Every finding on record at Arizona Hospice Safford, LLC

Upon patient record review, 2 of 14 (Patient #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 3:The patient's plan of care includes an order for oxygen to be delivered at 1-4 liters per minute via nasal cannula as needed for shortness of breath. The medication profile entry includes the oxygen to be delivered at 4 liters per minute via nasal cannula. Corrected on site. Patient 6:The medication profile includes an entry for wound cleanser initiated on 7/19/23 to be discontinued when wound healed. There is no evidence that the cleanser was discontinued. Corrected on site.

Upon patient record review, 5 of 14 (Patient #2,#3,#4,#5,#11) 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:Upon admission, the medical record contains nursing documentation of history of seizures, use of anti seizure medication and co-morbidity of Parkinson's. There is no evidence of problems goals and interventions for Neuro issues or disease processes. Patient 3:Upon admission, the medical record contains nursing documentation of a primary diagnosis of congestive heart failure. There is no evidence of problems goals and interventions for cardiac disease and management. Corrected on site. In addition, the medical record contains nursing documentation on admission that an opioid was continued for pain control and that a bowel regimen was initiated. There is no evidence of a bowel regimen on the patient's plan of care. Patient 4:The medical record contains nursing documentation on admission that an opioid was continued for pain control and that a bowel regimen was initiated. There is no evidence of a bowel regimen on the patient's plan of care. Patient 5:Upon admission, the medical record contains nursing documentation of a primary diagnosis of congestive heart failure. There is no evidence of problems goals and interventions for cardiac disease and management. Corrected on site. Patient 11:The medical record contains nursing documentation of patient decline and transitioning on 2/20/23. There is no evidence of problems goals and interventions for imminence.

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: The patient's plan of care includes an order on 9/16/23 for wound care to left forearm to cleanse with wound cleaner, pat dry and apply nonstick dressing to wound bed. The plan of care does not contain evidence of the frequency for wound care to be performed. Corrected on site.

Upon patient record review 4 of 14 (Patient #1,#4,#6,#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:The aide plan of care indicated the tasks of comb hair, peri care, nail care, skin care, shampoo hair, shower, change linens and incontinent care to be completed every visit. Aide visit documentation on 6/11/23, 8/11/23 and 8/18/23 does not contain evidence that assigned tasks were completed per plan of care. Patient 4:The aide plan of care indicated the visit frequency of 2 visits per week. There is no evidence of documentation of visits for the week of 7/25/23. Patient 6:The aide plan of care indicated the visit frequency of 1 visit per week. There is no evidence of documentation of a visit for the week of 4/19/23. Patient 10:The aide plan of care indicated the visit frequency of 2 visits per week. There is no evidence of documentation of visits for the week of 9/7/23.