Every finding on record at Arizona Hospice Scottsdale LLC

Upon patient record review, 1 of 19 (Patient #1) 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) Patient's current medication profile and POC for certification period 6/26/25-08/24/25 had medication order for Loperamide HCL 2 mg tab PRN daily for diarrhea. Upon home visit, the patient's medications did not contain Loperamide HCL 2 mg.

Upon patient record review, 19 of 19 (Patients # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19) 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 #1) Upon review of the patient's POC, there was no evidence that the POC contained the medical supplies related to the management of the terminal illness needed for the palliation and management of the patient's end of life care. Patient #2) Upon review of the patient's POC, there was no evidence that the POC contained the medical supplies related to the management of the terminal illness needed for the palliation and management of the patient's end of life care. Patient #3) Upon review of the patient's POC, there was no evidence that the POC contained the medical supplies related to the management of the terminal illness needed for the palliation and management of the patient's end of life care. Patient #4) Upon review of the patient's POC, there was no evidence that the POC contained the medical supplies related to the management of the terminal illness needed for the palliation and management of the patient's end of life care. Patient #5) Upon review of the patient's POC, there was no evidence that the POC contained the medical supplies related to the management of the terminal illness needed for the palliation and management of the patient's end of life care. Patient #6) Upon review of the patient's POC, there was no evidence that the POC contained the medical supplies related to the management of the terminal illness needed for the palliation and management of the patient's end of life care. Patient #7) Upon review of the patient's POC, there was no evidence that the POC contained the medical supplies related to the management of the terminal illness needed for the palliation and management of the patient's end of life care. Patient #8) Upon review of the patient's POC, there was no evidence that the POC contained the medical supplies related to the management of the terminal illness needed for the palliation and management of the patient's end of life care. Patient #9) Upon review of the patient's POC, there was no evidence that the POC contained the medical supplies related to the management of the terminal illness needed for the palliation and management of the patient's end of life care. Patient #10) Upon review of the patient's POC, there was no evidence that the POC contained the medical supplies related to the management of the terminal illness needed for the palliation and management of the patient's end of life care. Patient #11) Upon review of the patient's POC, there was no evidence that the POC contained the medical supplies related to the management of the terminal illness needed for the palliation and management of the patient's end of life care. Patient #12) Upon review of the patient's POC, there was no evidence that the POC contained the medical supplies related to the management of the terminal illness needed for the palliation and management of the patient's end of life care. Patient #13) Upon review of the patient's POC, there was no evidence that the POC contained the medical supplies related to the management of the terminal illness needed for the palliation and management of the patient's end of life care. Patient #14) Upon review of the patient's POC, there was no evidence that the POC contained the medical supplies related to the management of the terminal illness needed for the palliation and management of the patient's end of life care. Patient #15) Upon review of the patient's POC, there was no evidence that the POC contained the medical supplies related to the management of the terminal illness needed for the palliation and management of the patient's end of life care. Patient #16) Upon review of the patient's POC, there was no evidence that the POC contained the

Upon personnel record review, 1 of 19 (Personnel # 7) 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.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel #7) Upon review of employee file, there was no evidence that the competency for appropriate and safe techniques in personal hygiene and grooming included shampooing in the sink, tub and bed.

Upon patient record review, 1 of 19 (Patient #2) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient # 2) Upon review of hospice aide POC the task of shower was ordered every visit. The documentation in the aide's notes on 5/23, 5/29. 6/5, 6/9, 6/12, 6/19 states patient refused shower. The one note on 5/23 states the daughter told the aide that the patient should only be getting a bed bath. The aide documented that she notified the RN however, no evidence the RN updated the aide POC.

Upon patient record review 1 of 19 (Patient # 2) 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 #2) Aide POC ordered patient shave, shower, assist with ambulation and transfers. These tasks were documented as not done on review of patient's Aide notes on the following days 5/23, 5/29. 6/5, 6/9, 6/12, 6/19. The aide note on 6/23 stated the tasks of shower, assist with ambulation and transfers as not completed. The aide note for 6/25 and 7/1/25 documented shave was not done.

Upon client record review, 4 of 5 records (Patients #1, #3, #4, #5) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: The SOC assessment visit by the MSW was a telehealth visit. There was no evidence that telehealth was a part of the POC. Corrected on site. Patient 3: The SOC assessment visit by the MSW was a telehealth visit. There was no evidence that telehealth was a part of the POC. Corrected on site. Patient 4: The SOC assessment visit by the MSW was a telehealth visit. There was no evidence that telehealth was a part of the POC. Corrected on site. Patient 5: The SOC assessment visit by the MSW and SC were telehealth visits. There was no evidence that telehealth was a part of the POC. Corrected on site.

Upon patient record review 1 of 4 applicable records (Patient #2) 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 2: There was an order for HHA visits 2x week. For week of 7/24/2022 there was one visit made 7/28/2022. For visit note of 7/29 "pt seen on Thursday rather than Friday". No evidence of a second visit this week.

Upon patient record review 1 of 11 records (Patient #5) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #5: The patient was admitted on 3/23/22. The record indicated that the spiritual assessment was not completed until 3/30/22.

Upon patient record review, 11 of 11 records (Patient #1,#2,#3,#4,#5,#6,#7,#8,#9,#10,#11)) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death.

Upon patient record review, 1 of 11 records (Patient #2) 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: The record indicated a medication for Diclofenac cream 3%, 1 thin layer twice/day for muscle pain/spasm to affected area every morning and at bedtime. There was not evidence of a specific location. Corrected on site.

Upon patient record review, 5 of 11 records (Patient #4,#5,#7,#8,#11) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #4: The patient was admitted on 5/14/22. The record indicated that the bereavement assessment was completed on 5/23/22. Patient #5: The patient was admitted on 3/23/22 and the record indicated that the bereavement assessment was completed on 3/30/22. Patient #7: The patient was admitted on 3/2/22 and the record indicated that the bereavement assessment was completed on 3/9/22. Patient #8: The patient was admitted on 4/23/22 and the record indicated that the bereavement assessment was completed on 4/29/22. Patient #11: The patient was admitted on 12/30/21 and the record indicated that the bereavement assessment was completed on 1/5/22.

Condition of Participation: Interdisciplinary Group, Care Planning, and Coordination of Services. L536

Upon patient record review, 2 of 11 records (Patient #6,#11) did not have evidence that a Registered Nurse ensured continuous assessment of the patient and family's needs and coordinated activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family Patient #6: The nursing assessment indicated that the patient had a pressure sore on her left buttock and a wound on her right lower leg. The integumentary section of the document contained check marks indicating wound and ulcer. There was not evidence that the wound was measured or assessed at this visit (6/7/22) or visits to current. Patient #11: The certification of terminal illness indicated that the patient had a Stage IV wound on her coccyx. The nurse assessment on admission indicated that there was a wound/ulcer (as indicated by checkmarks). There was not evidence of an assessment of the wounds including measurements, drainage, odor from admission through death.

Upon patient record review, 5 of 11 records (Patient #2,#4,#6,#9,#11) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient which reflects 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 patient was admitted with a hospice diagnosis of hypertensive heart disease. There was not evidence that the hospice has developed an individualized written plan of care that reflects patient/family goals and interventions based on the patient's cardiac disease that was identified in the initial, comprehensive, and updated comprehensive assessments. Corrected on site. Patient #4: The patient was admitted with a hospice diagnosis of Alzheimer's Disease. The patient was incontinent with a FAST score of 7C. She was agitate, dependent in 6/6 activities of daily living, consuming less than 50% of meals and had a high risk for skin breakdown. There was not evidence that the plan of care included goals and interventions for neurological well being or Alzheimer's. Corrected on site. Patient #6: The nursing assessment indicated that the patient had a pressure sore on the left buttock and a wound on the right lower leg. The integumentary section of the document there were check marks indicating wound and ulcer. There was not evidence that the plan of care included goals and interventions for wounds. The record indicated that a Foley catheter was placed. There was not evidence of goals and interventions related to the foley. Corrected on site. Patient #9: The patient was admitted with a diagnosis of multiple sclerosis. She was bedbound, incontinent, weak, had cognitive impairment and dependent in 5/6 activities of daily living. There was not evidence that the plan of care included neuro or neuromuscular goals and interventions. Corrected on site. Patient #11: The certification of terminal illness indicated that the patient had a Stage IV wound on her coccyx. The nurse assessment on admission indicated that there was a wound/ulcer. There was not evidence that the plan of care include goals and interventions for wounds.

Upon patient record review, 3 of 11 records (Patient #2,#6,#11) did not have evidence that the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #2: The record indicated an order for Diclofenac cream 3%, 1 thin layer twice/day for muscle pain/spasm to affected area every morning and at bedtime. There was not evidence of a specific location. Corrected on site. Patient #6: The nursing assessment indicated that the patient had a pressure sore on the left buttock and a wound on the right lower leg. The integumentary section of the document contained check marks indicating wound and ulcer. There was not evidence of orders for wound care. Patient #11: The certification of terminal illness indicated that the patient had a Stage IV wound on her coccyx. The nurse assessment on admission indicated that there was a wound/ulcer. There was not evidence of an order for wound care.

Upon client record review, 4 of 10 applicable (Patient #1,#5,#6,#11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1: The visit frequency for the social worker was 1x/week. The record indicated that the social worker conducted visits on 4/25/22 (evaluation), on 5/9/22 (phone call), on 5/24/22 and 6/9/22. Patient #5: The visit frequency for the skilled nurse was 1x/week. The record indicated that visits were conducted 3x for the week of 5/8/22-5/14/22 (5/9/22, 5/10/22, 5/11/22), and 2 times during the weeks of 5/15/22-5/21/22 (5/16/22 and 5/18/22) and 5/22/22-5/28/22 (5/23/22 and 5/26/22). The record indicated that the social worker conducted a telehealth visit on 4/21/22. There was not evidence that telehealth was a part of the plan of care. Corrected on site. Patient #6: The record dated 6/17/22, indicated that a Foley catheter was placed. There was not evidence of an order. Corrected on site. Patient #11: The skilled nurse visit frequency was 1x/week and 3 prn. There was not evidence of a visit between 1/1/22-1/17/22, then visits were conducted on 1/17/22, 1/18/22, 1/19/22, and 1/20/22.

Upon patient record review 1 of 10 applicable records (Patient #10) did not have evidence of documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care Patient #10: The aide visit frequency was 2x/week. There was not evidence of a visit for the week of 3/13/22-3/19/22.

Upon client record review, 1 of 1 applicable (Patient #10) did not have evidence that the hospice forwarded a summary and a copy of the patient record, if requested, to a facility when transferring the patient to that facility. Patient #10The patient was transferred to another hospice agency. There was not evidence of a transfer summary.