Every finding on record at Blossom Care Hospice Inc.

Upon patient record review, 2 of 14 (Patient #5, 8) 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: Med Profile includes Kesimpta prefilled pen 20 mg/0.4 ml solution for injection. Route is identified as intravenous, but frequency states inject subcutaneously once every month (for Multiple Sclerosis). Corrected to reflect subcutaneous route, by end of survey Patient #8: Upon medication review during home visit, the medications on the medication profile are not consistent with the medications on the plan of care and what the patient/caregiver states they are taking. The caregiver states patient is not taking Lipitor, as patient physician had advised against it.

Upon patient record review, 1 of 14 (Patient #4) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #4: SC frequency of one time then, prn for spiritual support. Frequency was not updated thru 3/6.

Upon client record review, 2 of 14 (Patient #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 #4: Initial MSW frequency of MSW 1/month and continued same thru 3/6/23 IDG/POC. Only visit documented is 1/12/24. No documented communication or order related to change. Patient #6 Initial MSW frequency of MSW 1/month and continued same thru 3/6/23 IDG/POC. Only visit documented is 1/19/24 initial assessment. No documented communication or order related to change. Record includes documentation of initial decline for SC services in initial comprehensive assessment. SC made visit 2/21/24. There is no updated order and/or frequency for the visit and no update to POC.

Upon patient record review, 1 of 14 (Patient #14) did not have evidence that Social work services are based on the patient's psychosocial assessment and the patient/family's needs and acceptance of these services. Patient #14: Clinical record includes communication note 5/3/23 12:06 PM "SN reported that the patient's family is requesting MSW visit regarding possible placement for patient due to progressive decline in Azheimer's disease. The patient continues to need maximum assistance with ADLs and continues to be aggressive and increase anxiousness. MSW aware and will visit family. Physician and IDT members updated." However, there is no evidence of follow up visit by MSW or other documentation to support follow up. No mention in IDG POC or otherwise.

Upon patient client record review, 3 of 14 (Patient #3, 8, 10) 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 #3: 2/7/24 IDG note- the RN entry says wound supplies ordered 1/31/24. Also noted 1/31/24 supply orders for 4x4 gauze, normal saline and surgical tape. There is no documented evidence of wound for this patient. Patient #8: Benefit Period #2 10/31/23 Recertification assessment/summary refers to patient as 64 year old Caucasian female . Benefit period #3 Recertification assessment/summary also refers to patient as 64 years old. In fact, patient is 93 year old male with birth year of 1930. Patient #10: 8/27/23 Recertification summary includes that facility staff made aware of current medications. The patient's location of care was private home residence according to record and staff interview.

Upon client record review, 1 of 14 (Patient #1) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed. Patient #1: There is no documented evidence that the written policies and procedures for managing controlled drugs was provided and discussed.