Every finding on record at Apricus Hospice and Palliative Care, LLC

Upon patient record review, 3 of 14 (Patient #1,2,9) 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-Order on 11/6/24 for ear wax removal drops for 5 days remained active on medication profile Patient #2-Orders on 7/31/24 for Zinc Oxide and Calmoseptine do not indicate the specific location of the medication Patient #9-Order on 11/14/25 for Cipro for 5 days remained active on the medication profile

Upon patient record review, 1 of 14 (Patient #2) 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 #2-Orders on 7/31/24 for Zinc Oxide and Calmoseptine do not indicate the specific location of the medication

Upon patient record review, 1 of 14 (Patient #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 equipment and supply needs. Patient #10-Patient has orders for oxygen therapy, however no DME orders present for oxygen administration equipment.

Upon client 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-SN did not assess the wound per orders during the visit on 11/20/24. The orders are to perform wound care 1x/week and PRN if soiled or dislodged.

Upon observation of home visit, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient#1 & 2- SN cleaned her equipment, but then placed the clean equipment onto the dirty barrier sheet.

Upon patient record review, 8 of 10 (Patient #1, 2, 3, 4, 5, 6, 8, 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 medications and treatments. Patient # 1, 2, 3, 5, 6, 8, 9: Plan of Care included the following prn orders regarding anticipated genitourinary symptoms in terminally ill: "May insert 14-22 Fr. Foley catheter for incontinence or urinary retention. Change Foley prn for blockage or malfunction. May irrigate with 30 cc NS for blockage or malfunction. Change 1x mo. or as needed. May use 2% Lidocaine gel topically for placement discomfort. May insert straight cath 14-22 French for bladder distention prn. May d/c Foley if necessary. May apply 02 2-5 LPM via NC. The orders are not specific. Patient #4: 11/24/21 Wound orders for skin tears include "Apply Tegaderm and replace as needed until healed." There is no as needed qualifier. Patient #6: 11/27/21 Wound orders for skin tears include "Apply Tegaderm until healed." Order does not contain a specific location or defined frequency.

Upon personnel record review, 1 of 1 applicable (Personnel #4) did not have evidence in the personnel file of a complete competency assessment performed by the aide with a patient. Personnel #4: The Hospice Aide competency checklist utilized by the agency does not separate types of bath or types of shampoo for specificity of competency validation specific to the standard.

Upon patient record review, 1 of 10 (Patient #10) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #10: Consent/Election Form completed during initial RN visit 6/7/21. All documents signed by RP 6/7/21, but effective date was documented as 5/7/21.

Upon patient record review, 1 of 10 (Patient #2) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #2: The plan of care listed patient as a DNR. The Initial Comprehensive assessment indicated that the patient was a Full COR.