Every finding on record at A1 Palliative Hospice Inc

Upon patient record review, 5 of 14 (Patient #1, #4, #5, #8, #12) 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: On admission documentation by RN dated 07-14-24, the nurse indicated patient should take Tylenol #3 every 8 hours for pain. The medication profile indicated Tylenol #3 was ordered every 12 hours. Patient # 4: Per admission documentation dated 09-23-24, the nurse indicated the patient was using oxygen. Oxygen was not on the medication profile. COS Patient #5: The recert documentation dated 07-14-24 indicated the patient was using 2 L of O2. Oxygen was not on the medication profile. COS Patient #8: The MD certification dated 8-15-23 indicated the patient was using O2 2L NC. Oxygen was not part of the medication profile. COS Patient #12: Per the MD certification dated 01-28-24, the MD documented O2 use at 2L NC. O2 was not on the medication profile. COS

Upon patient record review, 7 of 14 (Patient #1,2,3,8,9,11,12) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual's attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient's progress toward desired outcomes • Reassessment of the patient's response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient #1,#2,#3: There was a visit by a registered nurse on the day of admission with all further visits documented by a LVN. There was no evidence of a comprehensive assessment completed by a registered nurse. Patient #8,#9,#11,#12: Visits by a registered nurse were made on admission and prior to recertification. All other nursing visits were completed by an LVN with no evidence of a comprehensive assessment performed by a registered nurse.

Upon patient record review 5 of 14 (Patient #1, #2, #3, #11, #12) 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 #1,#2, #3, #11, #12: Aide supervisory visits not completed by an RN every 14 days by a registered nurse following the admission, the nurse only documented a supervisory visit in the medical record but no evidence of a visit to the home.

Upon patient record review, 4 of 14 (Patient #1, 2, 3, 10) 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: The hospice Medicare Election statement was signed 7-14-24 by the patient's representative without evidence of indication of the reason patient was unable to sign. Patient #2: The hospice Medicare Election statement was signed 8-26-24 by the patient's representative without evidence of indication of the reason patient was unable to sign. Patient #3: The hospice Medicare Election statement was signed 9-23-24 by the patient's representative without evidence of indication of the reason patient was unable to sign. Patient #10: The hospice Medicare Election statement was signed 9-23-24 by the patient's representative without evidence of indication of the reason patient was unable to sign

Upon patient record review, 1 of 14 (Patient #7) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #7: On 1-17-24, which was the last documented visit to the patient by the RN, the nurse documented the patient was "imminent of death" and "discussed findings with family." There are no death or follow-up notes, but the chart indicates the patient died on 2-2-24. There is a Medicare revocation form signed by the patient and dated 2-2-24, but there is no documentation as to the events that occurred on that day.

Upon patient record review, 6 of 14 (Patient #5,#6,#8,#9,#11,#12) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patient #5,#6,#8,#9,#11,#12: There was no evidence that an attending physician was identified or a discharge summary sent to the patient's attending physician

Upon patient record review, 6 of 14 (Patient #5,#6,#8,#9,#11,#12) did not have evidence that the discharge summary includes all required information. Patient #5,#6,#8,#9,#11,#12: There was no evidence of a discharge summary that included a summary of the patient's stay including treatments and pain management.