Every finding on record at America Hospice and Palliative Care, Inc

Upon patient record review 1 of 8 (Patient #1) 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: The patient declined a chaplain after admission on 03-13-25 however, there was no evidence a spiritual assessment was completed.

Upon patient record review, 2 of 8 (Patient #2, #3) 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: The respiratory section of the comprehensive visit and the IPOC dated 08-03-24 indicated the patient was on O2 2L NC. However, O2 was not on the medication profile. Patient #3: The comprehensive assessment and IPOC dated 02-27-24 indicated the patient was using continuous oxygen at 2L NC. However, oxygen was not on the medication profile.

Upon patient record review 2 of 8 (Patient #1,2) 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 #1: The plans of care dated 06-26-25 and 07-10-25 indicated the frequency for aide was 1wk8. However, for the weeks starting 06-29-25 and 07-05-25 there were no aide visits Additionally, for the week of 07-06-25 to 07-12-25 there were 2 aide visits dated 07-06-25 and 07-12-25. Patient #2: The initial plan of care dated 08-03-24 included an aide frequency of 3wk13 effective 08-04-24. However, there were no aide services provided until 08-09-24.

Upon patient record review, 1 of 6 records (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: The medication record revealed Hydrocodone APAP 10/350 po q4-6h prn pain and Acetaminophen 650mg po q8h prn fever. There was not evidence of a maximum allowable dose of Acetaminophen per 24h period.

Upon patient record review, 2 of 6 records (Patient #4,#5) did not have evidence the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #4: The record revealed an order for Hydrocodone APAP 10/350 po q4-6h prn pain and Acetaminophen 650mg po q8h prn fever. There was not evidence of a maximum allowable dose per 24h period. Patient #5: The comprehensive assessment conducted on admission indicated that the patient was receiving Jevity 1.2, 5 cans/day bolus feeding, and certification of terminal illness indicated that the patient has dysphagia and is receiving tube feedings. There was not evidence that the feeding tube or the nutrition was a part of the plan of care.

Upon patient record review, 1 of 6 records (Patient #2) did not have evidence in the patient record that hospice aide assignments and duties are: • Written patient care instructions, including precautions, 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 Patient #2: The record indicated that the patient was on Eliquis 5mg TID. There was not evidence that bleeding precautions were a part of the aide plan of care.

Upon patient record review 1 of 6 records (Patient #2) did not have evidence of documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care Patient #2: The aide plan of care indicated to provide a complete bath at every visit. For the dates of 8/1/22, 8/3/22, and 8/5/22, the aide documentation revealed that a shower was provided.

Upon policy and procedure review, the COVID vaccination policy did not include the provision for a process for ensuring that all documentation, which confirms recognized clinical contraindications to COVID-19 vaccines, and which supports personnel requests for medical exemptions from vaccination, has been signed and dated by a licensed practitioner, who is not the individual requesting the exemption, and who is acting within their respective scope of practice as defined by, and in accordance with, all applicable state and local laws, and for further ensuring that such documentation contains: •All information specifying which of the authorized COVID-19 vaccines are clinically contraindicated for the personnel member to receive and the recognized clinical reasons for the contraindications; and •A statement by the authenticating practitioner recommending that the personnel member be exempted from the Hospice's COVID-19 vaccination requirements for personnel based on the recognized clinical contraindications. Corrected on site.