Every finding on record at Arizona Hospice Tucson, LLC

Upon patient record review, 1 of 19 (Patient #4) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient 4: Patient was admitted on 9/9/24. The comprehensive assessment does not assess for imminence of death or notate in the visit summary. Initial IDG states, “Is patient imminent? Yes No”

Upon patient record review, 2 of 19 (Patient #1,3) 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: Medication profile contains an order for Triamcinolone Acetonide External cream 0.1% 1 dose twice a day as needed, indication is “sore”. Instructions state, "apply sparingly to affected area topically twice a day as needed for sore". Order does not indicate a site of application. Patient 3:The medication profile contains order dated 1/18/25 Acetaminophen 2 tabs (1000mg) twice daily by mouth, every 6 hours as needed for pain. There is no clear indication of dose.

Upon patient record review, 2 of 19 (Patient #1,3) 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 5/21/25 The record indicates an order for Triamcinolone Acetonide External cream 0.1% 1 dose twice a day as needed, indication is “sore”. Instructions state, "apply sparingly to affected area topically twice a day as needed for sore". POC for skin integrity dated 5/20/2025 and updated 8/25/25 does not include prescription cream, indication for use, site or frequency. Patient 3: The POC dated 8/28/25 contains orders for Acetaminophen 2 tabs (1000mg) twice daily by mouth, every 6 hours as needed for pain. There is no clear indication of dose.

Upon patient record review, 1 of 19 (Patient #2) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 2: Patient was admitted 3/25/25 initial and current POC include MSW frequency of monthly. There is no evidence that a visit was made in April, May or July.

Upon patient record review 2 of 13 (Patients #5 and #11) 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 2-12-22. The spiritual care assessment was completed 3-11-22. Patient #11: The patient was admitted on 2-23-22. The psychosocial assessment was completed on 3-1-22.

Upon patient record review, 2 of 13 (Patients #5, #8) 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 #5 The medical record contained documentation by the nurse on 7-14-22 the patient was taking D- Mannose this medication is not reflected on the medication profile. Patient #8 The patient is taking potassium 40 milliequivalents daily and eye drops bilaterally BID as observed during home visit. No evidence of these on the medication profile. Corrected on site.

Upon patient record review, 4 of 13 (Patients #1, #6, #10, #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 #1: There was no evidence of any nursing problem statements with goals, interventions and progress toward outcomes related to anxiety, restlessness, and pain. The comprehensive nursing assessment dated 6-22-22 identified the patient was experiencing restlessness, anxiety, and had increased pain in the back and hip. Patient #6: The medical record did not contain evidence of any nursing problem statements with goals, interventions and progress toward outcomes related to infection. The medical record contained a physician's order dated 4-28-22 for Nystatin powder for skin infection. Patient #10: The medical record did not contain evidence of any nursing problem statements with goals, interventions and progress toward outcomes related to restlessness, pain, and imminent death. Patient #11: The medical record did not contain evidence of any nursing problem statements with goals, interventions and progress toward outcomes related to nutrition due to unintentional weight loss and new onset depression per nursing note narrative dated 2-23-22.

Upon patient record review, 3 of 13 (Patients #4, #5, #12) 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 #4: The record indicated an order to irrigate foley catheter with no specification of solution, amount, frequency, or indication. Corrected on site. Patient #5: The record indicated that the patient was taking D-Mannose OTC on 7-14-22 skilled nursing visit. There was no evidence of an order for the D-Mannose OTC. Patient #12: The record indicated an order to place a foley catheter with no specification of foley catheter size, balloon size or amount/ solution to use to inflate the balloon.

Upon patient record review, 6 of 13 (Patients #1, #4, #5, #8, #9, #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 equipment and supply needs. Patient #1: The plan of care did not include DME and supply needs. On admission the patient requested a hospital bed, briefs, chux, and gloves. Patient #4: The plan of care did not include DME and supply needs. On admission the patient requested a hospital bed, commode, briefs, chux, and gloves. Patient #5: The medical record contained documentation on the nursing visit dated 7-21-22 that a donut pillow was ordered for the patient there was no evidence of the donut pillow on the plan of care. Patient #8: The plan of care did not include DME and supply needs. On admission the patient requested a hospital bed, bedside commode, briefs, chux, and gloves. Patient #9: The plan of care did not include DME and supply needs. On admission the patient requested a hospital bed, bedside commode, shower chair, specialty mattress, briefs, chux, and gloves. Patient #13: The plan of care did not include DME needs. On admission the patient requested a hospital bed and wheelchair.

Upon client record review, 2 of 13 (Patients #4 and #5) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #4: There is documentation the nurse applied an ABD pad with calazime topically to the sacrum there is no evidence of an order for the ABD pad. Patient #5: updated plan of care orders from 4-27-22 - 6-22-22 include chaplain frequency of 1x/month. No evidence of a visit completed by the chaplain from 4-27 to 6-22. There is documentation on 4-27-22 caregiver refused chaplain services, however the orders continued for the chaplain frequency of 1x/month.

Upon observation, in 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 visit #1 The nurse used her gloved hands that were "dirty" to go into the clean side of the nursing bag to obtain a measuring device.

Upon patient record review, 1 of 2 applicable (Patient #11) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient 11 bereavement plan of care included phone call within 2 weeks of the death on 4-11-22. The first bereavement call was completed on 7-7-22.

Upon personnel record review, 1 of 1 applicable (Personnel #5) 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 file #5: The employee hired 6-15-22 did not have evidence of a validated skills competency assessment by the RN prior to performing task independently, had self assessment only.

Upon patient record review, 4 of 13 (Patients #5, #6, #7, #9) 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 #5: The visit frequency on the aide plan of care was indicated at 2 x/week and for the weeks of 2-13-22, 5-22-22, and 6-5-22 only one visits was completed, no evidence of refusal of visit. Patient #6: The visit frequency on the aide plan of care was indicated at 2 x/week and for the week of 3-27-22 only one visit was completed, no evidence of refusal of visit. Patient #7: Aide documentation on all visits from 6-17-22 through 7-28-22 indicated that all tasks were refused by the patient. There was no evidence that the plan of care was updated. Patient #9: Aide documentation on all visits from 6-4-22 through 7-28-22 indicated that all tasks were refused by the patient. There was no evidence that the plan of care was updated.

Upon patient client record review, 3 of 13 (Patients #1, #4, #13) 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. Patient #1 The medical record contained duplicate physician orders for Tylenol 500 mg every 8 hours as needed for pain. Corrected on site. Patient #4 The medical record did not have evidence that the clinician's signature on the document was dated in accordance with the organizations policies. The hospice representative did not date their signature as a witness on the hospice informed consent. Patient #13 The medical record contained documentation discrepancies in the type of discharge. The discharge summary contained documentation the patient revoked their hospice benefit; the discharge note documented the patent transferred. The chart contained a signed transfer form that also contained a discrepancy in the transfer date. The transfer document dated the effective date of the transfer as 5-31-22 however the discharge summary has the effective date of 6-2-22.