Every finding on record at A Plus Hospice LLC

Upon patient record review, 3 of 19 (Patients #1, #2, #14) 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: The medication profile did not include Antifungal Powder 1% (8/7/24). Corrected on Site. Patient #2: The medication profile indicated an order for Polyethylene Glycol with no diluent (6/12/24). Corrected on Site. Patient #14: The medication profile indicated an order for Polyethylene Glycol with no diluent (11/29/23). Corrected on Site.

Upon patient record review, 1 of 19 (Patient #19 ) 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.

Upon patient record review, 2 of 19 (Patients #2, #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: The Plan of Care did not include an order for Polyethylene Glycol with no diluent (6/12/24). Corrected on Site. Patient #14: The Plan of Care did not include an order for Polyethylene Glycol with no diluent (11/29/23). Corrected on Site.

Upon patient record review, 2 of 19 (Patients #17, #19) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the Bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patients #17, #19: Did not have individualized Bereavement Plan of Care that included frequency of services.

Upon patient record review 8 of 19 (Patients #2, #3, #5, #6, #8, #9, #11,#12) 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 (POC) Patient #2: The POC listed Aide visit frequency of, 2 X's per week (6/12/24). For first Benefit Week there was only 1 visit on 6/14/24. Patient #3: The POC listed Aide visit frequency of, 2 X's per week (3/6/24). For first Benefit Week there were no visits by the Aide. Patient #5: The POC listed Aide visit frequency of, 5 X's per week (5/16/24). For first Benefit Week there was only 1 visit on 5/17/24. Patient #6: The POC listed Aide visit frequency of, 3 X's per week (7/24/24). For first Benefit Week there was only 1 visit on 7/25/24. Patient #8: The POC listed Aide visit frequency of, 2 X's per week (7/18/24). For first Benefit Week there was only 1 visit on 7/19/24. Patient #9: The POC listed Aide visit frequency of, 2 X's per week (11/1/23. For first Benefit Week there was only 1 visit on 11/3/23. Patient #11: The POC listed Aide visit frequency of, 2 X's per week (6/12/24). For first Benefit Week there was only 1 visit on 6/13/24. Patient #12: The POC listed Aide visit frequency of, 2 X's per week (7/4/24). For first Benefit Week there was only 1 visit on 7/5/24.

Upon personnel record review, 3 of 13 (Personnel #1, #2, #4 ) did not have evidence the hospice employees had received orientation on the hospice philosophy. Corrected on Site.

Upon patient client record review, 8 of 19 (Patients #4, #7, #9, #14, #15, #16, #18, #19) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patients # #4, #7, #9, #14, #15, #16, #18, #19: The Hospice Medicare Election statemen not provide BFCC-QIO contact information.