Every finding on record at Big Hearts Hospice Care

Upon client record review, 2 of 14 (Patient #10, 11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 10: The Spiritual Care frequency was recorded on the initial plan of care and all updated plans of care as, "1-every certification period for support and counseling." The Spiritual Care provider made an initial visit on 09/24/25 and another on 12/20/25. There was no documented evidence of any supplemental MD order to allow the clinician to perform a second visit during the same certification period. Patient 11: The plan of care records blood pressure parameters warranting report to the physician of Systolic BP less than 90mmHg and Diastolic BP less than 50 mmHg. The LVN visit dated 10/15/25 recorded a blood pressure of 82/48. The SN visit dated 10/17/25 recorded a blood pressure of 88/52. There was no documented evidence found of physician notification in either of the visit notes nor were there any other communication notes documented to show any collaboration.

Upon patient record review 1 of 14 (Patient #2) 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 2: Visit documentation for 01/07/26 revealed under the Aide Comments, "Complete shower provided patient tolerated care well." The aide instructions dated 10/24/25 indicate the need for a bed bath.

Upon client record review, 2 of 11 (Patient #1,8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1 SN frequency 1x/week. Visits completed 2x the week of 5/7/22. LVN on 5/7/22 and RN on 5/8/22. Both visits were documented as scheduled visits. No order for additional visit that week. Patient #8 SN frequency 1x/week, patient started out being seen 1x/week then visits increased to 2x week without an order to increase frequency starting 5/24/22.

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 #3, LVN washed his hands then went to set up his equipment on the table. LVN went in and out of nursing bag multiple times without using sanitizer every time he enters his nursing bag.

Upon patient record review 1 of 11 (Patient #1) 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 Aide frequency 1x/week for the first week then 2x/week there after. Aide visits completed 2x/first week then 3x/week. No evidence of visits completed from 11/29/22 to 12/12/22.