Every finding on record at Attentive Guardians

Upon patient record review, 1 of 14 (Patient #8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. #8-The plan of care dated 09/01/24 lists Oxygen 3 lpm via NC. Visit note dated 10/21/24 instructed the patient to titrate Oxygen up to 5 lpm to maintain O2 sats above 98%. There is no order to titrate the Oxygen to 5 lpm.

Upon patient record review, 1 of 14 (Patient #1) 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. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. #1-The comprehensive assessment dated 04/23/25 states that Alzheimer's is the patient's primary diagnosis. The plan of care dated 04/23/25 lists Heart Disease as the primary diagnosis. It is unclear what the primary diagnosis should be.

Upon patient record review, 3 of 5 (Patient #1,#3,#5) 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: The medical record contained documentation of shortness of breath on the comprehensive nursing assessment dated 6-19-22 there was no evidence of problems, interventions, or goals related to managing respiratory symptoms. Patient #3: The medical record contained documentation of the patient having 10% weight loss in a month and the comprehensive nursing assessment dated 6-19-22 there was no evidence of problems, interventions, or goals related to nutrition. Patient #5: The medical record contained documentation of the patient experiencing pain, 10% weight loss in a month and significant muscle wasting on the comprehensive nursing assessment dated 4-11-22 there was no evidence of problems, interventions, or goals related to pain or nutrition.

Upon patient record review, 3 of 5 (Patient #2,#4,#5) 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 #2: The medical record did not contain evidence of DME on the plan of care dated 6-19-22. The comprehensive nursing assessment dated 6-19-22 documented the patient has a wheelchair and hospital bed. Patient #4: The medical record did not contain evidence of DME on the plan of care dated 3-5-22. The comprehensive nursing assessment dated 3-5-22 documented the patient has a wheelchair, air mattress, hospital bed, and shower chair. Patient #5: The medical record did not contain evidence of DME on the plan of care dated 4-11-22. The comprehensive nursing assessment dated 4-11-22 documented the patient has a hospital bed, air mattress, and wheelchair.

Upon personnel record review, 1 of 1 applicable (Personnel #2) did not have evidence the alternate administrator's personnel record verifies that: • There is a signed job description for this role • The employee has been orientated to this role Personnel #2: The personnel file did not contain evidence of a signed job description or evidence of orientation for the role of alternate administrator. Corrected on site.

Upon personnel record review, 2 of 13 (Personnel #1,#6) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel #1: Did not have evidence of skills competency specific to the volunteer coordinator included in the personnel file. Corrected on site. Personnel #2: Did not have evidence of skills competency specific to the bereavement coordinator included in the personnel file. Corrected on site.