Every finding on record at Attaie Healthcare Inc.

Upon patient record review, 10 of 14 (Patient #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.

Upon patient record review, 1 of 14 (Patient #7) 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 #7 - During hospice visit the following medications were not on the medication profile: Vitamin C 1000mg, Zetia 10mg, Zoloft 25mg, Atrovastatin 80mg, Hydralazine 25mg, ASA 81mg, and Clopidogrel Bisulfate 75mg

Upon patient record review, 1 of 14 (Patient #10) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual's attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient's progress toward desired outcomes • Reassessment of the patient's response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient #10 - RN completed comprehensive assessment on 01/02/24 then again on 01/23/24 - greater than 15 days.

Upon patient record review, 1 of 14 (Patient #7) 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 #7 - POC dated 01/10/24 did not contain the following medications Vitamin C 1000mg, Zetia 10mg, Zoloft 25mg, Atrovastatin 80mg, Hydralazine 25mg, ASA 81mg, and Clopidogrel Bisulfate 75mg.

Upon patient record review, 2 of 14 (Patient #11, 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 equipment and supply needs. Patient #11 - POC dated 12/30/23 did not contain DME hospital bed, oxygen concentrator, oxygen portable tanks or trapeze bar. Patient #12 - POC dated 01/15/24 did not contain DME walker, oxygen concentrator, hospital bed or over bed table.

Upon client record review, 2 of 14 (Patient #8, 9) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #8 - POC dated 11/07/23 MSW visit frequency 2 x month - November only 1 visit made. Patient #9 - POC dated 11/08/23 MSW visit frequency 1 x month but 2 visits made November, December and January.

Upon patient record review 1 of 14 (Patient #13) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient #13 - SN performed HHA supervisory visit on 12/19/2023 then again on 01/03/24 - 15 days since last supervisory visit.

Upon client record review, 1 of 14 (Patient #7) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #7 - POC dated 01/10/24 wound care orders did not contain frequency.