Every finding on record at All in One Hospice Care Inc

Upon patient record review, 4 of 14 (Patient #2,3,5,7) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual's attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient's progress toward desired outcomes • Reassessment of the patient's response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient#2: - RN visit q 30 days not every 15 as required to update the comprehensive assessment. RN visits only made 5/17 admit- 6/26, 7/20, and 8/14/25. Patient#3: - RN visit ordered q 30 days. Visits made on 1/22, 2/21, 3/21, 4/21, 5/20, 6/20, 7/18, 8/18/25. Patient#5: - RN visit ordered q 30 days - RN visits made on 5/27, 6/27, 7/23, 8/23/25 . Patient#7: - RN ordered 1 month RN visits made on 5/9, 6/8, 7/8, 8/5/25.

Upon patient record review, 1 of 14 (Patient # 2) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient#2: The record indicates patient was admitted for senile degeneration of the brain. There is no evidence of neurological problems goals or intervention on plan of care. The admit nurse documented patient as confused and depressed. The MSW documented on 5/21/25 patient was oriented to person only. The LVN documented oriented to person only on 6/19/25 and 8/29/25. This was corrected on site as the plan of care was updated to reflect neurological problems goals and interventions.

Upon client record review, 1 of 14 (Patient #1) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient#1: The record indicates a PRN visit was made 7/22/25. There is no evidence of an order that includes PRN visits. Current frequency order states LVN 1 visit per week and RN visit every 14 days. The LPN also visited on 7/22 and the RN made her regular visit on 7/24. This was corrected on site as the agency added in order for PRN visits.

Upon patient record review, 1 of 14 (Patient #10) 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 Patient#10: The record indicates there is a physician order indicating the patient requires aspiration precautions and mechanical soft diet. This is also indicated on the plan of care. There is no evidence of aspiration precautions of mechanical soft diet on aide plan of care. Corrected on site as agency updated the aide plan of care to reflect these needs.

Upon patient client record review, 1 of 14 (Patient #1) 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. Patient#1: The record indicates there is a physician order on 7/10/25 for mechanical soft diet. However, the intervention on plan of care for nutrition states diet of regular consistency. This was corrected on site and plan of care intervention was updated appropriately.

Upon patient record review, 1 of 13 (Patient #2) 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, Oxygen 2-5l/nc PRN shortness of breath ordered and not on medication profile.

Upon client record review, 8 of 13 (Patient #1,2,4,6,7,9,11,12) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1, SN frequency 2x/week, visit completed 3/12/22. No evidence of second visit in the first week. Patient #2, SN frequency 2x/week, visit completed 8/26/22. No evidence of second visit in the first week. Patient #4, SN frequency 2x/week, visit completed 1x week of 7/17/22 and 3x weeks of 8/8/22, 8/9/22, 8/12/22. Patient #6, SN frequency2x/week, visit completed 8/22/22, 8/25/22, 8/29/22. Missed 2nd visit in the first week. Patient #7, SN frequency 2x/week, visits completed 7/24/22, 7/27/22, 7/30/22. Patient #9, SN frequency 2x/week, visit completed once the first week instead of 2x per MD order. Patient #11, SN frequency 1x/week, visits completed 2/1/22 and 2/4/22. Patient #12, SN frequency 2x/week, visit completed 1/20/22. No evidence of second visit this week.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #1, LVN washed hands and put on gloves then went in and out of nursing bag multiple times without sanitizing hands each time they entered the nursing bag. Patient #2, SC did not place barrier between his bag and the chair that bag was placed on. Patient #3, RN changed gloves without sanitizing hands before placing 2nd pair of gloves on.

Upon patient record review 2 of 8 applicable (Patients #6 and 8) 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 #6, Frequency for Aide 2x/week effective 8/20/22 which was a Saturday, unable to complete 2 visits with only 1 day left of week. Patient #8, Frequency of Aide 3x//week, patient seen only twice on 8/10/22, 8/12/22, 3rd visit missed.

Upon patient client record review, 1 of 13 (Patient #13) 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. Patient #13, Patient died on 4/25/22 with order written on 4/23/22 to discharge due to patient died.