Every finding on record at Bloom Hospice LLC

Upon patient record review 1 of 14 (Patient #9) 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 #9: The patient was admitted on 02/04/26. The SC did the initial spiritual assessment on 03/07/26. Although the nurse completed a spiritual care screening during admit, it did not include required components of an initial spiritual assessment.

Upon patient record review, 2 of 14 (Patient #5, 9) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #5: The patient has a stage 2 coccyx wound. The agency wound care policy calls for full wound assessment at each nursing visit. There is no evidence of the wound being assessed since the admission date of 03/04/26. Patient #9: The patient has several wounds that were assessed upon admission. The agency wound care policy call for a full wound assessment of each wound at every RN visit. There is no evidence of wound assessments being completed between the dates of 02/20/26 and 04/07/26, despite twice weekly nursing visits.

Upon patient record review, 2 of 14 (Patients #6, 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 #6: Patient is prescribed Plavix and Aspirin. There is no evidence of interventions or goals related to use of anticoagulants or bleeding precautions included in the plan of care. Patient #9: Patient admitted with combined congestive heart failure. He has an implanted defibrillator and pacemaker device that last had the generator changed in 2020. The patient and family do not wish to have further device checks. There is no evidence of interventions or goals for the pacemaker or ICD in the plan of care. The patient has co morbidities of type 2 diabetes and chronic kidney disease. There is no evidence of interventions or goals for endocrine or prescribed diabetic medications.

Upon patient record review, 6 of 14 (Patients #1, 2, 3, 5, 7, 9) 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 #1: The patient has oxygen ordered. There is an oxygen concentrator although the DME is not listed on the plan of care. Patient #2: The patient has an oxygen concentrator, back up oxygen tanks, and a nebulizer. These are not listed as DME on the plan of care. Patient #3: The patient has a hospital bed with scoop mattress, OBT, Geri chair, and bedside commode. Only the hospital bed is listed as DME on the plan of care. Patient #5: The patient is receiving wound care, there are no wound care supplies on the plan of care. Patient #7: The patient does not have supplies or DME listed on the plan of care, despite having a geri chair. Patient #9: The patient has a hospital bed and a bedside commode. These items are not listed as DME on the plan of care.

Upon patient record review, 2 of 14 (Patients #2, 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 #2: The patient was started on Bactrim DS on 03/11/26 for treatment of a UTI. There was no evidence of the plan of care being updated. Patient #6: The patient was started on Bactrim DS on 03/11/26 for treatment of a UTI. There was no evidence of the plan of care being updated.

Upon patient record review, 1 of 14 (Patient #2) 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: This patient had aide services ordered at admit. The IDG meeting notes going forward state under RN and physician to continue aide services twice weekly. There is no aide care plan.

Upon patient record review 3 of 14 (Patient #1,2,4) 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: The patient was admitted 03/25/26. The admission assessment and initial plan of care orders aide visits 1 week 1 and then 2 week 12. There is no evidence of an aide visit being made prior to 04/07/26. In addition, The aide had an aide plan of care written that included obtaining monthly weights. During the aide visit on 04/07/26, The aide documented that this was not completed due to "this is outside my scope of practice" and did not follow POC. Also, there is no evidence in aide's personnel record of follow up from the RN on this area of concern or to ensure care plan is consistent with aide training. Patient #2: On the initial plan of care, aide services are ordered twice weekly. During each subsequent IDG, the nurse and physician document to continue aide visits. There is no evidence of aide visits being made. Patient #4: The plan of care includes aide visits twice weekly. There was only one visit completed during the weeks beginning 03/15/26 as well as 03/22/26.

Upon patient client record review, 1 of 14 (Patient #5) 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 #5: Patient/caregiver requested addendum. They were provided with an addendum and signed it along with Hospice nurse signature. The addendum is blank and does not contain required documentation.

Upon patient client record review, 4 of 14 (Patients 2, 3, 4, 5)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. Patients #2, 3, 4, 5: These patients/caregivers signed an ABN on admission, leaving an end date open.

Upon client record review, 2 of 14 (Patients #11, 12) did not have evidence that the discharge summary includes all required information. Patients #11, 12: These patients were discharged. There was no evidence of the discharge summary included the patient's current plan of care or the patients latest physician orders.

Upon patient record review 1 of 6 (Patient #4) 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 Patient 4: Aide plan of care states that the aide is to provide light housekeeping at every visit. No evidence that light housekeeping was provided on 03/24/23 visit.