Every finding on record at Affinity Hospice, Inc.

Upon patient record review, 1 of 14 (Patient #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 06: The medication profile includes polyethylene glycol 17grams powder, take daily every morning, it does not include instructions for dilution.

Upon patient record review, 1 of 14 (Patient #4) 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 04: The patient was admitted on 9/25/23 with a primary diagnosis of Alzheimer's disease, unspecified. The plan of care does not include a problem statement with interventions and goals for neurological issues.

Upon patient record review, 1 of 14 (Patient #6) 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 06: The medication orders on 9/1/23 for polyethylene glycol 17grams take one dose daily, do not include a diluent.

Upon client record review, 2 of 14 (Patient #5, 7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 05: The frequency order for SN is 1 time per week. The patient did not receive a visit the week of 1/21/24 - 1/27/24 Patient 07: The frequency order for MSW visits is entered as "evaluate at each benefit period." The patient entered a new benefit period on 1/24/24, a visit has not been performed. The Spiritual Care frequency is entered as "evaluate at each benefit period," The patient entered a new benefit period on 1/24/24, a visit has not been performed.