Every finding on record at Angelic Touch Hospice

Upon observation, there was no evidence the Emergency Plan communication plan must includes an alternate means for communicating with hospice's employees and Federal, state, tribal, regional, and local emergency management agencies. Corrected on site.

Condition of Participation: Initial and Comprehensive Assessment of the Patient.

Upon patient record review 2 of 9 (Patient #2, #6) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient #2: No evidence of a spiritual needs assessment as part of the comprehensive assessment. Patient #6: No evidence of a spiritual needs assessment as part of the comprehensive assessment.

Upon patient record review, 3 of 9 (Patient #1, #3,#5) 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 #1: Medication profile dated 5/7/2024 included Hydrocortisone cream 2.5% cream apply to affected area 2 x day. No evidence of an area to apply. Dated 5/7/2024 Nystatin cream 30 GM apply to affected area 2x day for skin infection. No evidence of an area to apply. Corrected on site. Patient #3: Medication profile dated 9/11/2023 included Diclofenac sodium 1% topical gel, apply to affected area 4 x day for pain. No application area identified. Patient #5: Medication profile dated 12/8/2023 included O2 2-5 L via NC for SOB, no evidence dosage parameters.

Upon patient record review, 5 of 9 (Patient #2, #3, #4, #6, #7) 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 #2: RN comprehensive visits occurred only at recertification for each benefit period, SOC 2/27/2023, 5/22, 8/25, 10/23 and 12/23/2023. Live dc 1/26/2024. Patient #3: RN comprehensive visits occurred only at recertification for each benefit period. SOC 9/11/2023 and 12/9/2023, live dc 1/15/2024. Patient #4: RN comprehensive visits occurred only at recertification for each benefit period. SOC 9/4/2023 and 12/2/2023. Live dc 1/15/2024. Patient #6: RN comprehensive visits occurred only at recertification for each benefit period. SOC 3/2/2023, 5,27 and 8/22/2023. Live dc 9/20/2023. Patient #7: No evidence of RN comprehensive visits after SOC 9/11/2023. Live dc 10/18/2023.

Condition of Participation: Interdisciplinary Group, Care Planning, and Coordination of Services. L536

Upon patient record review, 1 of 9 (Patient #2) 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 #2: Phone call to agency on 12/13/2023- patient was kicked out of home and was now homeless and looking for shelter. No evidence of RN visit to patient to supervise care and service to patient. Next RN visit 12/23/23.

Upon patient record review, 7 of 9 (Patient #2, #3, #4, #5, #6, #7, #8) 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 #2, #3, #4, #5, #6, #7: MSW on SOC assessment identified moderate anxiety and moderate psychosocial distress, with no mortuary/funeral planning in place. Documented resources discussed and provided, no evidence on POC for problems/goals and interventions for psychosocial distress/anxiety or mortuary/funeral planning. Patient #8: SN SOC identified Braden risk score of 12- high, and patient on O2. No evidence on POC for problems/goals/interventions for skin integrity or respiratory/oxygen. MSW on SOC assessment identified moderate anxiety and moderate psychosocial distress, with no mortuary/funeral planning in place. Documented resources discussed and provided, no evidence on POC for problems/goals and interventions for psychosocial distress/anxiety or mortuary/funeral planning.

Upon patient record review, 1 of 9 (Patient#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 #4: Vol orders were 3 PRN on each POC/IDG without a quantity defined.

Upon patient record review, 3 of 9 (Patient #1, #3, #5) 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 #1: Order dated 5/7/2024 included Hydrocortisone cream 2.5% cream apply to affected area 2 x day. No evidence of an area to apply. Dated 5/7/2024 Nystatin cream 30 GM apply to affected area 2x day for skin infection. No evidence of an area to apply. Corrected on site. Patient #3: Order dated 9/11/2023 included Diclofenac sodium 1% topical gel, apply to affected area 4 x day for pain. No application area identified. Patient #5: Order dated 12/8/2023 included O2 2-5 L via NC for SOB, no evidence dosage parameters.

Upon patient record review, 2 of 9 (Patient #2,#3) 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 #2: On 12/13/2023 patient became homeless and looking for shelter. New order for O2 dated 1/8/2024. No evidence on updated POCs of problems/goals/interventions for homelessness/shelter needs or oxygen therapy. Patient #3:New order for O2 dated 10/18/2023. No evidence on updated POCs of problems/goals/interventions for oxygen therapy.

Upon client record review, 5 of 9 (Patient #2, #3, #4, #6, #7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2: SOC 2/27/2023 and all POCs/IDGs identified SC visits monthly. There was no evidence of a SC visit throughout the service. Spiritual care note in IDG states declined in all notes but orders remained. Orders dated 2/27/2023 and on each POC/IDG throughout service included SN 1x week and 3 PRN (these weekly visits were done by LVN), no evidence of RN visits ordered. RN visits for recertification's on 5/22, 8/25, 10/24 and 12/23/2023. Patient #3: Orders dated 9/11/2023 and on each POC/IDG throughout service included LVN 1x week and 3 PRN. There were no orders for RN visits. One RN visit occurred on 12/9/2023 for recertification. Patient #4: SOC and all POCs/IDGs identified Vol visits 3 PRN. There was no evidence of a volunteer visit. Orders dated 9/4/2023 and on each POC/IDG throughout service included SN 1x week and 3 PRN (these weekly visits were done by LVN), no evidence orders for RN visits. One RN visit occurred on 12/2/2023 for recertification. Patient #6: Orders dated 3/2/2023 and on each POC/IDG throughout service included SN 1x week and 3 PRN (these weekly visits were done by LVN). There were no orders for RN visits. RN visits occurred on 5/27/2023 and 8/22/2023 for recertification. Patient #7: Orders dated 9/11/2023 and on each POC/IDG throughout service included LVN 1x week and 2-3 PRN. There were no orders for RN visits. No RN visits after SOC 9/11/2023.

Upon observation, there was no evidence Dietary counseling services is available to the patient and family to assist them in minimizing the stress and problems that arise from the terminal illness, related conditions and the dying process.

Upon patient record review, 2 of 9 (Patient #5,#8) 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: On SN SOC documented risk of aspiration and O2 use. No evidence on the aide assignment of risk or aspiration or precautions for O2. Patient #8: Patient on Plavix, no evidence on aide assignment of bleeding precautions.

Upon patient record review 1 of 9 (Patient #8) 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 #8: Order 12/5/2023 aide visits 2x week. For week one, one aide visit documented with no evidence of a missed visit.

There is no evidence that all patient records are retained for a minimum of 6 years from the date of the most recent discharge or death of the patient. Agency was purchased with a final CHOW dated 11/22/2022. No records from previous owner/agency are available.

Upon client record review, 4 of 9 (Patient #5, #6, #7, #8) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patient #5: No evidence of a discharge summary sent to attending physician. Patient #6: No evidence of a discharge summary sent to attending physician. Patient #7: No evidence of a discharge summary sent to attending physician. Patient #8: No evidence of a discharge summary sent to attending physician.