Every finding on record at Best Palliative Hospice Care, Inc.

Upon patient record review, 1 of 14 (Patient #10) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #10, No initial bereavement assessment completed. Documented patient declined.

Upon patient record review, 3 of 14 (Patient #4,6,7) 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 #4, 6, 7, Missing DME on plan of care oxygen, hospital bed and mattress.

Upon patient record review, 1 of 14 (Patient #1) 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 #1, orders for increased oxygen 2-8l/min by face mask was not updated to plan of care.

Upon client record review, 8 of 14 (Patient #1,2,3,4,6,7,8,9,12,14) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1,LVN frequency 1x/week for first week then 2x/week. Missing visit on week 4/7/23. Three visits week of 3/27/23 without order for additional visit. Patient #2,MSW frequency eval then every recert, visit on 1/16/23 and 3/10/23. Certification periods 1/24/23 and 4/24/23. SC frequency eval then every recert, visit on 1/15/23 and 3/9/23, Certification periods 1/24/23 and 4/24/23. Patient #4, LVN frequency 1x/week, Missing first visit week of 3/3/34. Patient #6, RN frequency every 14 days, visits 3/26/23, 4/9/23, 4/16/23. Visit was only 7 days apart instead of 14 days. MSW frequency eval and every cert, visits made 8/18/22, 11/18/22, 12/17/22, 4/11/23. Certifications start dates 8/16/22, 10/15/22, 12/14/22, 2/12/23, 4/13/23. SC frequency eval and every recert. Visits made 8/20/22, 10/17/22, 12/16/22, 2/14/23, 4/14/23. Certifications start dates 8/16/22, 10/15/22, 12/14/22, 2/12/23, 4/13/22, 9/9/22, 11/13/22, 1/14/23, 3/9/23. Certification dates 6/15/22, 9/13/22, 11/12/22, 1/11/23, 3/12/23. SC frequency eval and every recert. Visits made 6/17/22, 9/15/22, 11/14/22, 1/13/23, 3/7/23. Certification dates 6/15/22, 9/13/22, 11/12/22, 1/11/23, 3/12/23. Patient #8, MSW frequency eval and every recert. Visits made 6/1/22, 8/28/22, 11/26/22, 1/22/23, 3/18/23. Certification dates 5/29/22, 8/27/22, 11/25/22, 1/24/23, 3/25/23. SC frequency eval and every recert. Visit denied until 3/17/23. No missed visits noted or order changed. Patient #9, MSW frequency eval and every cert. Visits made 4/28/22, 7/22/22, 9/13/22, 10/24/22, 12/25/22, 2/23/23. Certification dates 4/26/22, 7/25/22, 10/23/22, 12/22/22, 2/20/23. SC frequency eval and every recert. patient declined visits, no change in order frequency. Patient #12, RN frequency every 14 days, visits made 6/2/22, 6/16/22, 6/23/22. Patient #14, RN frequency 2x/month and 1 PRN. Visits made 12/2/22, 12/10/22, 12/23/22, 1/5/23, 1/18/23, 1/26/23, 1/27/23. SC frequency as needed and recert. Visits made 12/4/22, 1/4/23.

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, #2, #3, LVN would enter clean side of nursing bag without sanitizing hands every time she entered her nursing bag.

Upon patient client record review, 14 of 14 (Patient #1,2,3,4,5,6,7,8,9,10,11,12,13,14) 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. Patient #1, missing MSW and SC signature on 3/2/23, 3/13/23, 3/27/23, 4/10/23 IDG notes. Patient #2, missing MSW and SC signature on 2/13/23, 2/27/23, 3/2/23, 3/13/23, 3/27/23, 4/10/23 IDG notes. Patient #3, #8, #9, missing MSW and SC signature on 2/27/23, 3/2/23, 3/13/23, 3/27/23, 4/10/23 IDG notes. MSW signature only 2/13/23 IDG notes. Patient #4, missing MSW and SC signature on 3/3/23, 3/13/23, 3/27/23, 4/10/23 IDG notes. Patient #5, missing MSW signature on 11/7/22, 11/21/23, 12/5/22, 12/19/22 IDG notes. Patient #6, missing MSW signature on 2/13/23, 2/27/23, 3/2/23, 3/13/23, 3/27/23, missing MSW and SC, 4/10/23 IDG notes. Patient #7, missing MD and MSW 9/26/22,10/10/22, 1024/22, 12/19/22 IDG notes. Patient #10, missing MSW and SC signatures on 5/13/22, 5/16/22, 2/30/22, 6/13/22 IDG notes. Patient #11, missing MSW, SC and MD on 6/4/22, missing MD, MSW and RN on 7/5/22 IDG notes. Patient #12, missing MSW signature on 6/27/22 IDG notes. Patient #13, missing MSW signature on 5/10/22, 5/13/22 IDG notes.