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

Upon patient record review, 6 of 14 (Patient #1, #4, #5, #7, #8, #10) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #1: The record indicated the patient was admitted on 10/22/24. There was no evidence the patient chose an attending physician for hospice. Patient #4: The record indicated the patient was admitted on 05/20/24. There was no evidence the patient chose an attending physician for hospice. Patient #5: The record indicated the patient was admitted on 03/30/24. There was no evidence the patient chose an attending physician for hospice. Patient #7: The record indicated the patient was admitted on 01/10/24. There was no evidence the patient chose an attending physician for hospice. Patient #8: The record indicated the patient was admitted on 08/14/23. There was no evidence the patient chose an attending physician for hospice. Patient #10: The record indicated the patient was admitted on 04/06/23. There was no evidence the patient chose an attending physician for hospice.

Upon patient record review 1 of 14 (Patient #6) 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 #6: The record indicated the patient was admitted to hospice on 02/27/24. The psychosocial comprehensive assessment was not completed until 03/16/24.

Upon patient record review, 2 of 14 (Patient #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 • Drug therapy currently associated with laboratory monitoring Patient #5: The medication profile indicated on 07/08/24 Nystatin Powder 100,000 Units/gm topical powder, sprinkle a thin layer. Note: Cleanse with warm soapy water, pat dry gently, and apply nystatin powder daily and as needed if soiled and after a bath. Monitor and discontinue when healed. There was no evidence of the site location as to where this powder was to be applied. COS Patient #7: Miralax did not include reconstitution with an amount and type of liquid, the dose of 35 mg ordered was in error. COS. Also, Acetaminophen 500mg po @ bedtime was ordered. The Hospice Administrator confirmed with the dispensing pharmacy and Pharmacist that the original order should have been Acetaminophen 500mg/Benadryl 25mg po QHS, the order was entered in the EMR system incorrectly as Acetaminophen 500mg po @HS by the Administrator/DPCS therefore incorrect on medication profile. COS.

Upon patient record review, 2 of 14 (Patient #6, #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 #6: The record indicated the patient was admitted on 02/27/24. The initial bereavement assessment was not completed. Patient #10: The record indicated the patient was admitted on 04/06/23. The initial bereavement assessment was not completed.

Upon patient record review, 3 of 14 (Patient #2, #3, #10) 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 #2: The record indicated the patient was started on Eliquis 5mg po BID on 10/17/24. There was no evidence of an individualized plan of care to reflect the patient/family goals and interventions regarding bleeding precautions. COS. Patient #3: The record indicated treatment orders for minor cuts/abrasions 1.) clean with Shur-clens (or Soap and warm water), pat dry. 2.) Apply antibiotic ointment. 3.) cover with band aide dressing. 4.) Change daily as needed. 5.) Observe daily for signs and symptoms of infections; increased redness, swelling, pain, drainage or temperature. 5.) if the resident experiences any of this symptoms, notify MD and discontinue when healed. There was no evidence of the care plan being written to reflect individualization to include the patient family goals and interventions based on this skin integrity problem identified. COS. Patient #10: The record indicated the patient was started on Eliquis 5mg po BID on 10/17/24. There was no evidence of an individualized plan of care to reflect the patient/family goals and interventions regarding bleeding precautions. COS.

Upon patient record review, 2 of 14 (Patient #5, #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 medications and treatments. Patient #5: The Physician Order indicated on 07/08/24 Nystatin Powder 100,000 Units/gm topical powder, sprinkle a thin layer. Note: Cleanse with warm soapy water, pat dry gently, and apply nystatin powder daily and as needed if soiled and after a bath. Monitor and discontinue when healed. There was no evidence of the site location as to where this powder was to be applied. COS Patient #7: Miralax did not have an order to include reconstitution with an amount and type of liquid, the dose of 35 mg ordered was in error. COS. Also, Acetaminophen 500mg po @ bedtime was ordered. The Hospice Administrator confirmed with the dispensing pharmacy and Pharmacist that the original order should have been Acetaminophen 500mg/Benadryl 25mg po QHS, the order was entered in the EMR system incorrectly as Acetaminophen 500mg po @HS by the Administrator/DPCS. COS.

Upon patient record review, 3 of 14 (Patient #1, #2, #7) the plan of care did not include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient #1: The patient had a hospital bed, shower chair with back support, walker with seat and four wheels, bedside table and bedside commode order on 10/23/24. There was no evidence the plan of care included these equipment needs. COS. Patient #2: The patient had a hospital bed with half rails, oxygen, nebulizer and shower bench ordered on 10/17/24. There was no evidence the plan of care included these equipment needs. COS. Patient #7: The patient had a wheel chair with high back and nebulizer ordered on 01/10/24. There was no evidence the plan of care included these equipment needs. COS.

Upon patient record review, 1 of 14 (Patient #5) 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 #5: The record indicated a Physician Order on 07/08/24 for Nystatin Powder 100,000 Units/gm topical powder, sprinkle a thin layer. Note: Cleanse with warm soapy water, pat dry gently, and apply nystatin powder daily and as needed if soiled and after a bath under both breast areas. Monitor and discontinue when healed. There was no evidence an individualized plan of care was written to reflect the patient/family goals and interventions based on this problem. COS.

Upon patient record review, 2 of 14 (Patient #4, #7) did not have evidence that the IDG documents the sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement. Patient #4: The record indicated the IDG meeting was held on 11/04/24 with the previous meeting being on 10/21/24. There was no evidence of the MD or RN signature showing their attendance to this meeting on 11/04/24. COS. Patient #7: The record indicated the IDG meeting was held on 11/04/24 with the previous meeting being on 10/21/24. There was no evidence of the MD or RN signature showing their attendance to this meeting on 11/04/24. COS.

Upon patient record review, 2 of 14 (Patient #2, #10) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #2: The record indicated the patient was started on Eliquis 5mg po BID on 10/17/24. There was no evidence the hospice aide care plan had bleeding precautions. COS. Patient #10: The record indicated the patient was started on Eliquis 5mg po BID on 04/06/23. There was no evidence the hospice aide care plan had bleeding precautions. COS.

Upon observation, there was no evidence the governing body assumed full legal authority and responsibility for the management of the hospice, the provision of all services, its fiscal operations, and the continuous quality assessment and performance improvement that are consistent with acceptable standards of practice. The governing body meeting minutes did not include Quality Assessment Performance Improvement, no annual review of policies and procedures, no human resource management and no oversight of the management and fiscal affairs of the hospice and no review of any written bylaws.

Upon patient client record review, 7 of 14 (Patient #1, #4, #5, #7, #8, #9, #10) 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 record indicated the patient was admitted on 10/22/24. There was no evidence an attending physician was the patients choice. Patient #4: The record indicated the patient was admitted on 05/28/24. There was no evidence an attending physician was the patients choice. In addition, the patient/family requested a copy of the non covered items. There was no evidence this was given to the patient/family. Patient #5: The record indicated the patient was admitted on 03/20/24. There was no evidence an attending physician was the patients choice. Patient #7: The record indicated the patient was admitted on 01/10/24. There was no evidence an attending physician was the patients choice. In addition, the patient/family requested a copy of the non covered items. There was no evidence this was given to the patient/family. Patient #8: The record indicated the patient was admitted on 08/14/23. There was no evidence an attending physician was the patients choice. Patient #9: The record indicated the start of care was on 04/08/23. The patient/family requested a copy of the non covered items. There was no evidence this was given to the patient/family. Patient #10: The record indicated the patient was admitted on 04/06/23. There was no evidence an attending physician was the patients choice.

Upon client record review, 1 of 14 (Patient #7) did not have evidence that all drugs and biologicals are labeled in accordance with currently accepted professional practice and include appropriate usage and cautionary instructions, as well as an expiration date, if applicable. Patient #7: During a home visit the medication profile had Acetaminophen 500mg po @ bedtime was ordered the medication on hand was in a bubble pack with a blue tablet that had on the prescription Acetaminophen 500 - 25 mg po QHS but there was no medication listed regarding what the 25mg included. This medication was not labeled correctly. The pharmacy was called by the hospice nurse and the medication was identified as Acetaminophen 500mg / Benadryl 25mg po QHS, this was relabeled by the pharmacy while the surveyor was still on site. COS.

Upon patient record review 1 of 11 (Patient #8) 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 #8 Patient admitted on 4/13/21. The spiritual care assessment was completed on 4/24/21.

Upon patient record review 2 of 11 (Patient #2, 3) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient #2 Patient did not have a comprehensive assessment of spiritual needs upon admission on 3/20/21 and to date. Patient #3 Patient did not have a comprehensive assessment of spiritual needs upon admission on 1/5/22 and to date.

Upon patient record review, 2 of 11 (Patient #6, 10) 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. Patient #6 The record reflects that the patient had ordered oxygen 2-3L per NC PRN SOB upon start of care 2/20/21 but this was not listed in the medication profile. Patient #10 Patient had new orders on 1/18/21 for oxygen 2-5L n/c PRN SOB but this was not entered into the medication profile.

Upon patient record review, 2 of 11 (Patient #5, 6) 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 #5 The patient record reflects that the patient was started on an antibiotic for a wound to left shin, Septra 800mg x 10 days on 4/22/21 and was treated on 7/31 with Augmentin for URI, but the POC was not updated to include interventions and goals related to wound/infection. Patient #6 The patient records reflects that she was treated with Cipro starting 6/8/21 for a UTI, but the POC was not updated to include interventions and goals for infection.