Every finding on record at Amazon Hospice, Inc.

Upon patient record review 1 of 14 (Patient #1) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #1 - Patient was admitted on 12/05/25. The spiritual comprehensive assessment was not completed until 12/17/25.

Upon patient record review 1 of 14 (Patient #12) 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 #12 - Patient was admitted on 02/18/25. There is no evidence of an psychosocial comprehensive assessment in the medical record. The elements of that comprehensive were not captured in the nursing comprehensive dated 02/18/25.

Upon patient record review, 1 of 14 (Patient #11) 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 #11 - The medical record showed a LVN visit on 05/09/25 regarding complaints from the patient and the caregiver of constipation. There was no evidence of follow up with the patient by the RN, no bowel regimen initiated and no follow up visit documented. Patient transferred to another hospice on 05/12/25.

Upon patient record review, 4 of 14 (Patient #1,3,6,7) 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 nursing comprehensive assessment documented the patient was a 12 on the Braden scale or at high risk for skin integrity. There was no evidence of problems, goals, or interventions related to skin integrity. Corrected and updated onsite. Patient #3 - The patient's advanced directive indicated patient was undecided as to his code status. There was no evidence of problems, goals, or interventions related to the code status. Corrected and updated onsite. Patient #6 - The medical record showed patient's admitting diagnosis was heart failure with a related diagnosis of COPD. There was no evidence of problems, goals, or interventions related to these diagnoses. Patient's medication profile listed ASA daily as a blood thinner. There was no bleeding risk problems, goals, or interventions listed. Patient #7 - The nursing comprehensive dated 12/18/24 documented patient was on a pureed diet with thickened liquids. There was no evidence of problems, goals, or interventions related to that diet.

Upon patient record review, 3 of 14 (Patient #2,13,14) 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 #2 - The medical record showed a frequency order dated 03/03/25, for spiritual care frequencies as "1 visit within first 5 days and then per spiritual care recommendation to assess spiritual support needs and provide spiritual guidance and counseling." There was no indication of the quantity of visits. Patent #13 - The medical record showed a frequency order dated 04/08/25, for spiritual care frequencies as "1 visit within first 5 days and then per spiritual care recommendation to assess spiritual support needs and provide spiritual guidance and counseling." There was no indication of the quantity of visits. Patient #14 - The medical record showed a frequency order dated 08/14/25, for spiritual care frequencies as "1 visit within first 5 days and then per spiritual care recommendation to assess spiritual support needs and provide spiritual guidance and counseling." There was no indication of the quantity of visits.

Upon patient record review, 1 of 14 (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 medications and treatments. Patient #7 - The nursing comprehensive dated 12/18/24 documented patient's diet as a pureed diet with thickened liquids. There was no evidence of an order on the patient's plan of care for this diet.

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 equipment and supply needs. Patient #6 - The medication profile indicated patient was on nebulized albuterol and ipratropium. There was no evidence of a nebulizer on the plan of care.

Upon client record review, 1 of 14 (Patient #12) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #12 - The initial plan of care dated 02/18/25, contained an order for spiritual care assessments to be completed monthly. Spiritual care assessments were completed on 02/21/25, 04/16/25, and 06/16/25. There was no evidence of assessments completed in March or May.

Upon patient record review 2 of 14 (Patient #2,3) 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 #2 - The aide plan of care dated 03/03/25 outlined frequency of aide visits at 2 times per week. There is no evidence of aide visits since 11/27/25 and no order to change or discontinue aide frequency. Patient #3 - The aide plan of care dated 01/24/25 outlined frequency of aide visits at 2 times per week. There is no evidence of aide visits since 11/27/25 and no order to change or discontinue aide frequency.

Upon client record review, 1 of 14 (Patient #11) did not have evidence that the hospice forwarded a summary and a copy of the patient record, if requested, to a facility when transferring the patient to that facility. Patient #11 - Patient signed a transfer form transferring to another hospice on 05/12/25. There was no evidence indicating that transfer form or summary was forwarded to the receiving hospice.

Upon client record review, 1 of 14 (Patient #11) 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 Patient #11 - The discharge summary dated 05/12/25, stated "tx to another hospice". There was no evidence this summary was sent to patient's attending MD.

Upon client record review, 2 of 14 (Patient #11,12) did not have evidence that the discharge summary includes all required information. Patient #11 - The discharge summary dated 05/12/25, stated "tx to another hospice". The summary did not include the necessary elements of the discharge summary. Patient #12 - The medical record indicated the patient was discharged due to extended prognosis on 06/17/25. There was no evidence that the discharge summary was completed.

Upon patient record review, 5 of 13 (Patient #1,#3,#6,#7,#13) 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 1: The medication profile indicates the patient was on Hydrocortisone Cream 0.5% topical, apply to rash/itchiness areas twice daily. There was not evidence of a location to apply the cream. Corrected on site. Patient 3: The medication profile indicates the patient was on Diclofenac 1% topical gel apply to affected area for pain. There was not evidence of a location to apply the gel. Corrected on site. Patient 6: The medication profile indicates A&D ointment was to be applied with ample amount of ointment to irritation area twice daily. There was not evidence of a location to apply the ointment. Corrected on site. Patient 7: The medication profile indicates A&D ointment was to be applied with ample amount of ointment to irritation area twice daily. There was not evidence of a location to apply the ointment. Corrected on site. Patient 13: The medication profile indicates A&D ointment was to be applied with ample amount of ointment to irritation area twice daily. There was not evidence of a location to apply the ointment. Corrected on site.

Upon patient record review, 5 of 13 (Patient #1,#3,#6,#7,#13) 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 1: The plan of care included Hydrocortisone Cream 0.5% topical, apply to rash/itchiness areas twice daily. There was not evidence of a location to apply the cream. Corrected on site. Patient 3: The plan of care included Diclofenac 1% topical gel apply to affected area for pain. There was not evidence of a location to apply the gel. Corrected on site. Patient 6: The plan of care included A&D ointment to be applied with ample amount of ointment to irritation area twice daily. There was not evidence of a location to apply the ointment. Corrected on site. Patient 7: The plan of care included A&D ointment to be applied with ample amount of ointment to irritation area twice daily. There was not evidence of a location to apply the ointment. In addition, Neosporin was ordered to apply ample amount of cream to wound areas twice daily as needed for minor wounds. There was not evidence of where the wounds are located or what type of wound. Corrected on site. Patient 13: The plan of care included A&D ointment to be applied with ample amount of ointment to irritation area twice daily. There was not evidence of a location to apply the ointment. Corrected on site.

Upon patient record review, 1 of 13 (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: SN was ordered 1 time a week. There was not evidence of a SN visit the week of 6/12/22.

Upon patient client record review, 1 of 13 (Patient #1) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient requested the Notice of Non-coverage items, services and drugs on 9/10/22 there was not evidence it was provided in the record. This was corrected on site.