Every finding on record at Bay Hospice Care Inc.

Upon patient record review, 4 of 5 (Patient #1,#3,#4,#5) 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 #1: The medication list indicated Miralax powder 17g 1 pack po daily PRN constipation; however, instructions for reconstitution of this powdered medication were not included on the medication list. (corrected onsite) Patient #3: The patient's allergies have not been reviewed since the time of hospice admission; therefore, actual or potential interactions cannot be assessed. Additionally, the medication list indicated Miralax powder 17g 1 pack po daily PRN constipation; however, instructions for reconstitution of this powdered medication were not included on the medication list. Finally, the medication list also indicated Nystatin powder 100,000 units/g apply daily PRN redness; however, the location ordered for use does not appear on the medication list. (corrected onsite) Patient #4: The medication list indicated Miralax powder 17g 1 pack po daily PRN constipation; however, instructions for reconstitution of this powdered medication were not included on the medication list. (corrected onsite) Patient #5: The medication list indicated Miralax powder 17g 1 pack po daily PRN constipation; however, instructions for reconstitution of this powdered medication were not included on the medication list. (corrected onsite)

Upon patient record review, 1 of 5 (Patient #2) 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 #2: The RN made a visit to complete the comprehensive initial assessment on 07.06.2024; the next update to the comprehensive assessment was completed by the RN on 09.04.2024, which exceeds the 15 day allowable limit.

Upon patient record review, 1 of 5 (Patient #2) 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 comprehensive initial nursing assessment and subsequent nursing visit notes indicate the patient utilizes both a cane and walker for mobility assistance. However, this DME does not appear on the plan of care. (corrected onsite)

Upon patient record review 2 of 5 (Patient #1, #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 #1: On 08.13.2024, the plan of care was updated with orders for the aide to visit the patient 2 x weekly. However, since the week of 08.25.2024, the aide has only seen the patient 1 x weekly. The DPCS verified that the patient's POA requested the change to 1 x weekly visits and the plan of care has failed to be updated; the plan of care was updated accordingly during the survey. Patient #3: The plan of care indicates the aide is to visit the patient 2 x weekly. However, the aide has been seeing the patient 3 x weekly on an ongoing basis. The RN updated the plan of care accordingly.

Upon patient client record review, 3 of 5 (Patient #1,#2,#3) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #1: The patient was admitted for hospice services onc7/29/24; however, the election form did not indicate the date the date hospice services were initiated. Patient #2: The patient was admitted for hospice services on 7/6/24; however, the election form did not indicate the date the date hospice services were initiated. Patient #3: The patient was admitted for hospice services on _6/18/24; however, the election form did not indicate the date the date hospice services were initiated.