05/25·      08/08/25·      08/12/25·      08/15/25 On 08/27/25 at 12:47 p.m., Staff A stated the plan of care did not include interventions and goals for hospice aide services. Patient #14A review of a plan of care dated 01/16/25 to 04/15/25 showed no interventions and goals for hospice aide services for visits conducted:·      01/20/25·      01/23/25·      01/24/25·      01/27/25·      01/29/25·      01/31/25·      02/04/25·      02/05/25·      02/07/25·      02/10/25·      02/12/25·      02/13/25·      02/17/25·      02/20/25·      02/21/25·      02/24/25·      02/26/25·      02/28/25 ·      03/04/25·      03/05/25·      03/07/25·      03/10/25·      03/14/25·      03/17/25·      03/21/25·      03/26/25·      03/28/25·      03/31/25 On 08/27/25 at 1:00 p.m., Staff A stated the plan of care did not include interventions and goals for hospice aide services.

Based on record review and interview, the hospice failed to ensure volunteer services met hospice program requirements in calendar year 2024 for all patients, caregivers, and staff. --- Findings: A review of volunteer records showed the hospice program had 0.86% utilization of volunteer personnel and showed no recruitment activities until the month of September in calendar year 2024.  On 08/27/25 at 1:30 p.m., Staff H stated:1.    There wasn’t a volunteer coordinator until the end of 2024.2.    There weren’t any volunteers until I started recruitment activities last September.

Based on record review and interview, the hospice failed to ensure effective pain management was provided in the plan of care for two (Patients #6 and8) of 11 patients --- Patient #6 A review of the plan care dated 11/02/22 to 01/30/23 showed a primary diagnosis of senile degeneration of the brain and documented for the doctor to only be notified of a pain level greater than 8 on the classic 1-10 pain scale. Patient #8 A review of the plan care dated 08/03/22 to 10/31/23 showed a primary diagnosis of cancer of the pancreas and documented for the doctor to only be notified of a pain level greater than 8 on the classic 1-10 pain scale. On 12/13/22 at 2:06 pm, Staff B stated the pain level to notify the physician was not adequate for pain control for Patients #6 and 8.

Based on record review and interview, the hospice failed to ensure: 1. Completion of the initial bereavement assessment no later than 5 calendar days after the election of hospice care for eight (Patients #1, 3, 4, 6, 7, 8, 10 and 11) of 11 patients; 2. Completion of the initial spiritual assessment no later than 5 calendar days after the election of hospice care for three (Patients #1, 3 and 4) of 11 patients; and 3. Completion of the initial psychosocial assessment no later than 5 calendar days after the election of hospice care for one (Patient #6) of 11 patients. --- Patient #1 A review of the clinical record showed an election of the hospice benefit on 10/13/22 with no completion of the initial bereavement assessment from 10/13/22 to 12/13/22 (60 days after election of the hospice benefit) and no completion of the initial spiritual assessment from 10/13/22 to 12/13/22 (60 days after the election of the hospice benefit) with no documentation of attempts to contact the patient made by the Chaplain and no patient or caregiver refusal of Chaplain visits. Patient #3 A review of the clinical record showed an election of the hospice benefit on 10/26/22 with no completion of the initial bereavement assessment from 10/26/22 to 12/13/22 (48 days after election of the hospice benefit) and no completion of the initial spiritual assessment from 10/26/22 to 12/13/22 (48 days after the election of the hospice benefit) with no documentation of attempts to contact the patient made by the Chaplain and no patient or caregiver refusal of Chaplain visits. Patient #4 A review of the clinical record showed an election of the hospice benefit on 09/20/22 with no completion of the initial bereavement assessment from 09/20/22 to 12/13/22 (55 days after election of the hospice benefit) and no completion of the initial spiritual assessment from 09/20/22 to 12/13/22 (55 days after the election of the hospice benefit) with no documentation of attempts to contact the patient made by the Chaplain and no patient or caregiver refusal of Chaplain visits. Patient #6 A review of the clinical record showed an election of the hospice benefit on 11/02/22 with no completion of the initial bereavement assessment from 11/02/22 to 12/13/22 (41 days after election of the hospice benefit) and no completion of the initial psychosocial assessment from 11/02/22 to 12/13/22 (41 days after the election of the hospice benefit) with no documentation of attempts to contact the patient made by the Medical Social Worker or Chaplain and no patient or caregiver refusal of Medical Social Worker or Chaplain visits. Patient #7 A review of the clinical record showed an election of the hospice benefit on 11/25/22 with no completion of the initial bereavement assessment from 11/25/22 to 12/13/22 (17 days after election of the hospice benefit) with no documentation of attempts to contact the patient made by the Chaplain and no patient or caregiver refusal of Chaplain visits. Patient #8 A review of the clinical record showed an election of the hospice benefit on 08/03/22 with no completion of the initial bereavement assessment from 08/03/22 to 10/31/22 (90 days after election of the hospice benefit) with no documentation of attempts to contact the patient made by the Chaplain and no patient or caregiver refusal of Chaplain visits. Patient #10 A review of the clinical record showed an election of the hospice benefit on 12/01/22 with no completion of the initial bereavement assessment from 12/01/22 to 12/13/22 (9 days after election of the hospice benefit) with no documentation of attempts to contact the patient made by the Chaplain and no patient or caregiver refusal of Chaplain visits. Patient #11 A review of the clinical record showed an election of the hospice benefit on 10/14/22 with no completion of the initial bereavement assessment from 10/14/22 to 12/13/22 (59 days after election of the hospice benefit) with no documentation of attempts to contact the patient made by the Chaplain and no patient or caregiver refusal of Chaplain visits. On 12/13/22 at 2:25 pm, Staff B stated: 1. the initial bereavement assessments were not completed within the first five days after the election of the hospice benefit for Patients #1, 3, 4, 6, 7, 8, 10 and 11; 2. the initial spiritual assessments were not completed within the first five days after the election of the hospice benefit for Patients #1, 3 and 4; and 3. the initial psychosocial assessment was not completed within the first five days after the election of the hospice benefit for Patient #6.

Based on record review and interview, the hospice failed to ensure wound care was provided in accordance with the plan of care for one (Patient #2) of 11 patients. --- Patient #2 A review of the plan of care dated 10/01/22 to 11/29/22 showed orders for collagen powder to be applied to the right inner ankle and a skilled nurse frequency of three visits per week for eight weeks and one visit per week for one week. A review of the electronic medical record showed the following: A skilled nurse assessment dated 10/03/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 10/05/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 10/07/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 10/10/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 10/12/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 10/14/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 10/17/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 10/19/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 10/21/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 10/24/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 10/26/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 10/28/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 10/31/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 11/02/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 11/04/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 11/07/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 11/09/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 11/11/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 11/14/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 11/16/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 11/18/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 11/21/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 11/23/22 which documented no use of collagen powder to the right inner ankle. A skilled nurse assessment dated 11/25/22 which documented no use of collagen powder to the right inner ankle. On 12/13/22 at 1:15 pm, Staff B stated wound care was not provided in accordance with the plan of care for Patient #2.

Based on record review and interview, the hospice failed to ensure the plan of care was fully developed to include all services necessary for the palliation and management of the terminal illness for eleven (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11) of 11 patients reviewed. --- Patient #1 A review of the plan of care dated 10/13/22 to 01/10/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #2 A review of the plan of care dated 10/01/22 to 11/29/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #3 A review of the plan of care dated 10/26/22 to 01/23/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #4 A review of the plan of care dated 09/20/22 to 12/18/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #5 A plan of care dated 09/24/22 to 11/22/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #6 A plan of care dated 11/02/22 to 01/30/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #7 A review of the plan of care dated 11/25/22 to 02/22/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #8 A review of the plan of care dated 08/03/22 to 10/31/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #9 A plan of care dated 12/08/22 to 03/07/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #10 A plan of care dated 12/01/22 to 02/28/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #11 A plan of care dated 10/14/22 to 01/11/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. On 12/13/22 at 12:46 pm, Staff B stated the plans of care for Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11 failed to include services necessary for the palliation and management of the terminal illness.

Based on record review and interview, the hospice failed to: 1.ensure the plan of care was revised to reflect the updated diagnosis for one (Patient #1) of 11 patients and; 2. ensure the plan of care was revised to reflect the accurate location of wounds for one (Patient #2) of 11 patients. --- Patient #1 A review of the plan of care dated 10/13/22 to 01/10/23 with plan of care updates dated 10/26/22, 11/09/22, 11/23/22 and 12/05/22 showed a primary diagnosis of hypertensive heart disease with heart failure. A review of the electronic medical records showed a physician's order dated 10/15/22 which showed a primary diagnosis of cardiovascular disease with congestive heart failure. No changes were made to reflect the updated terminal illness. Patient #2 A review of the plan of care dated 10/01/22 to 11/29/22 with plan of care updates dated 10/12/22, 10/27/22, 11/09/22 and 11/23/22 showed a wound to the left heel, a wound to the bilateral buttocks and a wound to right inner ankle. A review of the electronic medical record showed the following: A skilled nurse assessment dated 10/03/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 10/05/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 10/07/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 10/10/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 10/12/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 10/14/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 10/17/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 10/19/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 10/21/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 10/24/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 10/26/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 10/28/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 10/31/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 11/02/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 11/04/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 11/07/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 11/09/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 11/11/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 11/14/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 11/16/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 11/18/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 11/21/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 11/23/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 11/25/22 which documented a diabetic ulcer to the left inner ankle, a wound to the coccyx and a right heel wound. No updates were made to the plan of care to reflect the current wound sites. On 12/13/22 at 1:20 pm, Staff B stated: 1. the plan of care for Patient #1 should have been updated to reflect the new diagnosis and; 2. the plan of care for Patient #2 should have been updated to reflect the accurate location of wounds.