Every finding on record at Adventa Hospice, L.L.C.

Upon client record review, 1 of 19 (Patient #4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #4: There is evidence in the medical record of an order 3/19/26 for Volunteer Assessment. On 3/24/26 the volunteer evaluation determined volunteer accepted for companionship. On 3/24/26 the Volunteer add-on order stated "Additional visits to be provided ;VC will recruit volunteer to meet the needs of the patient". No volunteer visits have been scheduled.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. The Volunteer cost savings was: 1.07%.

Upon patient record review, 3 of 19 (Patient #2,#3,#6) 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 2:Upon admission, the patients medication administration record with oxygen profiled to be delivered at 2 liters per minute. There was no evidence that a route for oxygen administration is included in the plan of care. Corrected on site Patient 3:Upon admission, the patients medication administration record with oxygen profiled to be delivered at 2-4 liters per minute. There was no evidence that a route for oxygen administration and instructions for titration are included in the plan of care. Patient 6: Upon admission, the patients medication administration record with entry of MiraLAX powder 17 grams daily as needed profiled and oxygen profiled to be delivered at 2-4 liters per minute. There was no evidence of the type and amount of diluent needed for MiraLAX administration or evidence of a route of administration and instructions for titration of oxygen included in the plan of care . Corrected on site

Upon patient record review, 2 of 19 (Patient #7,#11) 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 7:The patient medical record contains documentation that the patient was admitted to hospice services on 05/03/23. The initial Bereavement Risk Assessment was completed on 05/09/23. Patient 11:The patient medical record contains documentation that the patient was admitted to hospice services on 05/05/23. The initial Bereavement Risk Assessment was completed on 06/22/23. Corrected on site.

Upon patient record review, 1 of 19 (Patient #8) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient 8:The patients medical record contains nursing documentation upon admission of stage III pressure ulcer to sacrum. There is no evidence of wound measurements documented in record from admission on 5/6/23 to 6/26/23.

Upon patient record review, 3 of 19 (Patient #1,#4,#6) 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 1:The patients medical record contains documentation that the patient has a primary diagnosis of Parkinson's disease. There is no evidence of problems, goals and interventions included in the plan of care for the management of Parkinson's Disease. Corrected on site. Patient 4:The patients medical record contains nursing documentation upon admission of patient experiencing genitourinary issues and use of PureWick external catheter. There was no evidence of problems with goals and interventions related to genitourinary management in the plan of care. Corrected on site. Patient 6:The patients medical record contains nursing documentation upon admission that patient was currently using Eliquis as an anticoagulant and was a high risk for falls. There is no evidence of problems with goals and interventions to manage anticoagulation therapy and safety. Corrected on site.

Upon patient record review, 2 of 19 (Patient #2,#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 2: The patients medical record contains nursing documentation on 5/18/23 that the son could not locate Medi-honey to complete wound care. Skilled nurse noted that kalamzine cream and a bordered dressing were used. The plan of care does not contain evidence that kalamazine cream and a bordered dressing were included in the wound care regimen. The medical record contains documentation on 5/11/23 that patient was using over the counter MiraLAX and Dulcolax. There is no evidence that MiraLAX or Dulcolax are included in the plan of care. Corrected on site. Patient 11: The patients medical record contains nursing documentation on 5/13/23 that Oxygen is in use at 3,5 liters per minute via nasal cannula; on 5/19/23, 6/2/23, 6/19/23, 6/22/23 and 6/23/23 nursing documentation notes oxygen in use at 2.5 liters per minute via nasal cannula. The patients plan of care includes Oxygen therapy at 2 liters per minute via nasal cannula upon admission with no evidence of a change to the order/plan of care. Corrected on Site

Upon patient record review, 1 of 19 (Patient #7) 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 equipment and supply needs. Patient 7:The patients medical record contains documentation upon admission that patient utilized a wheelchair for mobility. There is no evidence that a wheelchair is present on the plan of care. Corrected on site.

Upon patient record review 1 of 19 (Patient #4) 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 4:The patient's aide plan of care included the task of shampoo hair weekly. Aide visit frequency on the plan of care is twice weekly. Aide visit documentation notes that task of shampoo hair was completed every visit from 5/31/23 - 6/16/23.