Every finding on record at Ample Care Hospice LLC

Upon patient record review, 3 of 6 (Patient #1, 3, 4) 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: Patient admitted 5/7/23. Identified as Full Code on EMR home screen and Initial Comprehensive Assessment and CTI, but has POLST form dated start of care. POLST Section A choice marked is Allow Natural Death. Do not attempt resuscitation. Patient #3: Patient admitted 2/8/23. Patient identified as DNR on EMR home screen. Identified as Full code in both CTIs (2/8 and 5/3/23), RN Initial and Recert assessments (2/8 and 5/3/23). POLST (2/8/23) Section A choice marked is Allow Natural Death. Do not attempt resuscitation. Patient #4: Patient admitted 5/16/23. Patient identified as DNR on EMR home screen and CTI, but POLST dated and signed 5/16/23 Section A is blank, as to which choice patient made. Reviewed all with staff and provided education.

Upon patient record review, 4 of 6 (Patient #1, 2, 3, 4) 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 • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #1: Admitted 2/7/23. Initial IDG POC freq. MSW One time then prn. SC one time then prn. Same frequencies stated thru 7/20/23 IDG. Patient #2: Admitted 2/7/23. Initial IDG POC frequency MSW one time then prn. SC one time then prn. Same frequency from admission IDG thru 7/20/23. Patient #3: Admitted 2/8/23. Initial IDG POC frequency MSW One time then prn. SC one time then prn. Same frequency from initial IDG thru 7/20/23 IDG. Patient #4: Admitted 5/16/23. Initial IDG POC frequency MSW One time then PRN. SC one time then prn.

Upon client record review, 4 of 6 (Patient #1, 2, 3, 4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1: Admitted 2/7/23. Initial IDG POC freq. MSW One time then prn. SC one time then prn. Same frequencies stated thru 7/20/23 IDG. MSW made visits 4/22 and 7/8/23. Patient was seen monthly by SC 2/9, 3/20, 4/22, 5/8, 6/9/23. Patient #2: Admitted 2/7/23. Initial IDG POC frequency MSW one time then prn. SC one time then prn. Same frequency from admission IDG thru 7/20/23. MSW made patient visits 2/11 and 7/8/23. SC visited monthly 2/10, 3/20, 4/22, 5/8, 6/9, 7/26/23. Patient #3: Admitted 2/8/23. Initial IDG POC frequency MSW One time then prn. SC one time then prn. Same frequency from initial IDG thru 7/20/23 IDG. MSW visits 2/11 and 7/8/23. SC visits monthly 2/11, 5/9, 3/20, 4/22/23. Patient #4: Admitted 5/16/23. Initial IDG POC frequency MSW One time then PRN. SC one time then prn. MSW saw patient 5/20, 7/8/23. SC saw patient 5/18, 6/24, 7/24/23.

Upon patient record review 1 of 6 (Patient #1) 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 Aide Visits ordered 3x/wk. Aide Visits Jun 3, 9, 10, 17, 24, July 1, 8, 15, 22, 29.

Upon patient client record review, 6 of 6 (Patient #1, 2, 3, 4, 5, 6) 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, 2,3, 4, 5, 6: Blank Release of Medical information signed and no date. Patient #5: Comprehensive Assessment created by and assigned to staff member and signed by a different RN to close note on behalf of assigned. Upon interview, RN stated she was present with visiting clinician. This was not evident in record.