Every finding on record at Angel Palliative Care & Hospice

Upon observation, there was no evidence the Emergency Plan communication plan must includes a primary and alternate means for communicating with hospice's employees.

Upon patient record review, 1 of 14 (Patient #10) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #10: The record did not contain evidence the patient choose a health care provider, including an attending physician.

Upon patient record review, 1 of 14 (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 medication profile did not include comfort medications.

Upon patient record review, 1 of 14 (Patient #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 medications and treatments. Patient 4 did not have orders for comfort medications.

Upon patient record review, 1 of 14 (Patient #14) 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 #14: The record has a plan of care dated 2/10/23 and all subsequent plans of care that indicates the volunteer is to provide support, socialization and respite for caregiver relief there is no evidence of volunteer services accepted in the record. In addition, there are problems, goals, and interventions for psychosocial. The record indicates the patient declined SW services.

Upon client record review, 2 of 14 (Patient #3 and 4) 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 SW visit order dated 5/12/22 was indicated 1wk1. The SW visit was made outside of the Medicare week on 5/18/22. Patient #4 The RN completed the admission visit without an order for the visit.

Upon patient record review, 1 of 14 (Patient #12) did not have evidence that the IDG shares information on a on-going basis with non-hospice healthcare providers furnishing services unrelated to the terminal illness and related conditions. Patient #12: The medical record did not contain evidence the staff shared information with the physical therapist the patient was seeing 1-3x/wk.

Upon patient record review, 1 of 14 (Patient #3) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient #3: The medical record did not contain evidence that a bereavement plan of care was developed based on the risk level assessed as high risk and accepted bereavement services.

Upon patient record review, 4 of 14 (Patient #5,#7,#12,#14) 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 #5: The visit frequency on the aide plan of care was indicated as 1-2/wk and 2 PRN. The aide frequency included 2 PRN and is not specific to the patient. Patient #7: The visit frequency on the aide plan of care was indicated as 1-2/wk and PRN. The aide frequency included PRN and is not specific to the patient. Patient #12: The visit frequency on the aide plan of care was indicated as 1-2/wk and PRN. The aide frequency included PRN and is not specific to the patient. Patient #14: The visit frequency on the aide plan of care was indicated as 1wk 8 and 1 PRN. The aide frequency included PRN and is not specific to the patient.

Upon patient record review 1 of 14 (Patient #5) 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 #5: The aide plan of care indicated visits 1-2x wk and 2 PRN. There was no evidence of aide tasks were completed on 6/17/23, 6/24/23, 7/15/23, and 7/29/23.

Upon patient record review, 2 of 14 (Patient #1, #5) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient's life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination: • The primary terminal condition • Related diagnosis • Current subjective and objective medical findings • Current medication and treatment orders • Information about the medical management of any of the patient's conditions unrelated to the terminal illness Patient #1: The record indicates the patient was admitted 02/17/23 and the verbal certification was not obtained until 02/21/23 which was 3 days after the patient was admitted. Patient #5: The physician's narrative does not reflect the patient's individual clinical circumstances or medical management of any of the patient's conditions unrelated to the terminal illness.

Upon patient client record review, 10 of 14 (Patient #1,#2,#3,#4,#6,#7,#9,#10,#13,#14) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #10: The Hospice Medicare Election statement does not clearly identify the patient’s choice for the attending physician nor does it clearly indicate the patient chooses the hospice Medical Director as their attending. The line to write in the attending physician is left blank. Patients #1,#2,#3,#4,#6,#7,#9,#10,#13,#14: The Election of Benefit (EOB) form did not include the patient's right to request "Patient Notification of Hospice Non Covered Items". There were no initials or dates on the form to indicate a choice was presented to the individual or representative to "elect" or "decline" notification.

Upon patient client record review, 1 of 14 (Patient #6) did not have evidence that each patient record contains Physician certification and recertification of terminal illness. Patient #6: The medical record does not contain an appropriately completed recertification for benefit periods dated 07/13/23-09/10/23. The recertification is not signed or dated by the medical director. In addition, the verbal certification contains incorrect benefit period dates 09/11/23-11/09/23, which would be for the following certification period.

Upon patient record review, 1 of 14 (Patient #13) did not have evidence that if a drug order is verbal or given via an electronic transmission, it is given to a Registered Nurse, Nurse Practitioner, pharmacist, physician or other licensed individuals as designated by state regulations. The person receiving the order records and signs it immediately and has the prescribing person sign it in accordance with state and federal regulations. Patient #13: The medical record contained a verbal order from the Medical Director dated 01/03/23 that has not been signed at the time of survey.