Every finding on record at Applied Palliative and Hospice Services, Inc.

Observed in Record Review. In 1 of 14 patient records reviewed, During RR4 it was noted the patient had multiple wounds and wound care orders ranging from daily to every 3 days then reduced to 2x/week. The POC documentation from the SOC the beginning of September 2025 stated Provide/educate on wound care as ordered but lacked specific education on the wound care frequency and procedures until it was documented on the POC the end of October 2025. This was discussed with the organization leadership.

Observed in Record Review. In 11 of 14 patient records reviewed, During review of patient POCs, it was noted the stated goals did not contain specific information that could be used to accurately determine the patient's progress toward achieving goals. RRHV1 the following goals were not measurable; Patient will exhibit decrease in subjective distress within the benefit period, Patient will not experience bleeding with blood pressure and pulse within normal range within this benefit periodRRHV2 the following goals were not measurable; patient will show adequate cardiac output as evidenced by blood pressure, heart rate, and rhythm within normal limits, return to baseline activity level, and display adequate breathing as evidenced by appropriate oxygen saturation level and absence of adventitious breath sounds within 1 certification period, Patient will be able to participate in activities of daily living along with normal vital signs within this benefit period. During RRHV3 the following goals were not measurable; Patient will show adequate cardiac output as evidenced by blood pressure, heart rate, and rhythm within normal limits, return to baseline activity level, and display adequate breathing as evidenced by appropriate oxygen saturation level and absence of adventitious breath sounds within the certification period, Patient will have blood glucose levels within acceptable levels within one certification period. Patient will not experience bleeding with blood pressure and pulse within normal range within 1 certification period. During RR2 it was noted the goals were not measurable; Patient will consume adequate nourishment within this benefit period, Patient will show adequate cardiac output as evidenced by blood pressure, heart rate, and rhythm within normal limits, return to baseline activity level, and display adequate breathing as evidenced by appropriate oxygen saturation level and absence of adventitious breath sounds within this benefit period During RR4 it was noted goals that were not measurable; Patient's quality of life will be improved by managing their symptoms and promoting comfort through appropriate medication management, sensory interventions, and emotional support within this benefit period. During RR5 it was noted goals that were not measurable; Patient will show adequate cardiac output as evidenced by blood pressure, heart rate, and rhythm within normal limits, return to baseline activity level, and display adequate breathing as evidenced by appropriate oxygen saturation level and absence of adventitious breath sounds within this benefit period. Patient will not experience bleeding with blood pressure and pulse within normal range within this benefit period, the patient will report ability to breathe comfortably within this benefit period. During RR7 it was noted goals that were not measurable; goals: Patient's quality of life will be improved by managing their symptoms and promoting comfort through appropriate medication management, sensory interventions, and emotional support within this benefit period. During RR10 it was noted goals that were not measurable;Patient will manifest adequate cardiac output as evidenced by the following: Stable vital signs Patient will adhere to lifestyle modifications of exercise and weight loss. in the diabetic section Patient will consume adequate nourishment within this benefit period. Patient's quality of life will be improved by managing their symptoms and promoting comfort through appropriate medication management, sensory interventions, and emotional support within this benefit period.During RRHV2, 3 and RR8 it was noted the same intervention for the chaplain documented as a goal on the POC; Chaplain will facilitate the patient, family, and caregiver in freely verbalizing their needs for desired spiritual and emotional support. Patient and/or family will receive ongoing emotional and psychosocial support to promote comfort, dignity, and quality of life throughout the end-of-life process.During RR6 it was noted the MSW intervention, “Patient and family will be provided with emotional support and empathetic listening throughout end of life process was documented on the POC as a goal. During RR10 it was noted the MSW intervention was documented as a goal on the POC; To improve patient psycho-social functioning of pt throughout hospice stay. During RRHV1, 4, and RR2-5 and 7 it was noted the MSW and the chaplain documented the same intervention as a goal on the patients’ POCs; Chaplain will facilitate the patient, family, and caregiver in freely verbalizing their needs for desired spiritual and emotional support. Patient and/or family will receive ongoing emotional and psychosocial support to promote comfort, dignity, and quality of life throughout the end-of-life process.The goals were discussed with the organization leadership.

Observed in Record Review. In 1 of 14 patient records reviewed, During RR6 it was noted the patient had a fall with a Rt ankle sprain, swollen and tender to touch that was discussed at an IDG meeting. There was lack of interventions added to the POC to assess and instruct staff on care of the sprained ankle. This was discussed with the organization leadership.

Observed in Record Review. In 1 of 14 patient records reviewed, During RR8 it was noted a wound care order to the patient's right second toenail bed to Clean with wound cleanser pat dry with gauze paint with betadine leave open to air however it lacked the frequency of the wound care change. The wound care was performed at each SN visit, 2x/week. This was discussed with the organization leadership.

Observed in Record Review. In 1 of 14 patient records reviewed, It was noted during RR4 there were multiple wound care orders that were not documented as provided according to hospice plan of care. The patient had an order for daily wound care to a wound over her left eyebrow secondary to a fall prior to the hospice, from the beginning of September 2025 to the end of September. In addition there were pressure ulcers on the left heel, right heel, and a wound on her left great toe with wound care to be provided every 3 days and PRN if soiled from the SOC the beginning of September to the last week in September. The SN frequency on the POC was 2x/week. There was lack of documentation if the wound care was performed by the facility staff in between SN visits. This was discussed with the organization leadership.

Observed in Individual Tracer. In 1 of 2 home visits conducted, Hospice surveyor noted the medication profile in the board and care facility did not match the current medication list of the hospice. For example, the board and care medication record documented the patient had received Lasix 20 mg daily and Sertraline 25 mg daily on November 14th and the week of November 7th when the hospice medication list indicated this medication had been discontinued on 10/31/22. This was confirmed by the RN making the home visit.

Observed in Record Review. In 1 of 10 patient records reviewed, Hospice surveyor noted the plan of care did not address fall risk for record #5. For example, the record indicated in the nursing notes that the patient had fallen several times and the fall risk score was high. Risk for falls was not listed on the plan of care. This was confirmed by the Director of Nursing

Observed in Individual Tracer. In 1 of 3 home visits conducted, Hospice surveyor noted for home visit #2, the nurse cleaned all equipment used such as the blood pressure cuff, thermometer and stethoscope with alcohol pads and then immediately dried the newly cleaned items with the used barrier that was used to place items during the home visit. The organizations policy stated when the visit is completed reusable items will be cleaned with alcohol and returned to the bag.

Observed in Individual Tracer. In 1 of 1 home visits conducted, Hospice surveyor noted the hospice aide care plan had marked that the patient had oxygen but did not contain any instructions to the aide as to if the patient wears the oxygen continuously or intermittently or if the oxygen is needed during the shower. This was confirmed by the Director of Nursing.

Observed in Individual Tracer. In 2 of 3 home visits conducted, Hospice surveyor noted the staff using electronic medical equipment on home visits #1 and #2 such as electronic blood pressure cuffs and thermometers. The organization did not have the manufacturer guidelines for the care and maintenance of this equipment. Therefore, they could not follow the guidelines. This was confirmed by the Director of Nursing.

Observed in Document Review. In 1 of 7 contracts reviewed, Hospice surveyor noted the pharmacy contract did not contain a requirement for criminal background checks. This was confirmed by the Director of Nursing.