Every finding on record at Arc Hospice of Florida LLC

Upon patient record review, 1 of 14 (Patient #5) did not have evidence that the patient has received effective pain management and symptom control from the hospice for conditions related to the terminal illness. Patient 5: On the RN comprehensive assessment 12/5/24 The RN documented "pt. in extreme pain", Morphine was ordered at this time. On 12/9/24 a visit was made by the RN and documented, “moaning and clearly in discomfort, repositioning for comfort, gave tramadol, morphine not arrived at facility yet per nurse instructed nursing to give pain meds as frequently that it is ordered until scheduled medication order becomes effective in system”. On 12/12/24 the Chaplain documented "Patient in pain, discomfort and facility did not receive morphine yet". There is no documentation of follow up on pain medication or follow up between visits from the RN. Patient continued to have pain until a visit documented on 12/12/24.

Upon patient record review, 3 of 14 (Patient #1,2,3) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient 1,2,3: The RN did not take into consideration imminence of death on the comprehensive assessment.

Upon a Home Visit Review 2 of 14 (Patient 1,3) did not have medications on the medication profile that are consistent with the medications on the plan of care and what the patient/caregiver states they are taking. Patient 1: There are medications on the SNF plan of care that are not on hospice agency medication plan of care, Capsaicin external cream, Atorvastatin 40mg daily, Fleet enema, hydrocortisone external cream, ketoconazole external shampoo, multivitamin, nystatin-triamcinolone cream, Vitamin D tablet. There are medications on hospice plan of care that are not on the SNF plan of care, Lorazepam 0.5mg tablet, Tramadol 50mg tablet and Digoxin 125mcg tablet. Corrected on site. Patient 3: There are medications on the SNF plan of care that are not on hospice agency plan of care, Morphine 20mg/5ml ordered and the doses on each plan of care are different. Nystatin powder, Pro-stat 30ml, Trazadone 50mg. There are medications on the hospice agency plan of care and not on the SNF plan of care: Hyoscyamine 0.125mg sublingual tablet and Seroquel 25mg. Corrected on site.

Upon patient record review, 4 of 14(Patient #1,2,4,13) 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: On the plan of care there are medications listed, Albuterol sulfate 2.5 mg/3ml solution for nebulization there is no dose. Ipratropium 0.5mg-Albuterol 3mg/3ml, there is no dose. Polyethylene glycol 17gm 1 packet 2 times daily there is no diluent. Corrected on site. Patient 2: On the plan of care 5/19/25, there is Zinc oxide ordered without a dose, corrected on site. Patient 4: On the plan of care 5/27/25 there are medications, Artificial Tears 1 drop every 12 hours, does not say which eye. Fleet Enema 19gram-7gram/118ml Per instruction , does not have a dose. Ipratropium 0.5mg-Albuterol 2.5mg/2.5ml solution for nebulization, per instruction, does not have a dose. Corrected on site. Patient 13: On the plan of care 11/25/24 there are medications ordered, Albuterol sulfate 2.5/3ml per instruction, does not have a dose.

Upon patient record review, 2 of 14 (Patient #1,2) 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 equipment and supply needs. Patient1: On 5/16/25 the RN comprehensive assessment includes, "DME equipment supplied by facility", the equipment is not listed on the plan of care. Corrected on site. Patient 2: On 1/27/25 the RN comprehensive assessment includes, "hospital bed and wheelchair" the equipment is not listed on the plan of care. Corrected on site.

Upon patient record review, 1 of 14 (Patient #6) 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 6: On 6/9/25 the RN documented, "patient has G-tube", there is no evidence of the G-tube on the plan of care or how to care for the G-tube.

Upon patient client record review, 1 of 14 (Patient #3) 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 3: On 6/23/25 the RN documented "reports that she and pts dght will be alt days for visits”, dght is not an approved abbreviation.

Upon client record review, 5 of 14 (Patient #3,4,11,12,13) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 3: On RN comprehensive assessment, there is documentation, "has scoop mattress and fall mats, there is no risk for falls on the plan of care. Patient 4: On the RN comprehensive assessment there is documented a risk for skin breakdown and a risk for falls, there is no risk of skin break down or risk for falls on the plan of care. Patient 11: On 4/29/25 the RN documented, "G-tube site cleaned and dressed". There are no orders on the POC for the G-tube or how to care for the G-tube. Patient 12: On 12/5/24 the RN documented "Wound on coccyx", there is no evidence of wound care on the plan of care. Patient 13: On 11/22/24 the RN documented, "patient has PEG tube", there is no evidence of a PEG tube order on the plan of care or how to care for the PEG tube.

Upon personnel record review, 1 of 13 (Personnel #13) did not have evidence that all Speech Therapy Services are provided by a qualified licensed Speech-Language Pathologist (SLP) or Audiologist in accordance with the state's Speech-Language Pathology Practice Act and the hospice's policies and procedures and/or job descriptions. Personnel 13: There is no evidence that speech therapy services are provided by a qualified licensed speech language pathologist in accordance with the state's practice act. There is not an SLP personnel file to review with the therapy contract.

Upon personnel record review, 1 of 13 (Personnel #12) did not have evidence all Occupational Therapy Services are provided by a qualified licensed Occupational Therapist (OT) in accordance with the state's Occupational Therapy Practice Act and the hospice's policies and procedures and/or job descriptions. Personnel:11 There is no evidence that OT are provided by a qualified licensed OT, the agency does not have a personnel file for OT with the therapy contract.

Upon personnel record review, 2 of 13 (Personnel #12,13) did not have evidence the hospice obtained a criminal background check on all contracted individuals who have direct patient care and access to patient records. No OT or SLP files available for review.