Every finding on record at Absolute Care Health Systems Hospice Inc.

Upon patient record review, 7 of 15 (Patients # 1, 4, 8, 9, 11, 12, 13) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patients # 1, 4, 8, 9, 11, 12, 13: The patients' medical records did not contain evidence that during the comprehensive assessment the imminence of death was taken into consideration.

Upon patient record review, 4 of 15 (Patients # 3, 4, 11, 14) 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 # 3: The patient had orders dated 9/3/23 for an aide 2 PRN visits that did not contain a scope and on 8/21/23 MSW as needed with no frequency or scope. There was no indication of the quantity of visits. Patient # 4: The patient had orders dated 7/14/23 for an aide 2 PRN, MSW 1 PRN, SC 1 PRN. None of the orders contained a scope. There was no indication of the quantity of visits. Patent # 11: The patient had orders dated 11/2/24 for an MSW 1 PRN and on 10/30/24 an order for a nurse 2 PRN. Neither order contained a scope. There was no indication of the quantity of visits. Patient # 14: The patient had orders dated 4/3/25 for an MSW, SC as needed and a nurse the PRN. None of the orders contained a scope. There was no indication of the quantity of visits.

Upon patient record review, 2 of 15 (Patients # 7, 9) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient # 7: The patient's documentation of the 3/24/23 IDG meeting did not contain the MSW's signature demonstrating participation. Patient # 9: The patient's documentation of the 2/10/23 IDG meeting did not contain the MSW's signature demonstrating participation.

Upon patient record review, 14 of 15 (Patient # 1, 2, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15) 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 Patients # 1, 14: The most current aide plan of care did not contain frequencies for the tasks of, a) turn and reposition and b) change patient linens. Patients # 2, 5, 11: The most current aide plan of care did not contain frequencies for the tasks of, a) turn and reposition, b) record bowel movement and c) change linens. Patient # 4: The most current aide plan of care did not contain frequencies for the task of record bowel movements. Patient # 6, 15: The most current aide plan of care did not contain frequencies for the tasks of, a) turn and reposition, b) record bowel movement, c) change linens, d) empty urine collection bag and e) measure urine output. Patients # 7, 8: The most current aide plan of care did not contain frequencies for the tasks of, a) feeding assistance, b) record bowel movement and c) change linens. Patient # 9: The most current aide plan of care did not contain frequencies for the tasks of, a) turn and reposition, b) record bowel movement, c) change linens and d) assist with medications per RN's instructions. Patients # 10, 12: The most current aide plan of care did not contain frequencies for the tasks of, a) turn and reposition, b) record bowel movement, c) change linens, d) assist with medications per RN's instructions and e) encourage fluids if not contraindicated. Patient # 13: The most current aide plan of care did not contain frequencies for the tasks of, a) turn and reposition, b) record bowel movement, c) change linens, d) feeding assistance and e) aspiration precautions.

Upon personnel record review, 1 of 11 (Personnel # 8) did not have evidence in the hospice aide personnel file that a registered nurse made an annual on-site visit to the location where a patient is receiving care in order to observe and assess each aide while he or she is performing care. Personnel # 8: The aide's employee file did not contain evidence that a registered nurse made an annual on-site visit at the patient's residence to observe and assess the aide while performing care with the aide present.