Every finding on record at Advent Hospice LLC

Upon observation, there was no evidence of contracts/agreements with other facilities/agencies/hospices to receive patients in the event the hospice cannot provide care to their patients during an emergency.

Upon patient record review, 1 of 5 (Patient # 1) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #1 did not have evidence in the election statement an identification of the attending physician. This was left blank and did not state if patient refused to choose a physician.

Upon patient record review, 1 of 5 (Patient #4) did not have evidence that patient and family received education and training as appropriate to their responsibilities for the care and services identified in the plan of care. This patient had nephrostomy tube and urinary catheter.

Upon patient record review, 1 of 5 (Patient #4) did not have evidence the plan of care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Comprehensive assessment documentation included patient had an order for Oxygen via nasal cannula, this was not included in the plan of care or the physician's order for all medications of the patient.

Upon patient record review, 4 of 5 (Patient #1,2,3 7 4) did not have evidence the plan of care included all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient # 1 comprehensive assessment completed on 6-2-23 indicated patient did have wheelchair, shower bench, toilet seat, hospital bed. These were not on the plan of care. Patient # 2 comprehensive assessment completed on 6-2-23 indicated patient did have hospital bed, wheelchair,Toilet seat, walker. These were not on the plan of care Patient # 3 comprehensive assessment completed on 6-3-23 indicated patient did have a hospital bed. This was not on the plan of care. Patient # 4 comprehensive assessment completed on 5-29-23 indicated patient did have an oxygen concentrator. This was not on the plan of care.

Upon personnel record review, 2 of 11 (Personnel 5 & 8 ) did not have evidence that the competency skills assessment was completed upon hire.

Upon patient record review, 1 of 5 (Patient #1) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient's life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination: Patient #1 did not have evidence that there is a physician's brief narrative explanation of the clinical findings that supports a life expectancy of 6 months or less as part of the certification forms, or as an addendum to the certification form.

Upon patient client record review, 1 of 5 (Patient #1) did not have evidence in the election statement an identification of the attending physician. This was left blank and did not state if patient refused to choose a physician.

Upon patient client record review, 1 of 5 (Patient #2) 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. IDG conference and nursing narrative in comprehensive assessment done on 6/02/23 stated another hospice agency name, inconsistent with the agency's information.

Upon client record review, 2 of 5 (Patient #4 & 5) 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 Patients #4 & 5 did not have evidence that the discharge summary was sent to the attending physician.

Upon client record review, 1 of 5 (Patient #4) did not have evidence that the discharge summary included all required information. The discharge summary was blank and had no entries for the summary of the patient's stay, including treatments, symptoms and pain management, patient's current plan of care, patient's latest physician orders and other documentation that will assist in post-discharge continuity of care or that may be requested by the attending physician or receiving facility.