Every finding on record at Amedicus Hospice 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 Patient #4: Hydrocortisone cream was listed on the medication profile as, "apply to effected area" without indicating the specific affected area.

Upon patient record review, 1 of 6 (Patient #1) 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 Patient #1: Though the aide plan of care frequency was documented as 3 x week, the hospice plan of care dated 07-01-2025 indicated a lack of detail to the frequency of aide services which was written as 1 -3 x week.

Condition of participation: Initial and Comprehensive assessment of the patient The hospice must conduct and document in writing a patient-specific comprehensive assessment that identifies the patient’s need for hospice care and services, and the patient’s need for physical, psychosocial, emotional, and spiritual care. This assessment includes all areas of hospice care related to the palliation and management of the terminal illness and related conditions.

Upon patient record review 2 of 14 (Patient #1,3) 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: The patient was admitted 6/12/24 the MSW did not complete their assessment until 6/18/24. There is no evidence the SN completed the psychosocial assessment in the initial comprehensive assessment. Patient 3: The patient was admitted 12/19/24 the MSW did not complete their assessment until 12/28/24. There is no evidence the SN completed the psychosocial assessment in the initial comprehensive assessment.

Upon patient record review, 10 of 14 (Patient #1,2,3,4,5,6,7,8,9,10) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient 1,2,3,4,5,6,7,8,9,10: did not take in consideration the imminence of death in the comprehensive assessment.

Upon patient record review, 10 of 14 (Patient # 1,2,3,4,5,6,7,8,11,12) 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. Patient 1: The medication profile contains an order for Nystatin as needed with no frequency. Corrected on site. The hospice medication profile has Nystatin cream 100,000 u/grams PRN, Amino Acid 500 mg oral liquid dose 30 ml 2 x daily and Benadryl 25mg oral q HS and during home visit in Facility there is no evidence of these medications on the facility medication profile. The facility medication profile contains orders for Influenza Vaccination annually, Zinc Oral tablet 1 tab daily and Ascorbic Acid 500 mg tab BID and these medications are not found on hospice medication profile. Patient 2: The medication profile contains orders for Bisacodyl Rectal suppository 1 q 24 hours, Ensure Oral Liquid 1 TID PRN for supplement and Omega 3-6-9 oral liquid 2 caps 2x daily for supplement that are not found on facility MAR during home visit on 5/14/25. Morphine Sulfate (conc) 100mg/5ml Give 0.75ml po q 2 hours PRN SOB and Morphine Sulfate conc 100mg/5ml Give 1.0 ml po q 2 hr PRN SOB, with no directive of when to take each dose of medication and are not found on the hospice medication profile. Corrected on site. Patient 3: The medication profile contained Sucralfate oral tablets, the caregiver states patient has not taken this medication in a very long time. Corrected on site. Patient 4: The medication profile does not contain the oxygen that is ordered on the POC. Albuterol on medication profile listed with two frequencies 4 times daily and 5 times daily, no clear instruction for dosing. Corrected on site. Patient 5: The medication profile contains hemorrhoidal rectal ointment 1 application prn. No frequency or dose. Corrected on site. Patient 6: The medication profile contains Lantiseptic skin protectant ointment apply dose 1, 4x/day with no dose amount or instructions for where to apply. Oxygen order for 2 L via NC with no frequency for use. Corrected on site. Patient 7: The medication profile contains ondansetron PRN with no frequency and Miconazole 1 application does not contain a dose. The lidocaine menthol cream dose is 3 applications 3-4 times daily with no application site. Corrected on site Patient 8: The medication profile contains Bisacodyl PRN with no frequency. Corrected on site. Patient 11: The medication profile on 2/19/25 contains Tylenol ES 500mg 1 tab q. 6 hours and Hydrocodone/Acetaminophen 10/325mg at HS and 2 tabs every 6 hour PRN and 1 tab q 6 hour PRN with none of these orders containing do not exceed 3-4grams in 24 hours. Patient 12: The medication profile 10/23/23 contains an order for Preparation H dose 1 QID apply to area as needed. Does not include where and how much to apply. Voltaren gel documented 1 application daily without documentation of where and how much to apply.

Upon patient record review, 1 of 14 (Patient #2) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient 2: The Bereavement assessment was not completed until 1/7/25 this is greater than 5 days and there was no evidence it was completed in the RN initial assessment.

Condition of participation: Interdisciplinary group, care planning, and coordination of services. The hospice must designate an interdisciplinary group or groups as specified in paragraph (a) of this section which, in consultation with the patient's attending physician, must prepare a written plan of care for each patient. The plan of care must specify the hospice care and services necessary to meet the patient and familyspecific needs identified in the comprehensive assessment as such needs relate to the terminal illness and related conditions.

Upon patient record review, 1 of 14 (Patient #5) 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 5: The POC contains evidence that the patient has a Permacath for dialysis. There is evidence that the SN assessed the Permacath site during visits on 4/18/24, 4/24/24, and 5/6/24. There was no evidence of the site being assessed at any other of the visits. Pt was being seen by SN 1-3 times per week.

Upon patient record review, 1 of 14 (Patient #11) did not have evidence that the hospice follows the individualized plan of care developed in in collaboration with the attending physician (if any), the patient or representative, and the primary caregiver in accordance with the patient's needs if any of them so desire. Patient 11: The POC did not have evidence that the hospice provided planning and arranging for any required post discharge services. The POC did not contain evidence of Discharge planning activities, coordination with other care providers, the patient's response and understanding of these activities.

Upon patient record review, 3 of 14 (Patient #5,6,9) 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 5: The comprehensive assessment 3/26/25 and CTI contain evidence patient is on dialysis 3 times per week and has a Permacath. There was no nursing care plan with goals and interventions related to renal. Corrected on site. Patient 6: The POC 2/20/25 contains an order for Clopidogrel Bisulfate. There was no risk for bleeding care plan initiated with goals and interventions. Corrected on site. Patient 9: The POC 2/24/25 contains an order for Eliquis. There was no risk for bleeding care plan initiated with goals and interventions. Corrected on site.

Upon patient record review, 1 of 14 (Patient #1) 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: Patient 1: The POC 5/6/25 contains an order for SN 1-5 days per week. This is not a detailed statement of the scope and frequency to meet the individual needs of the patient. Correction on site.

Upon patient record review, 2 of 14 (Patient #4, 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 measurable outcomes are anticipated from implementing and coordinating the plan of care for each patient by using data elements identified by the hospice and is used as part of the Hospice's QAPI program. Patient 4: The nursing care plan contains goals of: Patient/caregiver will verbalize understanding of oxygen use by death or discharge and patient/caregiver will verbalize understanding of O2 use and safety by death or discharge. These goals are not measurable. Corrected on site. Corrected on site Patient 6: The nursing care plan contains goals of : Patient/caregiver will demonstrate how to maintain skin integrity by death or discharge and Pt will achieve and maintain pain level at an acceptable level as defined by patient/family by death or discharge. These goals are not measurable. Corrected on site.

Upon patient record review, 9 of 14 (Patient #1,2,4,5,6,7,8,11,12) 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 POC 5/6/25 contains an order for Nystatin as needed with no frequency. The HSP POC contains orders for Nystatin cream 100,000 u/gms PRN, Amino Acid 500 mg oral liquid dose 30 ml 2 x daily and Benadryl 25mg oral q HS and during home visit in Facility there is no evidence of these medications on the facility med profile. The Facility Med Profile contains orders for Influenza Vaccination annually, Zinc Oral tablet 1 tab daily and Ascorbic Acid 500 mg tab BID and these medications are not found on HSP POC. Corrected on site Patient 2: The POC contains orders for Bisacodyl Rectal suppository 1 q 24 hrs, Ensure Oral Liquid 1 TID PRN for supplement and Omega 3-6-9 oral liquid 2 caps 2x daily for supplement that are not found on facility MAR during home visit on 5/14/25. Morphine Sulfate (conc) 100mg/5ml Give 0.75ml po q 2 hrs PRN SOB and Morphine Sulfate conc 100mg/5ml Give 1.0 ml po q 2 hr PRN SOB with no directive of when to take each dose of medication and are not found on the HSP POC. Corrected on site. Patient 4: The POC contains an order for Albuterol with two frequencies 4 times daily and 5 times daily, no clear instruction for dosing. Corrected on site. Patient 5: The POC 3/26/25 contains "Perma cath dressing right chest". There are no details for the dressing. In addition, the POC contains hemorrhoidal rectal ointment 1 application prn. No frequency or dose. Corrected on site. Patient 6: The POC on 2/20/25 contains Lantiseptic skin protectant ointment apply dose 1 4x/day with no dose amount or instructions for where to apply. Oxygen order for 2 L via NC with no frequency for use. Corrected on site. Patient 7: The POC 1/16/25 and 3/17/25 contains Ondansetron PRN with no frequency. The POC on 3/17/25 contains Miconazole 1 application does not contain a dose. The lidocaine menthol cream dose is 3 applications 3-4 times daily with no application site. Corrected on site. Patient 8: The POC 4/1/25 contains Bisacodyl PRN with no frequency. Corrected on site. Patient 11: The POC on 2/18/25 contains Tylenol ES 500mg 1 tab q6 hours and Hydrocodone/Acetaminophen 10/325mg at HS and 2 tabs every 6 hours PRN and 1 tab q 6 hours PRN with none of these orders containing Do Not Exceed max allowable dose in 24 hours. The POC 2/18/25 contains an order for Foley cath #18 Fr with no balloon size, frequency to change or directives of what to irrigate with. Patient 12: The POC 10/23/23 contains an order for Preparation H dose 1 QID apply to area as needed. Does not include where and how much to apply. Voltaren gel documented 1 application daily without documentation of where and how much to apply.

Upon patient record review, 2 of 14 (Patient #1,4) 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 equipment and supply needs. Patient 1: The SN documented on the comprehensive assessment 6/12/24 patient has w/c, cushion, specialty mattress and over bed table. These were not on the POC. Corrected on site. Patient 4: The SN documented on 4/30/25 patient uses a walker. The walker was not included on the POC. Corrected on site.

Upon patient record review, 2 of 14 (Patient #7, 8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 7: SN documented 5/6/25 "HN administered Tylenol PRN to patient. HN instructed patient to take another Tylenol in one hour if pain is not relieved." There is no order to repeat the Tylenol in one hour. Patient 8: SN documented 4/23/25 "HN instructed CG to apply compression stockings". There is no order for compression stockings.

Upon patient record review 1 of 14 (Patient #12) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient 12: The patient refused an aide. Though MSW identified a need for more help in the home. Assisted patient and family in getting hired caregivers through DADS 18-22 hours per week. There was no evidence volunteers were offered to assist the family to offer more support from the hospice.

Upon patient record review, 2 of 14 (Patient #7, 9) did not have evidence that the IDG documents the sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement. Patient 7: SN documents on 4/2/25 patient had a fall, the SN notified the Medical Director, there was no evidence the chosen attending physician was notified. Patient 9: SN documented on 4/29/25 patient having constipation. SN notified Medical Director and did not attempt to call chosen attending physician.

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 3: The SN cleansed equipment with gloved hands and placed equipment directly in to nursing bag with gloved hands without hand hygiene performed after patient care. Per Agency Bag Technique IC.60 When visit is completed, reusable equipment is cleaned using alcohol, disinfectant wipe and /or antimicrobial soap and water as appropriate, hands are washed, and equipment and supplies are returned to the bag.

Upon patient record review 1 of 14 (Patient #8) did not have evidence documentation in the patient record that a hospice aide provides services that are Patient 8: The aide POC contains orders to change linens Q week. The aide changed linens on 4/8/25 and 4/10/25, 4/15/25 and 4/17/25. There was no evidence the aide called the SN for directives to change the linens the second time during those weeks.

Upon personnel record review, 2 of 13 (Personnel #7,9) did not have evidence the hospice employees and contract employees have received orientation on the hospice philosophy. Personnel 7, 9: There was no evidence in the personnel file that the contracted staff have received orientation on the hospice philosophy. The agency states they have used PT and ST.

Upon patient record review, 2 of 14 (Patient #1,6) did not have evidence that each patient record contains: Patient 1: The EOB did not contain an election date. Patient 6: The EOB did not contain an election date.

Upon patient record review, 2 of 14 (Patient #2,7) did not have evidence that each patient record contains Physician certification and recertification of terminal illness. Patient 2: The EOB indicates the patient chose an attending physician that is not the medical director. There was no CTI by the attending. Patient 7: The EOB indicates the patient chose an attending physician that is not the medical director. There was no CTI by the attending.

Upon patient record review, 3 of 14 (Patient #1,10,11) 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: The SN documented 6/12/24 "Cleanse with NS, pat dry, calcium alginate, cover with dry dressing daily". It is not clear if the wound care was performed as the documentation is not in past tense. Patient 10: The SN documented on 4/4/25 "HN" this is not an approved abbreviation. The IDG on 3/25/25, the SN documented that the "wound is healed". It is unclear which wounds are healed as patient had wounds on the right and left foot. Patient 11: The SN documented on 2/18/25 Performed "wound care per orders and area almost closed." It is not clear that the SN followed the POC.

Upon patient record review, 2 of 14 (Patient #11,12) 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: Patient 11 and 12: There was no evidence in the medical records that a discharge summary was sent to the attending physicians.

Upon patient 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 did not include the following: foley care, wound care treatments. the patient's current plan of care, the patient's latest physician orders, any other documentation that will assist in post-discharge continuity of care or that is requested by the attending physician or receiving facility. Patient 12: The discharge summary did not include the following: The patient's current plan of care, the patient's latest physician orders, any other documentation that will assist in post-discharge continuity of care or that is requested by the attending physician or receiving facility.

Upon patient record review, 2 of 14 (Patient # 5,11) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 5: SN documented 4/24/25 Diabeti-Source AC 1.2 kcal/min infusion at 40 cc/hr to be infused via G-tube from 8pm-5am via PEG tube with 150 ml of water every 4 hours via GTube with no evidence of an order. On 5/6/25 the SN documented checking patency of G tube there is no order to check patency and the SN documented checking placement of the G tube and documented the dressing was clean and dry. There was no order to check placement or for a dressing. Corrected on site. Patient #11: SN documented in plan of care that Spiritual Care visits should be made 1-3 times/week and Spiritual care visits were made 1 time/month. Foley catheter changed by the SN on 08/6/24 with no orders to change the foley.

Upon patient record review, 1 of 11 (Patient #10) 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 #10 the medical record did not contain a plan of care and did not include a medication profile for identified medications.

Upon patient record review, 1 of 11 (Patient #10) 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.

Upon patient record review, 1 of 11 (Patient #10) 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 #10 the medical record did not contain a plan of care and did not include any orders for identified medications.

Upon client record review, 6 of 11 (Patient #1,3,4,5,10,11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1 For POC 4/18/22 SW ordered 1-2 mo 3, SW visited 5/5/22. No evidence of visit or missed visit for April 2022 nor order to correct freq. Patient #3 For POC 4/23/22 SW order 1-3 mo3, SW visited 5/24. No evidence of visit or missed visit for April 2022 nor order to correct freq. Patient #4 For POC 4/28/22 SN ordered 1-2 w 90 and 3 prn, SN visited 5/2/22, 5/11/22, 5/18/2022. No evidence of visit for first week of episode nor missed visit or order to correct frequency. Patient #5 For POC 4/9/22 Sn order 1-2 mo3 3 prn, SN visits 4/13/22, 4/21 (MV), 4/28, 5/2. No evidence of visit for first week (4/9/22 or 4/10/22) nor missed visit or order to correct frequency. Patient #10 the medical record did not contain a plan of care and did not include any orders for visits completed by the RN. Patient #11 For POC dated 3/9/22 SN ordered 1-2 wk 3mo, 3 prn. SN visits 3/14, 3/24, 3/31, 4/5, 4/7, 4/13. No evidence of visit for first week of episode nor missed visit or order to correct frequency.

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: SN did not place barrier down between patient bench and nursing bag nor between her tablet/keys and patient table. Patient #3: SN did not place barrier down between patient bench and nursing bag.

Upon patient record review 4 of 8 applicable (Patient #2, 7, 8, 9) 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: For POC dated 2/28/22, Aide ordered 2-3wk/90, Aide visit on 3/5. No evidence of additional visit(s) for first week of episode nor missed visit or order to correct frequency. Patient #7 POC dated 6/7/21 Aide order 2-5 Wk 90, Aide started care 6/21. No evidence of visit for prior to 6/21/21 in episode nor missed visit or order to correct frequency. Patient #8 POC dated 4/7/21: Aide ordered 3wk/90 Aide visits for 4/13/21, 4/15, 4/20, 4/22. No evidence of visit for first week of episode nor missed visit or order to correct frequency. Additionally aide services were not performed after 5/14/21 and there is no evidence of order to discontinue services. Patient #9 POC dated 1/6/22 Aide ordered 2w90d. No evidence of second visit for first week of episode nor missed visit or order to correct frequency.