Every finding on record at Angel's Pure Hospice Care Inc.

Upon patient record review, 3 of 14 (Patient #4, 5, 7) 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 Patient 4: The medication list indicates ammonium lactate 12% topical lotion apply bid for dry skin, but does not provide a location for the use of this topical lotion. Additionally, the medication list indicates artificial tears 1 gtt bid PRN for dry eyes; however, no site is specified, which eye(s), for use of these ophthalmic drops. (corrected onsite) Patient 5: The patient's oxygen does not appear on the medication list. (corrected onsite) Patient 7: The medication list contains a duplicate medication order. Tylenol is listed for use q 6 hours and acetaminophen is listed for use qid, both in the same dosage and with instructions PRN for pain. (corrected onsite)

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: The order for ammonium lactate 12% topical lotion apply bid for dry skin, but does not provide a location for the use of this topical lotion. Additionally, the order for artificial tears 1 gtt bid PRN for dry eyes; however, no site is specified, which eye(s), for use of these ophthalmic drops. (corrected onsite)

Upon patient record review, 2 of 14 (Patient #2, 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 equipment and supply needs. Patient 2: Treatment orders indicate the patient requires suctioning for comfort; however, no suction machine appears in the plan of care addressing necessary DME. (corrected onsite) Patient 4: Treatment orders indicate the patient utilizes albuterol via nebulizer to alleviate shortness of breath; however, no nebulizer appears in the plan of care addressing necessary DME (corrected onsite)

Upon patient client record review, 2 of 14 (Patient #1, 7) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient 1: The election statement does not indicate the effective date for the initiation of hospice services. Patient 7: The election statement does not indicate the effective date for the initiation of hospice services. Additionally, at the time hospice services were initiated, the patient/family requested notification of noncovered services; however, there is not evidence in the patient record that this information was returned to the patient/family within 5 days of the election, or at any subsequent time.