Every finding on record at Amica Hospice Care, Inc.

Upon patient record review, 2 of 14 (Patient #5,9) 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 5: Voltaren 1% gel, apply 2 grams topical 4 times daily as needed for pain-there is no evidence of application site for this medication in the medication list. Patient 9: Patient has an order for oxygen on plan of care, listed as DME. There is no evidence of oxygen order on the patient medication list.

Upon patient record review, 1 of 14 (Patient #10) 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 10: Patient was admitted to continuous care on 01/24/2025. Patient expired 01/27/2025, while still on continuous care. 2-015 continuous care policy states RN must visit and assess patient daily. There is no evidence of RN visits in the medical record after admission assessment. Admission IDT note, written by RN states that patient was admitted to routine level of care. Admission order was written for continuous level of care. Patient had physician’s order for vital sign parameters. Nurses were to report to MD whenever the vital signs were outside the documented parameters. There was also an order for SpO2 to be checked every visit with no parameters given for this vital sign. There is no evidence of documentation in the medical record that any of the low SpO2s were reported to the physician, the patient received the available supplemental oxygen, and that vitals signs outside of parameters were reported to the physician.

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 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: Identified needs: diabetes, anxiety, cardiac, pain, max assist, high risk for high risk for falls, edema, dyspnea, weakness, high risk for high risk for skin breakdown breakdown, nutrition/aspiration precautions precautions. No evidence of problems, goals, interventions on the plan of care: pain, weakness, high risk for skin breakdown COS Patient 2: Identified needs: depression cardiac, dyspnea, bleeding precautions, constipation, weakness, edema, high risk for falls, high risk for skin breakdown, bleeding precautions. No evidence of problems, goals, interventions on the plan of care: depression, constipation, high risk for falls, high risk for skin breakdown, bleeding precautions (COS), dyspnea. Patient 3: Identified needs: bleeding precautions, moderate assist high risk for high risk for falls, cardiac, edema, dyspnea, weakness, pain, high risk for skin breakdown. No evidence of problems, goals, interventions on the plan of care: dyspnea, weakness, high risk for high risk for skin breakdown breakdown (COS), pain. Patient 4: Identified needs: bleeding precautions, high risk for falls, dyspnea high risk for skin breakdown, weakness, cardiac. No evidence of problems, goals, interventions on the plan of care: dyspnea, bleeding precautions, high risk for skin breakdown (COS). Patient 5: Identified needs: weakness, diabetes, high risk for skin breakdown, pain, cardiac, neuropathy, fall, dyspnea, edema. No evidence of problems, goals, interventions on the plan of care: weakness, high risk for skin breakdown, cardiac, dyspnea (COS), neuropathy. Patient 6: Identified needs: moderate assist, high risk for falls, anxiety, edema, dyspnea, weakness, pain, high risk for skin breakdown, cardiac, bleeding precautions. No evidence of problems, goals or interventions on the plan of care: bleeding precautions, high risk for falls, anxiety, edema, high risk for skin breakdown (COS), dyspnea. Patient 7: Identified needs: respiratory, oxygen, pain, constipation, dyspnea, high risk for falls, weakness, neuro/confusion, anxiety, high risk for skin breakdown, nutrition/aspiration precautions, diabetes, total care. No evidence of problems, goals, interventions on the plan of care: high risk for falls, weakness, high risk for skin breakdown COS. Patient 8: Identified problems: neuro/confusion, high risk for skin breakdown, high risk for falls, weakness, dyspnea, edema, anxiety, depression, pain, cardiac, bleeding precautions. No evidence of problems, goals, interventions on the plan of care: bleeding precautions, high risk for skin breakdown, high risk for falls, weakness, dyspnea, edema. COS Patient 9: Identified problems: pain, neuro/anxiety and confusion, high risk for falls, high risk for skin breakdown, wound, edema, dyspnea, respiratory, productive cough, constipation, nutrition, aspiration precautions, oxygen, weakness. No evidence of problems, goals, interventions on the plan of care: high risk for skin breakdown, edema, dyspnea, respiratory, productive cough, oxygen. Patient 10: Identified problems: neuro, respiratory, dyspnea, oxygen, nutrition/aspiration precautions, high risk for skin breakdown, high risk for falls, pain, constipation, mobility. No evidence of problems, goals, interventions on the plan of care: neuro, aspiration precautions, high risk for skin breakdown, constipation. In addition, the patient was admitted 1/24/25 for continuous care. There is no evidence in the medical record that patient plan of care was updated to include continuous care.

Upon patient record review, 2 of 14 (Patient #5,9) 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 5: Voltaren 1% gel. Apply 2 grams topical 4 times daily as needed for pain: There is no evidence of application site for this medication in the plan of care. Patient 9: There is no evidence of oxygen medication order on patient’s plan of care. Patient’s oxygen order is listed as DME.

Upon patient record review, 1 of 14 (Patient #2) 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 2: Patient admitted to hospice on 11/10/24 with initial IDT held the same day. The next IDT was held on 11/26/24, which is 16 days. This is outside the 15 days plan of care review.

Upon patient record review, 4 of 14 (Patient #1,2,3,9) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1,9: MSW and SC visit frequency order is once monthly. There is no evidence of social worker visits or spiritual care visits after initial assessment. SC visit frequency order is once monthly. Patient 2,3: MSW and SC visit frequency order is initial, on recertification, and as needed. There is no evidence of social worker or spiritual care visits after initial assessment.

Upon patient record review, 1 of 14 (Patient #9) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions 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 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient 9: The following tasks written on the aide care plan: record bowel movement; pajama/gown have no evidence of frequency of task to be performed. Aspiration precautions not on aide care plan despite being on plan of care.

Upon patient record review, 1 of 14 (Patient #4) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 Patient 4: Patient’s election of benefits does not have evidence of the first day of service, as this area of the document is blank. • Signed election statement in accordance with 418.24

Upon inpatient contract review, Astoria Nursing and Rehab (contract #2) did not have evidence that the hospice patient's inpatient clinical record includes a record of all inpatient services furnished and events regarding care that occurred at the facility; that a copy of the discharge summary be provided to the hospice at the time of discharge; and that a copy of the inpatient clinical record is available to the hospice at the time of discharge. Contract #2:There is no evidence in this contract that the facility is required to provide hospice a discharge summary upon discharge, regardless of request for document. Further, there is no evidence in this contract that the facility is required to provide hospice with a discharge summary when discharging from one level of care to another.

Upon SNF/NF contract review, Astoria Nursing and Rehab (contract#2) did not have a delineation of the responsibilities of the hospice and the SNF/NF to provide bereavement services to SNF/NF personnel. Contract #2: There is no evidence in this contract that the hospice is required to provide bereavement services to the SNF staff.