Every finding on record at American Hospice, Inc.

Upon patient record review, 1 of 19 (Patient #6) 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 #6: Upon record review, nurse documents on 12/22/25 and 1/6/26 that blood sugars are being checked 3 times per week and spouse is administering insulin. There is no evidence of problems with goals and interventions related to endocrine on the written plan of care. This has been corrected on site.

Upon client record review, 2 of 19 (Patient #1,#3) 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. Patient#1: Upon record review, there is IDG documentation that volunteer services began on 6/12/25 at a frequency of one time per week for tuck in calls. For IDG meetings 8/7/25, 8/19/25, 9/3/25, 9/18/25, 10/2/25 volunteer services is blank. Patient#3: Upon record review, there is documentation for the volunteer on the POC 12/1 that volunteer services to start on 12/11/25 at 2 times a month. IDG note on 12/23/25 and 1/7/26, states no volunteer services.

Upon patient record review, 1 of 19 (Patient#11) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient#11: The plan of care indicates there are problems goals and interventions assigned to chaplain and social worker, however there are no spiritual or social worker services being provided. This has been corrected on site.

Upon client record review, 3 of 19 (Patient #3,6,12) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #3: The visit on 11/30/25, the nurse states she spoke with the medical director and instructions given to flush the suprapubic catheter tomorrow with isotonic water. There is no documentation this was completed. Patient#6: Upon record review, there is documentation on 12/23/25 of a volunteer care plan stating tuck in calls to be completed one time per week starting 1/5/26. There is no evidence that volunteer services were provided. Patient#12: Upon record review, there is documentation of labs being obtained on 9/9/25 and 12/16/25 for UA with C&S. There is no evidence of an MD order for these labs.

Upon observation and home visits, 1 of 4 (Patient #15) there was missing evidence the hospice investigates all adverse events, incidents, accidents, variances or unusual occurrences that involve patient care and develops a plan of correction to prevent the same or similar event from occurring again. Patient#15: Upon observation, it was noted that patient revoked hospice services due to complaints regarding aide services. There is no evidence of a complaint report or investigation.

Upon observation, there was no evidence of contracts/agreements with other facilities/agencies/hospices to receive patients in the event the hospice cannot provide care to their patients during an emergency. Corrected on site.

Upon patient record review, 9 of 13 records (Patient #1,#2,#3,#6,#7,#8,#11,#12,#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: Nurse documentation dated 1/23/23 indicated that oxygen was increased to 5L/min. There was not evidence that the oxygen liter flow was to be increased to 5L/min on medication profile. Corrected on site. Patient #2: The nurse documentation from a visit dated 12/6 indicated that the nurse advised to administer Tums. There was not evidence that Tums was a medication in the medication profile. Corrected on site. Patient #3: The record indicated Acetaminophen rectal supp, 1 q6h for pain or fever. There was not evidence of a parameter for fever. Corrected on site. Patient #6: The record indicated Acetaminophen 325 mg, 2 tabs q6h prn for pain or fever. There was not evidence of a parameter for fever. Corrected on site. In addition, Miralax 17 GM powder packet daily, mix with 8 oz fluid of choice, and a duplicate Miralax order but listed as prn. Corrected on site. Patient #7: The medication profile contained Senna 8.6mg-50mg, 4 po hs (routine med). Also Dulcolax rectal supp, 1 daily prn and Miralax 17 Gm powder packet. There was not evidence of the sequence to administer these medications based on ineffectiveness. Corrected on site In addition, the record indicated Acetaminophen rectal supp, 1 q6h for pain or fever. There was not evidence of a parameter for fever. Corrected on site. Patient #8: The medication profile indicated for oxygen 2-5L continuous. There was not evidence of a route. Corrected on site. Patient #11: The record indicated oxygen 2-4L q2h prn by mouth/under tongue. Patient #12: The record indicated Acetaminophen rectal supp, 1 q6h for pain or fever. There was not evidence of a parameter for fever. Patient #13: The record indicated Acetaminophen rectal supp, 1 q6h for pain or fever. There was not evidence of a parameter for fever. In addition, oxygen 2-4l as needed for shortness of breath. There was not evidence of a route.

Upon patient record review, 1 of 13 records (Patient #3) 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 #3: The patient was admitted on 9/20/22. The record indicated the initial bereavement assessment was not completed until 11/2/22.

Upon patient record review, 9 of 13 records (Patient #1,#2,#3,#6,#7,#8,#11,#12,#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: Nurse documentation dated 1/23/23 indicated that oxygen was increased to 5L/min. There was not evidence of an order to increase the oxygen liter flow. (The order was for 2-4L/min). Corrected on site. Patient #2: The nurse documentation from a visit dated 12/6 indicated that the nurse advised to administer Tums. There was not evidence of an order. Corrected on site. Patient #3: The record indicated an order for Acetaminophen rectal supp, 1 q6h for pain or fever. There was not evidence of a parameter for fever. Corrected on site. Patient #6: The record indicated an order for Acetaminophen 325 mg, 2 tabs q6h prn for pain or fever. There was not evidence of a parameter for fever. Corrected on site. In addition, Miralax 17 GM powder packet daily, mix with 8 oz fluid of choice, and a duplicate Miralax order but listed as prn. Corrected on site. Patient #7: The medication profile contained Senna 8.6mg-50mg, 4 po hs (routine med). Also Dulcolax rectal supp, 1 daily prn and Miralax 17 Gm powder packet. There was not evidence of the sequence to administer these medications based on ineffectiveness. Corrected on site. In addition, the record indicated Acetaminophen rectal supp, 1 q6h for pain or fever. There was not evidence of a parameter for fever. Corrected on site. Patient #8: The order indicated for oxygen 2-5L continuous. There was not evidence of a route. Corrected on site. Patient #11: The record indicated an order for oxygen 2-4L q2h prn by mouth/under tongue. Patient #12: The record indicated an order for Acetaminophen rectal supp, 1 q6h for pain or fever. There was not evidence of a parameter for fever. Patient #13: The record indicated an order for Acetaminophen rectal supp, 1 q6h for pain or fever. There was not evidence of a parameter for fever. In addition, an order for oxygen 2-4l as needed for shortness of breath. There was not evidence of a route.

Upon patient record review, 1 of 13 records (Patient #2) did not have evidence in the patient record that hospice aide assignments and duties are: • Written patient care instructions including alerts and 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, 1 tab BID. There was not evidence of bleeding precautions in the aide plan of care. Corrected onsite.

Upon patient record review 4 of 13 records (Patient #2,#4,#9,#10) 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 Patient #2: The aide visit frequency was 3x/week. For the weeks starting 12/18/22, 12/25/22, and 1/1/23, the record indicated only 2 visits each of these weeks. Patient #4: The aide visit frequency from 1/9/23 to current was 5x/week. The tasks of nail care and shampoo were ordered to be performed 1x/week. The record indicated that nail care (from 1/9/23 to current) was performed at most of the visits. Shampoo was performed 2-3 times each of these weeks . And for the week beginning on 1/22/23, the record indicated 3 visits, 1 missed visit document and 1 missed visit with no evidence of the date the visit was missed or the reason it was missed. Patient #9: The aide visit frequency from 1/8/23-1/23/23 was 5x/week. For the week of 1/8/23-1/14/23, the record indicated only 3 visits. Patient #10: The aide visit frequency was 3x/week. For the week 12/18/22-12/24/22, the record indicated only 2 visits and for the week 12/25/22-12/31/22, the record indicated only 2 visits.

Upon patient client record review, 2 of 13 (Patient #3,#7) 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 #3: The narrative nurse note dated 1/28/23 indicated, '...bowel sounds present. Noah Demon noted, skin intact...' The verbiage was not comprehensible. Patient #7: The advance directive form of the admission legal documents had 2 checkboxes indicating that either the patient had or did not have an advance directive. Both of these boxes were blank. (Neither one was checked to indicate if there was an advance directive).