Every finding on record at Beatus Hospice Care Inc

Upon patient record review, 8 of 14 (Patient #1,2,3,4,5,6,7,9) 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 - Patient's advanced directives showed patient chose to remain a full code. There was no evidence of problems, goals or interventions related to the full code status. The patient's medication profile also contained aspirin. There was no evidence of problems, goals, or interventions related to the bleeding risk of that medication. Patient #2 - Patient's advanced directives showed patient chose to remain a full code. There was no evidence of problems, goals or interventions related to the full code status. Patient's plan of care also listed patient has a mechanical soft diet order with no evidence of problems, goals or interventions related to dysphagia. Patient #3,4,6,7 - Patient's advanced directives showed patient chose to remain a full code. There was no evidence of problems, goals or interventions related to the full code status. Patient #5 - The patient medication profile showed patient was taking Xarelto daily as a blood thinner. There was no evidence of problems, goals, or interventions related to the bleeding risk of this medication. Patient #9 - Patient's advanced directives showed patient chose to remain a full code. There was no evidence of problems, goals or interventions related to the full code status. The patient's medication profile also contained Eliquis as a daily blood thinner. There was no evidence of problems, goals, or interventions related to the bleeding risk of that medication.

Upon patient record review, 1 of 14 (Patient #13) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #13 - The patient record showed that the IDG dated 10/31/25 discussed discharging the patient for extended prognosis. There was no other evidence of documentation related to this discharge until this IDG and the plan of care showed no evidence of problems, goals or interventions related to this discharge and no documented discharge preparation. The patient was discharged on the date of the IDG.

Upon patient record review, 4 of 14 (Patient #1,3,4,6) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1 - The IDG had a spiritual care frequency order for one time per month. The medical record showed spiritual care assessments completed on 07/18/25, 09/08/25, and 10/05/25. There was no evidence that a visit occurred in August 2025 Patient #3 - The IDG had a spiritual care frequency order for one time per month. The medical record showed spiritual care assessments completed on 06/23/25, 09/02/25, and 10/06/25. There was no evidence of spiritual care assessments completed in July or August 2025. Patient #4 - The medical record showed a physician order from the medical director dated 06/27/25 to obtain lab work on the patient (CBC,CMP, Hgb A1C, Lipid panel, urine with culture, Vit D, 25-OH, and Total 1A). These labs were scheduled at Quest Diagnostics. There was no documented evidence that this order was completed. There was no documented evidence that the RN Case Manager completed any follow up on these labs. Patient #6 - The IDG had documented an order that patient declined spiritual care. The medical records showed that spiritual care visits had occurred without an order on 02/11/25, 03/10/25, 04/13/25, 05/09/25, 06/13/25, 07/11/25, 08/13/25, 09/10/25, 10/14/25 without an order.

Upon patient record review, 7 of 14 (Patient #1,2,3,4,5,6,7) 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# 1,2,3,4,5,6,7 - All medical records contained signed Election of the Hospice Benefit forms. Page 4 of 7 contained the addendum statement for which all noted patients/POA's declined to receive the Patient Notification of Hospice Non-Covered Items, Services, and Drug." Page 6 of 7 contained the Patient Notification of Hospice Non-Covered Items. All Patient Notification of Hospice Non-Covered Items forms were left blank with no listed non-covered/covered items, but contained signatures of patient/POA as an acknowledgement that the list of items, services, and drugs not covered or related to the terminal diagnosis were outlined.

Upon patient record review, 1 of 5 (Patient #4) did not contain an individualized written Plan of Care. 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. The RN Initial Assessment noted that, "the patient has been drinking Glucerna dietary supplement to maintain her weight." This was not on the 90-day Plan of Care beginning 05/28/22, nor on the latest IDG POC update of 07/10/22. Additionally, the 07/04/22 SN visit noted, "Sometimes the patient uses compression stockings to prevent further lower extremity edema." This was not on the latest IDG POC update of 07/10/22.

Upon patient record review, 1 of 5 (Patient #3) did not contain evidence that the IDG had ensured that all care and services were provided in accordance with the Plan of Care. The RN documents on the 10/03/22 home visit, "Instructed patient on non-pharmacological pain relief measures including relaxation techniques, massage, .... and use of warm/cold packs." There was no Physician order for the application of warm/cold packs on the Plan of Care, to include a Physician-ordered frequency, duration, method of application, etc...

Upon patient record review, 1 of 5 (Patient #3) did not contain evidence that each patient record contained: A signed Election of Hospice Benefit Statement, in accordance with 418.24 The Election Statement form had been left blank where the patient was to have designated his/her Attending Physician of choice.

Upon patient record review, 4 of 5 (Patients #1, 2, 4, and 5) did not contain evidence that all entries were legible, clear, complete, and/or appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice: Patients #1 and 5: For each of these patients, receiving Aide care/services, all of the Aide-documented home visit notes contained the Aide's signature, without the addition of the Aide's credentials. Patients #1, 2, 4, and 5: For each of these patients, the admitting RN(s) had documented within the Initial SOC Assessment(s) that each of these patients had a DPOA-Healthcare, to include the documented name and contact information for legal surrogates. For each of these patients, the Physician-signed POLST, dated the same date as these patients' Initial Assessments, did not include the designation of a DPOA-Healthcare. This is not clear documentation of these patients' Advance Directive status, or the absence of .

Upon inpatient contract review, 1 of 1 applicable (CC) did not contain a provision that the inpatient facility shall: Provide the Hospice with a copy of the Discharge Summary at the time of the patient's discharge from such inpatient facility.