Every finding on record at Ambassadore Hospice Care, Inc.

Upon patient record review, 1 of 6 (Patient #4) 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 4: Medication profile included Polyethylene Glycol 3350 powder 17G once daily as needed if no BM for 3 days, without instructions on how to diluent the powder. Corrected on site.

Upon patient record review, 1 of 6 (Patient #4) 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 4: Medication ordered on 09/23/2022 Polyethylene Glycol 3350 powder 17G once daily as needed if no BM for 3 days, the order did not include a diluent. Corrected on site.

Upon patient record review, 4 of 6 (Patient #3,#4,#5,#6) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patients 3,4,5,6: No evidence that IDG occurred for 18 days between 11/21/2022-12/09/2022.

Upon patient client record review, 2 of 6 (Patient #1, #3) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient 1, 3: Did not have evidence of an effective date listed on notice of election form.