Every finding on record at Avila Hospice, Inc.

Upon patient record review, 4 of 14 (Patient #2, 4, 5, 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 Patient 2: The patient's oxygen does not appear on the medication list. (corrected onsite) Patient 4: The medication list indicates hydrocortisone topical cream 2.5% apply topically bid for rash. However, the location for use of this topical medication, though noted on the order, was not included on the medication list. (corrected onsite) Patient 5: The medication list indicates GlycoLax, but does not include instructions for reconstitution of this powdered medication. (corrected onsite) Patient 7: The medication list indicates GlycoLax, but does not include instructions for reconstitution of this powdered medication. Additionally, the medication list indicates Brimonidine 0.2% ophthalmic solution 1 gtt bid. However, the location (which eye[s]) for use of this medication, though noted on the order, was not included on the medication list. (corrected onsite)

Upon patient record review, 1 of 14 (Patient #5) 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 5: The registered nurse visited the patient on 03.24.2024 for a comprehensive assessment visit; the patient was not seen again by a registered nurse for a comprehensive assessment visit until 04.14.2024. This exceeds the 15 day requirement for an update to the assessment. To be clear, the patient was seen routinely by the LVN during this period and all needs and concerns were addressed.

Upon patient record review, 3 of 14 (Patient #4, 8, 9) did not have evidence the plan of care must 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 4: Visits for the MSW were ordered 1 as needed only. Visits for each discipline must be ordered on a routine basis, to anticipate changes and needs. Patient 8: Visits for the MSW were ordered on recertification and as needed only. Visits for each discipline must be ordered on a routine basis, to anticipate changes and needs. Patient 9: Visits for the MSW were ordered on recertification and as needed only. Visits for each discipline must be ordered on a routine basis, to anticipate changes and needs.

Upon client record review, 7 of 14 (Patient #1, 2, 3, 5, 9, 10, 14) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: MSW visits were ordered for 1 x monthly per the care plan; however, there was not evidence that the MSW has seen the patient. Patient 2: MSW visits were ordered for 1 x monthly per the care plan; however, there was not evidence that the MSW has seen the patient. Patient 3: The MSW entered PRN orders to visit the patient on 12.04.2023, 02.02.2024, and 02.06.2024; however, the MSW only completed one PRN visit, which was made on 02.26.2024. Patient 5: MSW visits were ordered at each recertification per the care plan. The MSW also made a visit on 03.18.2024, which was made without an order. Additionally, SN visits were ordered for 2 x weekly per the care plan. However, during the week of 04.07.2024, only one visit was made by a nurse (LVN) on 04.12.2024. Patient 9: Chaplain visits were ordered for 1 x monthly per the care plan; however, there was not evidence that the chaplain made a visit during the month of April. Patient 10: MSW visits were ordered at each recertification per the care plan. The MSW also made a visit on 10.25.2023, which was made without an order. Patient 14: MSW services were declined by the patient/family on admission for hospice services. The MSW also made a visit on 08.27.2023, which was made without an order.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient 1: During the home visit with the LVN, the SN did not utilize a barrier underneath the bag per the bag technique process to ensure the patient's safety related to infection risk.

Upon patient record review 1 of 14 (Patient #3) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 3: HA visits were ordered for 1 x weekly per the care plan; however, there was not evidence that the HA visited the patient during the weeks of 03.03.2024, 03.24.2024, and 04.21.2024. There was also no documentation of a missed visit.