Every finding on record at Astute Care Hospice, Inc.

Upon patient record review, 1 of 14 (Patient #8) did not have evidence that the hospice obtained the patient's or representative's signature confirming that they received a copy of the Patient's Rights and Responsibilities. Patient 08: The Hospice Election form indicates that the patient elected to receive the Patient notification of Hospice Non-covered items, services and drugs addendum, there is no evidence in the patient record that this was provided to the patient.

Upon patient record review, 2 of 14 (Patient #1, 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 01: The medication profile includes Diclofenac 1% topical gel, apply 1-2 grams on the skin 3 times a day as needed for pain, it does not include an application site. Patient 02: The medication profile includes Diclofenac 1% topical gel, apply 2 times a day as needed for pain, it does not include an application site.

Upon patient record review, 1 of 2 (Patient #2) 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 02: Upon admit on 4/19/24, the patient record reflects that the patient is pre-diabetic and checks her blood sugar regularly, the hospice agency is providing a glucometer for the patient for monitoring, the record does not include a problem statement with interventions and goals for the endocrine issues.

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 medications and treatments. Patient 01: The medication order on 8/5/24, includes Diclofenac 1% topical gel, apply 1-2 grams on the skin 3 times a day as needed for pain, it does not include an application site. Patient 02: The medication order on 7/29/24, includes Diclofenac 1% topical gel, apply 2 times a day as needed for pain, it does not include an application site.

Upon patient record review, 1 of 14 (Patient #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. Patient 02: Upon admission on 4/19/24, the patient record indicates that the patient utilizes a walker for ambulation, the orders for activity level include ambulate with max assist using a walker. The walker is not included in the DME plan of care.

Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient's life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination: • The primary terminal condition • Related diagnosis • Current subjective and objective medical findings • Current medication and treatment orders • Information about the medical management of any of the patient's conditions unrelated to the terminal illness Patient 01: The patient was admitted on 8/5/24 in the first benefit period. The physician narrative included in the certificate of terminal illness is copied and pasted directly from the initial comprehensive assessment performed by the RN on 8/5/24, and was not composed by the physician.

Upon patient record review, 2 of 14 (Patient #2, 3) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient's clinical information and provide written documentation that it is anticipated that the patient's life expectancy is 6 months or less. Patient 02: The physician narrative included in the certificate of terminal illness for the 5th benefit period starting 4/25/24, is copied and pasted from the RN comprehensive assessment visit performed on 4/23/24 and was not composed by the physician. The physician narrative included in the certificate of terminal illness for the 6th benefit period starting 6/24/24, is copied and pasted from the RN comprehensive assessment visit performed on 6/18/24 and was not composed by the physician. Patient 03: The narrative statement for the 2 certification period starting 6/26/24 was copied and pasted from the RN comprehensive assessment performed on 6/20/24.

Upon client record review, 1 of 14 (Patient #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 12: The patient revoked the election of hospice benefit on 4/12/24, there is no evidence in the patient record that the discharge summary was provided to the patient's attending physician.