Every finding on record at Allstate Care Hospice Inc.

Upon patient record review 5 of 11 (Patient #1,2,4,5,6,) 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 #1,2,4,5,6, Patient declined SC, no evidence of spiritual assessment.

Upon patient record review, 1 of 11 (Patient #9) 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 #9, Patient admitted 12/8/21, no documented IDT until 6/1/22. Only nursing updated comprehensive assessment, no updates to comprehensive assessment for spiritual and psychosocial during this time.

Upon patient record review, 3 of 11 (Patient #6,9,11) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #6, order on 2/26/23 for spiritual care ordered as needed 3. Patient #9, order on 2/1/23 for spiritual care ordered as needed 3. Patient #11, order dated 12/28/21 declined services starting 12/8/21, no service or discipline identified.

Upon client record review, 9 of 11 (Patient #2,3,4,5,6,7,8,9,11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2, SN frequency 1x/week, SN visit on 1/4/23 and 1/6/23 which is 2x in one week. MSW order eval only, MSW visit made 1/6/23 and 2/10/23. Patient #3 RN visit on 3/13/23 without an order. Patient #4, SN frequency 1x/week, RN visit 2/21/23, LVN 2/22/23. Patient #5, SN frequency 2x/week, missed 2nd visit of the first week. SN visits 1/16/23, 1/18/23, 1/19/23, extra visit this week. SN visits 1/31/23, 2/1/23, 2/3/23, extra visit this week. Patient #6, SN frequency 1x/week, every week had LVN visit and every other week RN visit without order for RN assessment (2 visits every other week). Patient #7, SN frequency 2x/week SN visit 1/30/23, 2/1/23, 2/3/23, 2/6/23, 2/7/23, 2/10/23, 2/13/23, 2/15/23, 2/17/23. Patient #8, SC frequency 1x/month, missed visit in Feb. MSW frequency 1x/month, missed visit in Feb. SN frequency 1x/week, visits made on 1/25/23, 1/27/23, 2/8/23, 2/10/23, 2/22/23, 2/24/23. Patient #9, SN frequency 2x/month, RN visit 12/8/23, 12/22/23, LVN visits 12/23/23, 12/20/23, 1/7/23, 1/13/23, 1/20/23, 1/27/23. Patient #11, SN frequency 1x/week, SN visit 12/22/22, 12/23/22, 1/5/23, 1/7/23, 1/19/23, 1/20/23, 2/2/23, 2/3/23.

Upon patient record review, 1 of 11 (Patient #2) 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 #2, Aide care plan instructed vital signs every visit without documentation of parameters to report to RN.

Upon patient record review 5 of 11 (Patient #4,6,7,10,11) 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 #4, Aide frequency 2x/week, only 1 visit week of 2/10/23. Patient #6, Aide frequency 2x/week starting 7/1/22. No visits on 7/1/22 or 7/2/22. Only 1 aide visit week of 7/7/22. Patient #7, Aide frequency 2x/week only 1 aide visit on 1/13/23. Patient #10, Aide frequency 2x/week starting 11/18/22, no aide visit the first week. One visit on 11/23/22 for this week. Patient #11, Aide frequency 2x/week, one visit week 12/9/22 and 12/13/22. No aide visit week of 12/20/22.

Upon personnel record review, 3 of 10 (Personnel #1,2,6) did not have evidence the hospice employees and contract employees have received orientation on the hospice philosophy. Personnel #1,2,6 Missing signature documenting staff received orientation on hospice philosophy.

Upon patient client record review, 10 of 11 (Patient #1,2,3,4,5,6,7,8,9,11) 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, IDT notes from 2/3/23, 2/17/23, 3/3/23, missing signature of MSW, RN,SC. Patient #2, IDT note from 1/9/23 missing RN signature, 2/16/23 missing RN, SC signature, 3/2/23 missing RN, MD, SC signature. Other signatures missing credentials. Patient #3, Missing signature on initial RN assessment. Patient #4, IDT on 3/2/23 missing RN, SC signature, other signatures missing credentials. Patient #5, IDT signatures had no credentials on 1/1/9/23 note. Patient #6, IDT note on 2/2/23, 2/16/23, missing RN, SC signature. Patient #7, IDT note on 2/2/23 missing RN, SC signature. Patient #8, IDT note on 1/19/23 missing RN, SC signature. Patient #9, IDT note on 2/16/23 missing RN,SC signature. IDT note on 6/1/22 missing MD, SC, MSW signature. Patient #11, IDT note on 2/16/23 missing RN, SC signature.

Upon client record review, 3 of 11 (Patient #9,10,11) did not have evidence that the discharge summary includes all required information. Patient #9,10,11, incomplete discharge summary. All 3 patient charts was missing documentation of current plan of care, latest MD orders.