Every finding on record at Angel?S Hand Hospice Care, Inc.

Upon patient record review, 1 of 14 (Patient #1) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual's attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient's progress toward desired outcomes • Reassessment of the patient's response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days. Patient #1 Upon patient record review, there was evidence that the frequency for RN visits every fourteen days. There was no evidence of either an RN or LVN visit between 04/21/25 and 05/10/2

Upon patient record review, 4 of 14 (Patient #5,7,8,9) 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 #5 Pt was admitted to hospice on 03/21/25 and verbalized her wishes to remain a full code. There was no evidence of problems, goals, and interventions addressing full code status. Patient #7 Pt was admitted to hospice on 04/07/24 and POA verbalized patient wishes to remain a full code. There was no evidence of problems, goals, and interventions addressing full code status. Patient #8 Pt was admitted to hospice on 04/17/25 and verbalized wishes to remain a full code. There was no evidence of problems, goals and interventions addressing full code status. Patient #9 Pt was admitted to hospice on 05/06/25 and POA verbalized wishes to remain a full code. There was no evidence of problems, goals and interventions addressing full code status.

Upon patient record review, 1 of 14 (Patient #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 equipment and supply needs. Patient #9 Upon record review, the comprehensive assessment dated 05/06/25, the genitourinary system section showed documented evidence that the patient was incontinent of bowel and bladder and utilizing incontinent supplies. There were no incontinent supplies listed on patient plan of care.

Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1 Upon patient record review, there was evidence that the frequency for RN visits every fourteen days. There was evidence that the frequency for LVN visits was also every fourteen days offsetting the RN visit. There was no evidence of either an RN or LVN visit between 04/21/25 and 05/10/25.

Upon patient record review, 1 of 14 (Patient 3) 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 #3 Upon record review, noted the Election of Benefit form showed that the Power of Attorney had elected to initiate the hospice benefit and signed document with a date of 10/24/24. Page seven on the Election of Benefit form had a hospice start of care date section that was left blank with no indicated start date.

Observed in Record Review. In 2 of 11 patient records reviewed, During RR#1 it was noted the following medications on the patient medication profile: Mucinex DM 20/400 mg/20 ml, 20 ml Oral Every 6 hours as needed Cough/congestion and Promethazine DM 6.25/15 mg/5ml, 5 ml Oral Every 8 hours as needed Cough/congestion. The medication indication lacked direction on which medication should be administered first. During RR#3 it was noted the following medications ordered for shortness of breath/wheezes/congestion on the medication profile without indication of which medication should be administered first. The medications were Albuterol 0.083% Soln for Inh 2.5 mg/3ml 1 vial -(3 ml)Inhalation via nebulizer Every 6 hours as needed shortness of breath/wheezing/congestion and Duoneb0.5/3 mg/3ml 1 vial -(3 ml) Inhalation via nebulizer Every 4 hours as needed for shortness of breath/wheezes/congestion.

Observed in Record Review. In 1 of 11 patient records reviewed, During RR#8 it was noted the frequency for the spiritual counselor (SC) was once a month. SC provided 2 visits in January 2022 after the initial SC assessment and 2 visits in February 2022. The IDG/POC lacked an update to increase the frequency of visits.

Observed in Patient Home. In 1 of 3 home visits conducted, Observed during HV#3, the staff person failed to perform hand hygiene consistent with organization policy Hand Hygiene 9-009. The staff person after washing his hands turned off the faucet without using a paper towel as a barrier and then dried his hands. Observed in Patient Home. In 1 of 3 home visits conducted, During HV#2 it was noted the SN placed the nursing bag on the extra bed in the patient's room. Policy 9-014 Bag technique stated #1., The bag will be placed on a clean dry surface (i.e., a surface that can be easily disinfected) in the car and in the home and #7., Paper towels/newspapers used as protective barrier for bag placement in the patient’s home will be discarded.

Observed in Record Review. In 1 of 6 patient records reviewed, who had orders for hospice aide service. During HV#2 record review it was noted the aide assignment form was inconsistent with the physician/IDG/POC. The hospice aide assignment stated 02 at 2L PRN SOB via nasal cannula. The order on the POC stated 02 continuous at 3 L/min, may remove for ADL care as tolerated.

Observed in Record Review. In 1 of 3 patient records reviewed, who received bereavement services. During RR#10 it was noted the post death bereavement assessment contained inaccurate documentation. The bereaved was identified as the patient's wife during the initial and post death assessments. The comment section documentation stated the survivor mentioned how difficult it was seeing her mother struggle and how she feels at peace knowing that her mother.... [passed peacefully].

Observed in Patient Home. In 1 of 2 home visits conducted, who had POC orders for oxygen therapy. During HV#1, it was noted 2 M-6 auxiliary oxygen tanks were standing upright unsecured. One E-tank was secured in a cannister.

Observed in Document Review. During review of the SNF contract it was noted the contract lacked a provision stating that the hospice will report all mistreatment, neglect, or verbal, mental, sexual, and physical abuse to the SNF, NF, or ICF/IID administrator within 24 hours of the hospice becoming aware of the alleged violation, including injuries of unknown source, and misappropriation of patient property by anyone unrelated to the hospice.

Observed in Document Review. During review of the organization's SNF contract it was noted it lacked a delineation of the responsibilities of the hospice and the SNF, NF, or ICF/IID to provide bereavement services to SNF, NF, or ICF/IID staff.