Every finding on record at Avalon Hospice Iowa, LLC

Upon patient record review 1 of 14 records (Patient #7) 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 #7: The patient was admitted on 3/19/24. The record indicated that the spiritual assessment was completed on 3/25/24.

Upon patient record review, 4 of 14 records (Patient #1,#2,#3,#9) 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: The medication profile contained Bio Freeze 4% topical gel q6h prn. Apply thin layer to painful areas. There was not evidence of a specific location. Corrected on site. Patient #2: The medication profile contained Acetaminophen 325mg, 2 tabs daily prn pain or fever. There was not evidence of a parameter for the fever. Corrected on site. Patient #3: The medication profile at the hospice agency had Trazadone listed as 100mg, 1 tab at bedtime and 50mg in the morning. The medication profile at the ALF had Trazadone 50mg only at bedtime. (No dose in the morning). Corrected on site. Patient #9: The medication profile contained MiraLax 17 grams as directed. There was not evidence of a diluent or a specific frequency.

Upon patient record review, 1 of 14 records (Patient #9) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient that reflects 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 #9: The patient was admitted with a diagnosis of arteriosclerotic heart disease. She was SOB and on oxygen. Medications included but were not limited to amlodipine and metoprolol. There was not evidence that the plan of care reflected patient/family goals and interventions based on the cardiac problems identified in the assessments.

Upon patient record review, 1 of 14 records (Patient #9) did not have evidence the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #9: The visit frequency for the spiritual care counselor and the social worker at admission were both 1 prn.

Upon patient record review, 5 of 14 records (Patient #1,#2,#5,#8,#9) 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: The record contained an order for Bio Freeze 4% topical gel q6h prn. Apply thin layer to painful areas. There was not evidence of a specific location. Corrected on site. Patient #2: The medication profile contained Acetaminophen 325mg, 2 tabs daily prn pain or fever. There was not evidence of a parameter for the fever. Corrected on site. Patient #5: The record contained a wound care order dated 4/19/24, Clean with wound cleanser. Apply sureprep rapid dry around wound edges. Apply Optifoam gentle ex. Change q 7 days and prn. There was not evidence of a wound location. Corrected on site. Patient #8: The record contained a wound care order dated 5/3/24, cleanse with wound cleanser. Apply Opticell antibacterial silver gelling fiber. Cover with bordered dressing. There was not evidence of a wound location. Corrected on site. In addition, the record indicated that the patient was on C-Pap with settings of PS7/ST15. There was not evidence of an order or that C-Pap was in the plan of care. Patient #9: Patient #9: The record contained an order for MiraLax 17 grams as directed. There was not evidence of a diluent or a specific frequency.

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. Volunteer usage percentage for the year 2023 was 0%.

Upon personnel record review, 1 of 10 records (Personnel #4) 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 #4: There was not evidence of a competency assessment for the bereavement coordinator.

Upon patient client record review, 1 of 14 records (Patient #12) did not evidence that each patient record contains physician orders. Patient #12: The patient was discharged for no longer meeting hospice criteria. There was not evidence of a discharge order from the medical director.

Upon patient client record review, 2 of 14 records (Patient #2,#9) 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 #2: The Iowa POST, which requires a physician signature, was completed by the patient/representative at admission (2/7/24). There was not evidence that the physician signed this document until 5/15/24. Patient #9: The patient was admitted with a diagnosis of arteriosclerotic heart disease. The ICD-10, the physician's certification of terminal illness and the plan of care all indicated this diagnosis. The nurse narrative upon admission indicated that the patient was admitted with a primary diagnosis of osteoporosis.

Upon client record review, 1 of 14 records (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 was discharged for no longer meeting hospice criteria. There was not evidence that documentation was sent to the attending physician

Upon client record review, 1 of 14 records (Patient #12) did not have evidence that the discharge summary includes all required information. Patient #12: There was not evidence of a summary of the patient's stay, including treatments, symptoms and pain management.