Every finding on record at A Touch of Grace Hospice LLC

Upon patient record review, 1 of 7 (Patient #4) 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 Pt #4- on home visit to memory care unit - the MAR had order dated 4/25/23 for Pepto Bismol 262 mg tabs bid x 3 days. Not on hospice medication profile. Corrected on site

Upon patient record review, 1 of 7 (Patient #4) 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. Pt #4 - no evidence of order on pt chart for Pepto Bismol 262 mg tab bid x 3 days. Corrected on site

Upon patient record review, 5 of 7 (Patient #1, 4, 5, 6, 7) 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 Pt 1, 4, 5, 6, 7- Aide order on the Physician orders state 2xweek and prn for COC (Change in Condition) Corrected on site for all patient records. Pt 1, 4, 5, 6, 7- Aide assignment included multiple bathing options.

Upon patient record review 5 of 7 (Patient #1, 4, 5, 6, 7) 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 Pt #1- Aide assignment sheet states: Nail care, Shave. No evidence of completion of nail care or shave. Aide documentation does also state she completed massage under skin care which is not on her assignment sheet. Pt #4- aide assignment sheets states: Nail Care; Assisted with Dressing; Assisted with Ambulation; Assisted with Feedings and Eating Activities; Hair Care - Comb/Brush, Shampoo; Oral Care - Denture care, toothette, brush teeth; Skin Care - Lotion, turn and position. Aide visit 6/28/23 - skin care - back care, lotion and massage (not on POC); no documentation of nail care (on the aide assignment); Hair care - comb/brush completed (no Shampoo documented but on aide assignment); Oral care and teeth completed (on Aide Assignment - denture care, toothette, and brush teeth assigned). Pt #5 -aide assignment sheets states - Nail Care; Assisted with Dressing; Assisted with Ambulation; Assisted with Feedings and Eating Activities; Hair Care - Comb/Brush, Shampoo 2 days wk; Oral Care - Denture care, toothette, brush teeth; Skin Care - Lotion, turn and position. Aide weekly visit on 6/28/23- complete and checked off; skin care, back care, lotion and massage (not on POC); no documentation of nail care (on the aide assignment); Hair care, comb/brush,Shampoo not always completed nor reason why not. Oral care and teeth completed (on Aide Assignment - denture care, toothette, and brush teeth assigned). Pt #6- Aide POC assignment states Hair care, shampoo 2 x wk. No evidence shampoo was provided on 6/28/23 visit. Pt #7- Aide POC assignment states: Nail Care, Shave, Hair care - shampoo 2 x wk. Oral Care - Denture care, toothette, brush teeth. Aide visit of 6/28//23- No evidence of nail care, Shampoo, denture care or toothette care completed.

Upon patient client record review, 7 of 7 (Patient #1, 2, 3, 4, 5, 6, 7) 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 Pts 1, 2, 3, 4, 5, 6, 7 - election statement - the effective date of the election was blank on the statement.- Corrected on site