Every finding on record at Atlas Hospice Care, Inc.

Upon patient record review, 14 of 14 (Patients # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patients # 1 - 14) The patients' initial comprehensive assessments did not contain evidence related to the consideration of the imminence of death.

Upon patient record review, 2 of 14 (Patient #2, 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 #2) During home visit, a review and reconciliation of the patient's home medications was completed. The patient did not have all ordered medications. The medication was Ondansetron 4 mg tab, oral every six hours for nausea and vomiting. Caregiver stated the patient did not have this medication at the home. Patient #3) During home visit, a review and reconciliation of the patient's home medications was completed. The patient did not have all ordered medications. The medications were, Ciprofloxacin 500 mg tab, oral, daily; Dexamethasone 2 mg tab, oral, daily; Dulcolax 10 mg rectal suppository, every 72 hours as needed for constipation; Folic Acid 1 mg tab, oral, daily; Jardiance 10 mg tab, oral, daily; Lasix 40 mg tab, oral, daily as needed for edema and swelling; Levetiracetam 500 mg tab, oral, every 12 hours for seizures. Caregiver stated the patient did not have these medications at the home.

Upon patient record review, 11 of 14 (Patients # 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, 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 comprehensive assessment dated 7/29/25 documented the patients equipment as a bedside commode and wheelchair. There was no evidence of this equipment on the patient's initial plan of care. Patient #2) The comprehensive assessment dated 5/1/25 documented the patients equipment as bedrails, hospital bed, and a wheelchair. There was no evidence of this equipment on the patient's initial plan of care. Patient #3) The comprehensive assessment dated 7/1/25 documented the patients equipment as hospital bed. There was no evidence of this equipment on the patient's initial plan of care. Patient #4) The comprehensive assessment dated 6/17/25 documented the patients equipment as a wheelchair and walker. There was no evidence of this equipment on the patient's initial plan of care. Patient #5) The comprehensive assessment dated 11/13/24 documented the patients equipment as a hospital bed, overbed table, and 02 concentrator. There was no evidence of this equipment on the patient's initial plan of care. Patient #6) The comprehensive assessment dated 4/30/25 documented the patients equipment as a mattress gel pressure pad, bedrails, hospital bed, hoyer lift, IV pole, IV pump, overbed table, and 02 concentrator. There was no evidence of this equipment on the patient's initial plan of care. Patient #7) The comprehensive assessment dated 2/24/25 documented the patients equipment as bedrails, hospital bed, and an overbed table. There was no evidence of this equipment on the patient's initial plan of care. Patient #8) The comprehensive assessment dated 2/27/25 documented the patients equipment as bedrails and a hospital bed. There was no evidence of this equipment on the patient's initial plan of care. Patient #10) The comprehensive assessment dated 6/4/24 documented the patients equipment as a cane. There was no evidence of this equipment on the patient's initial plan of care. Patient #11) The comprehensive assessment dated 11/13/24 documented the patients equipment as a bedside commode, hospital bed, walker, and a wheelchair. Patient #12) The comprehensive assessment dated 9/12/24 documented the patients equipment as a pressure mattress, bedrails, hospital bed, overbed table, O2 cylinder, and wheelchair. There was no evidence of this equipment on the patient's initial plan of care. Patient #13) The comprehensive assessment dated 4/30/25 documented the patients equipment as bedrails and a hospital bed. There was no evidence of this equipment on the patient's initial plan of care.

Upon patient record review, 4 of 14 (Patients # 2, 4, 6, 13) 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) Aide plan of care dated 6/26/25, stated the aide may file patient's nails every visit. The use of the word "may" indicates the aide may choose to perform or not perform this task. Patient #4) Aide plan of care dated 5/1/25, stated the aide may assist to toilet, while using shower chair or during bed bath every visit. The use of the word "may" indicates the aide may choose to perform or not perform this task. The use of the word "may" indicates the aide may choose to perform or not perform this task. Patient #6) Aide plan of care dated 4/30/25, stated the aide may file nails every visit. The use of the word "may" indicates the aide may choose to perform or not perform this task. Patient #13) Aide plan of care dated 5/5/25, stated the aide may file nails every visit. The use of the word "may" indicates the aide may choose to perform or not perform this task.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. The volunteer Cost savings report for 2024 reflects a 0% cost savings from volunteer activities.

Upon client record review, 1 of 14 (Patient # 11) 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) The medical record did not contain evidence that the discharge summary was sent to the attending physician upon discharge.

Upon observation, there was not evidence of written contract(s)/agreement(s) with other Agencies/Facilities/Hospices to receive Atlas Hospice patients in the event that Atlas Hospice cannot provide care to their patients during an emergency situation.

Upon patient record review, 1 of 5 (Patient #5) did not contain evidence of a current/comprehensive Medication Profile, specifically the inclusion of correct Allergies, if any. The patient had a documented allergy to Aspirin. The Medication Profile incorrectly listed an allergy to Penicillin.

Upon patient record review, 2 of 2 applicable (Patients #4 and 5) did not contain a DC Summary which included all CMS-required content. Both of these DC Summaries dated 06/16/22 and 06/10/22 respectively, did not include: • A summary of the patient's stay, including treatments, symptoms and pain management • The patient's current Plan of Care • The patient's latest Physician orders

Upon patient record review, 5 of 5 (Patients #1, 2, 3, 4, and 5) did not contain evidence that the Interdisciplinary Group, as part of the review of the Plan of Care, had determined the ability of the patient and/or family to safely self-administer drugs and biologicals to the patient in his or her home. If the patient and/or family are not capable of safely administering drugs and biologicals in the home, the Hospice must address this issue in the patient's Plan of Care.