Every finding on record at Argo Hospice Inc

Upon home visit observation 1 of 3, there was no evidence that the patient has the right: • To exercise his or her rights as a patient of the hospice • Have one's property and person treated with respect • To not be subjected to discrimination or reprisal for exercising his or her rights Patient #1: Hospice Aide did not have agency issued ID badge. When surveyor inquired about it, she presented an image on her phone, but it was for another agency. She referenced that she had one in car for this agency.

Upon observation during patient record review 5 of 14 (Patient #1, 2, 11, 12, 14), there was no evidence the hospice has an interdisciplinary group (IDG) or groups composed of individuals who work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of the hospice patients and families facing terminal illness and bereavement. Interdisciplinary group members must provide the care and services offered by the hospice, and the group, in its entirety, must supervise the care and services. Patient #1: No documented evidence MD participated in IDG Aug 21, Sept. 4, 8, Oct 2, 16, 30, 2025. Patient #2: March 3, 6, 20, April 3, 17, May 15, 29, Jun 12, 26, July 10, 24, Aug 7, 2025. There is no documented evidence of IDG between April 17 and May 15, 2025. Patient #11: No evidence MSW participated in IDG Aug 7, July 10, 24, June 26, 2025. Patient #12: No evidence MD, MSW, SC participated in IDG Sept 4, 18, Aug 7, 21 July 10, 24, 2025 Patient #14: No evidence of IDG for patient.

Upon patient record review, 4 of 14 (Patient #4, 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 #4: 8/16/25 order on SOC, may use Oxygen 2-5LPM via NC to maintain sat at 90% or above for SOB as needed. 9/18/25 IDG SN narrative says patient requires oxygen 2lpm. There are no related problems, goals, interventions until 9/28/25 respiratory problem started. Patient #6: CTI 9/29/25 MD documents patient appears SOB even at rest. RN initial assessment stated same, including marked dyspnea and fatigue, educated related to use of prn Oxygen. There are no related problems, goals, interventions for respiratory/oxygen Patient #7: CTI 9/30/25 and face-to-face, MD documents that patient uses O2 2LPM PRN for SOB and often refuses continuous. RN documented same in initial assessment and also that respirations were labored with mild use of accessory muscles, she further document that patient is uncomfortable with NC, but will use as necessary. There are no related problems, goals, interventions through 10/30/25 IDG, for respiratory and/or oxygen use. Patient #8: Patient admitted with Eliquis prescribed 10/10/25 but there are no related problems, goals, interventions thru 10/30/25 IDG.

Upon patient record review, 1 of 14 (Patient #1) 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: 3/27/25 order Cleanse sacrum with normal saline, pat dry and apply mixture of Vitamin A&D and zinc oxide, cover with Mediplex. There is no frequency of treatment specified.

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: DME does not include walker although CTI and SN visit notes reference need for walker and standby assist.

Upon patient record review, 2 of 14 (Patient #3, 10) 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 #3: 9/29/25 Communication note documenting patient complaint of itching skin and new order for hydrocortisone ointment related to pruritis. No evidence POC updated with problems, goals, interventions. Patient #10: Patient admitted 11/14/24. 4/23/25 and 10/19/25 orders for neomycin eye gtts for eye infection. The problems, goals, and interventions only included ear infection (2/5/25 and 5/13/25). 10/19/25 Communication note related to URI and Azithromycin ordered with no evidence of related problems, goals, interventions.

Upon client record review, 1 of 14 (Patient #12) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #12: SN Visit notes have time in and out however, are grossly incomplete and not authenticated with signature for the following dates:10/1, 6/15, 6/22, 6/29, 7/9/25

Upon patient record review 1 of 14 (Patient #10) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient #10: 10/13/25. Communication note related to conservator wants to update patient code status from Full Code to DNR and states physician notified. No further documentation to confirm if DNR obtained. Staff interview cannot confirm. EMR continues to identify patient's code status as Full Code with no additional follow up and no reference to request in subsequent IDG.

Upon observation 1 of 3 home visits, 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: Hospice aide, wearing gloves, filled basin with water, turned faucet off with gloves, and no paper towel barrier. She reached into her nurse bag without removing or changing gloves. Hand Hygiene Policy No 9-0092 #4 includes Use a dry disposable towel to turn off faucet. Bag Technique Policy No. 9-014 Sanitize hand before opening/entering nurse bag.

Upon personnel record review, 1 of 15 (Personnel #6) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·(B) Sponge, tub, and shower bath Personnel #6: Competency assessment form generalizes shampoo - does not specify all 3 types of sink, tub, bed

Upon patient record review 2 of 14 (Patient #1, 10) 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 #1: 3/3/25 order for hospice aide 2/wk. 9/9/25 note has time in and out, but note is blank. No interventions checked and note is not authenticated with signature. There was one completed visit 9/12/25 of same week. Patient #10: Hospice aide frequency 2x/week. Visit notes Oct 21, 24, 28, 31, 2025 are blank and are not authenticated with a signature, although time in and out is recorded as 1 hour each visit.

Upon patient record review, 2 of 14 (Patient #9, 10) did not have evidence that there is a physician's brief narrative explanation of the clinical findings that supports a life expectancy of 6 months or less as part of the certification forms, or as an addendum to the certification forms. Patient #9: CTI does not contain narrative other than certification statement. Patient #10: CTI does not contain narrative, only certification statement.

Upon client record review, 1 of 14 (Patient #10) did not have evidence that the physician provides a brief narrative explanation of the clinical findings that supports a life expectancy of 6 months or less as part of the recertification form, or as an addendum to the recertification form. Patient #10: Recertification CTI for 2nd 90 day benefit period 2/12-5/12/25 does not include physician narrative, only the certification statement.

Upon patient client record review, 1 of 14 (Patient #13) did not evidence that each patient record contains physician orders. Patient #13: Patient had continuous care effective 8/3-8/4/25 with no evidence of physician order. There are no orders written /dated beyond 7/3/24 admission orders.

Upon client record review, 2 of 14 (Patient #11, 12) 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 #11, 12: There is no documented evidence that DC summary was forwarded to the attending physician.

Upon personnel record review, 2 of 14 (Personnel #10, 11) did not have evidence of criminal background checks being obtained in accordance with state requirements. In the absence of state requirements, criminal background checks are obtained within three months of the date of employment for all states that the individual has lived or worked in the past 3 years. Personnel #10,11: There is no evidence of Criminal background check obtained. Obtained on site.

Upon patient record review 1 of 11 (Patient #2) 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: There was no evidence that the Initial SW assessment was in the chart.

Upon patient record review, 3 of 11 (Patient #2,#3,#6) 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 2: There was not evidence that Oxygen was on the patient medication profile. It was listed in DME. Corrected on site. Patient 3: The medication profile included Diclofenac Sodium 1% topical gel, 4 times a day as needed for mild pain. There is no evidence that a site was identified. Corrected on site. Patient 6: The medication profile included: Norco 10/325mg take 2 tabs every 4-6 hours for pain. Norco 10/325mg take 1 tab every 4-6 hours for pain. Tylenol 500mg, take 325mg 1 tab every 4 hours for pain. Tylenol Allergy 500mg take 1-2 tabs every 4 hours PRN for pain. There is no evidence of a warning to not exceed the maximum dose. In addition, one of the Tylenol orders contained 2 doses 500mg and 325mg. The Tylenol Allergy is for allergies or pain. Also, each acetaminophen did not include instructions to take for which level of pain. Corrected on site.

Upon patient record review, 2 of 11 (Patient #2 and 3) 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 The medication profile and orders included Eliquis 2.5mg 1 tab by mouth twice daily. There is no evidence of goals and interventions for bleeding precautions. Corrected on site. Patient 3 The medication profile and orders included ASA 81mg 1 tab by mouth daily. There is no evidence of goals and interventions for bleeding precautions. Corrected on site.

Upon patient record review, 3 of 11 (Patient #2,#3,#6) 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: There was no evidence of an order for Oxygen. It was listed in DME. Corrected on site. Patient 3: Orders included Diclofenac Sodium 1% topical gel was ordered to be applied on site, 4 times a day as needed for mild pain. There is no evidence that a site to apply. Corrected on site. Patient 6: The following were prescribed: Norco 10/325mg take 2 tabs every 4-6 hours for pain. Norco 10/325mg take 1 tab every 4-6 hours for pain. Tylenol 500mg, take 325mg 1 tab every 4 hours for pain. Tylenol Allergy 500mg take 1-2 tabs every 4 hours PRN for pain. There is no evidence of a warning to not exceed the maximum dose. In addition, one of the Tylenol orders contains 2 doses 500mg and 325mg. The Tylenol Allergy is for allergies or pain. Also, each acetaminophen order needs to state which level of pain. Corrected on site.

Upon client record review, 3 of 11 (Patient #2,#4,#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: The SN orders were SN 1 time a week. There was not evidence of SN visit the week of 10/30/22. In addition, there was not evidence of LVN orders. There were 8 visits by the LVN charted in the EMR on 10/13/22, 10/17/22, 10/20/22, 10/24/22, 11/3/22, 11/7/22, 11/10/22, 11/14/22. Patient 4: The SN orders were SN 1 time a week and did not include the LVN visit orders. There was not evidence of LVN visit orders in the EMR. There were 10 visits by the LVN charted in the EMR on 9/13/22, 9/20/22, 9/27/22, 10/4/22, 10/11/22, 10/18/22, 10/25/22, 10/31/22, 11/1/22, and 11/8/22. Patient 7: The RN visit order was 1 time a week. No evidence of a visit completed the weeks of 6/12/22 and 6/26/22.

Upon patient record review 2 of 6 applicable (Patient #4 and 7) 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 4: The aide was ordered 3 times a week. The aide did not make any visits the week of 10/9/22. Patient 7: There is not an order for the aides in the EMR. There are 36 aide visits documented.