Every finding on record at Adept Hospice Care, Inc.

Upon patient record review, 1 of 16 (Patient #15) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient 15: The Hospice Election statement does not identify a choice of attending physician or declination from selecting an attending physician.

Upon patient record review 1 of 16 (Patient #16) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient 16: The patient was admitted on 8/25/22, the psychosocial assessment was completed on 9/1/22.

Upon patient record review 3 of 16 (Patient #5, 9, 12) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient 05: The patient was admitted on 3/1/22, there is no evidence in the record that the psychosocial assessment was completed within 5 days or through the dates of services ending on 4/12/22. Patient 09: The patient was admitted on 4/28/22, there is no evidence in the record that the psychosocial assessment was completed within 5 days or through the dates of services ending on 4/12/22. Patient 12: The patient was admitted on 3/2/22, there is no evidence in the record that the psychosocial assessment was completed within 5 days or until patients death on 3/15/22.

Upon patient record review, 4 of 16 (Patient #1, 2, 7, 11) 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 01: The medication profile starting on 3/2/23 indicates "Comfort Pack to be opened with the instruction of the hospice nurse." There is no evidence in the patient record of the names of the medications, dosage, or indications for use for the comfort pack. During the home visit the caregiver produced Lorazepam 2mg/ml intensol which is not included on the medication profile. (Corrected on site.) Patient 02: The medication profile includes Hydrocortisone cream 2.5%, apply 2 times a day as needed for itching, this does not indicate the application site. Patient 07: The medication profile includes Glucosamine powder 2 scoops PO BID, there is no diluent included for administration of the powder. Patient 11: The medication profile includes Hydrocortisone cream 1%, apply thin film to affected area BID, this does not indicate an application site.

Upon patient record review, 1 of 16 (Patient #3) 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. Patient 03: The patient was admitted on 8/15/22, there is no evidence in the record of an initial bereavement assessment.

Upon patient record review, 2 of 16 (Patient #14, 16) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 14: The patient was admitted on 6/16/22 with evidence in the initial comprehensive assessment of a wound to the left lateral foot requiring wound care. The plan of care does not include a problem statement with interventions and goals for wound care or skin integrity. Patient 16: The patient was admitted on 8/25/23 with a diagnosis of Alzheimer's Disease with comorbidities of dysphagia and anorexia. The admission assessment indicates that "the patient has a very poor appetite, rarely eats and drinks milk in small amounts." The initial plan of care does not include a problem statement with interventions and goals for nutrition and risks for aspiration.

Upon patient record review, 4 of 16 (Patient #1, 2, 7, 11) 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 01: The orders on 3/2/23 for "comfort pack" do not include the specified medications, dosage, or indications for use. During the home visit the caregiver produced Lorazepam 2mg/ml intensol, there is no order in the record for this medication. (Corrected on site.) Patient 02: The medication order on 4/11/22 for Hydrocortisone cream 2.5%, apply 2 times a day as needed for itching, does not indicate the application site. Patient 07: Orders on 12/3/22 for Glucosamine powder 2 scoops PO BID, do not include a diluent for administration of the powder. Patient 11: Medication orders on 10/31/22 for Hydrocortisone cream 1% apply thin film to affected area BID, the order does not specify an application site.

Upon patient record review 1 of 16 (Patient #11) 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 Patient 11: The hospice aide documented on 11/23/22 that the patient requested and the aide performed a bed bath. The aide plan of care is ordered for the patient to receive a shower.

Upon patient client record review, 4 of 16 (Patient #6, 9, 14, 15) 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 06: The patient was admitted on 7/14/22, the Hospice Election Statement does not include the effective date of election for the start of care. The initial skilled nursing assessment was completed on 7/14/22, the election form was signed on 7/15/22. Patient 09: The patient was admitted on 4/28/22, the Hospice Election Statement does not include the effective date of election for the start of care. Patient 14: The patient was admitted on 6/16/22, the Hospice Election statement does not include the effective date of election for the start of care. Patient 15: The Hospice Election statement does not identify a choice of attending physician or declination from selecting an attending physician.

Upon patient client record review, 2 of 16 (Patient #1 and 12) did not have evidence that each patient record contains Advance Directives. Patient 01: The patient record is signed by JB who is identified as the POA, there are no documents in the patient record that includes the POA or an Advanced Directive. Patient 12: The patient record indicates that the patient is a DNR, there is no evidence of a POLST or Advanced Directive.