Every finding on record at Apa Hospice Care, Inc.

Upon patient record review, 3 of 14 (Patient #2, 4, 10) 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 02: A treatment order was entered on 9/27/22 for the use of Hydrocortisone cream 0.5% apply to affected area daily, PRN for puritis. This is not included in the medication profile. (Medication profile corrected and updated on site.) Patient 04: The medication profile includes Refresh Plus 0.5% lubricant eye drops with instructions to "instill 2 drops in affected eyes up to 2 times per day/PRN. Instructions do not specify left or right eye(s). (Medication profile corrected and updated on site.) Patient 10: The medication profile includes Diclofenac Sodium 1% topical gel, apply three times a day as needed for pain, the application site is not indicated. (Medication profile corrected and updated on site.)

Upon patient record review, 3 of 14 (Patient #2, 4, 10) 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 02: A treatment order was entered on 9/27/22 for hydrocortisone cream 0.5% "apply to affected area qday PRN. The order is not written as a medication order, and does not specify an application site. (Medication order updated and corrected on site.) Patient 04: The medication order on 6/20/23 for Refresh Plus 0.5% lubricant eye drops with instructions to "instill 2 drops in affected eyes up to 2 times per day/PRN, does not specify which eye/s to instill the medication into. (Medication order updated and corrected on site.) Patient 10: The medication order on 12/21/23 for Diclofenac Sodium 1% topical, apply three times a day as needed for pain, does not include an application site. (Medication order updated and corrected on site.)

Upon patient record review, 1 of 14 (Patient #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 03: New treatment orders were entered into the record on 1/26/24 for wound care to a left lower leg injury, the plan of care was not updated to include a problem statement with interventions and goals for the wound care.

Upon client record review, 2 of 14 (Patient #8, 9) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 08: The SN frequency is entered as 1 time per week, the patient was seen on 2/1/24 and 2/15/24, the record does not include evidence of a declined visit or frequency order change. Patient 09: The SN frequency is entered as 1 time per week, the patient was seen on 2/1/24 and 2/15/24, the record does not include evidence of a declined visit or frequency order change.

Upon patient record review, 1 of 14 (Patient #14) 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 14: The patient died on 12/10/23 and bereavement services were accepted by the bereaved family member, the record does not include an updated plan of care for bereavement services.

Upon patient record review, 1 of 14 (Patient #4) 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 04: The patient record includes aide task assignment for linen changes which does not include a frequency for performing the task.

Upon patient record review 1 of 14 (Patient #14) 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 14: The aide frequency order is indicated for 2 times per week. The patient was seen on 12/4/23 with no additional visit performed that week. No discontinue order or refused visit was noted in the patient record.

Upon patient record review 3 of 14 (Patient #1, 5, 8) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient 01: A supervisory visit was completed on 1/26/24, the record does not contain evidence of a supervisory visits being performed since that date. Patient 05: Supervisory visits are not completed every 14 days. Supervisory visits were completed on 12/12/23, 1/24/24 and 2/20/24. Patient 08: A supervisory visit was completed on 12/28/23 and then 2/23/24, greater than 14 day compliance.

Upon patient client record review, 8 of 14 (Patient #2, 4, 5, 6, 7, 8, 12, 13) 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 02: The patient was admitted on 9/6/22 and elected to receive the Notification of Hospice Covered and Non-Covered Items, there is no evidence in the patient record that this was completed and provided to the patient/family. Patient 04: The patient was admitted on 6/10/22 and elected to receive the Notification of Hospice Covered and Non-Covered Items, there is no evidence in the patient record that this was completed and provided to the patient/family. Patient 05: The patient was admitted on 6/10/22 and elected to receive the Notification of Hospice Covered and Non-Covered Items, there is no evidence in the patient record that this was completed and provided to the patient/family. Patient 06: The patient was admitted on 1/31/23 and elected to receive the Notification of Hospice Covered and Non-Covered Items, there is no evidence in the patient record that this was completed and provided to the patient/family. Patient 07: The patient was admitted on 5/17/23 and elected to receive the Notification of Hospice Covered and Non-Covered Items, there is no evidence in the patient record that this was completed and provided to the patient/family. Patient 08: The patient was admitted on 6/17/23 and elected to receive the Notification of Hospice Covered and Non-Covered Items, there is no evidence in the patient record that this was completed and provided to the patient/family. Patient 12: The patient was admitted on 3/21/23 and elected to receive the Notification of Hospice Covered and Non-Covered Items, there is no evidence in the patient record that this was completed and provided to the patient/family. Patient 13: The patient was admitted on 6/15/22 and elected to receive the Notification of Hospice Covered and Non-Covered Items, there is no evidence in the patient record that this was completed and provided to the patient/family.