Every finding on record at Blue Pacific Hospice Care, Inc

Upon client record review, 8 of 11 (Patient # 1, 2, 3, 5, 6, 7, 8, 11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1, frequency orders state RN 1time every 2 weeks. LVN made weekly visits without order stating LVN or skilled nurse. Patient #2, frequency orders state RN every 2 weeks. RN visits 11/22/21, 12/6/21, 12/22/21, 1/3/22, 1/17/22, 1/31/22, 2/14/22, 2/28/22. Time between 12/6/21 and 12/22/21 is 16 days and not 14 days. MSW frequency order for 1x month There was no evidence of visits. MSW documents decline in visit without discontinue of MSW order Patient #3, frequency order for LVN 1x/week. There was no LVN visit made in the first week, Patient #5, frequency order for LVN 1x/week There was no LVN visit made in the first week. RN frequency 1x every 2 weeks. Visits made 2/15/22, 2/22/22, 3/1/22, 3/8/22. RN visits made weekly instead of every 2 weeks. Patient #6, frequency order for RN 1x/week. LVN visits 2/7/22, 2/14/22, 2/28/22, 3/7/22 without frequency order for LVN. Patient #7, frequency order for LVN 1x/week. There was no LVN visit the first week. SC frequency 1x/month. There was no evidence of a visit for 2nd month. Patient #8, frequency order for MSW 1x/month. There was no evidence of visits made. documented patient declined visit with no discontinued order for MSW. Patient #11, frequency order for MSW 1x/2weeks. There were no visits made. There was documented patient declined visit with no discontinued order for MSW. RN frequency order 1x every 2 weeks. RN visits 12.22.21, 12.27.21, 1.3.22, 1.13.22. Visits made weekly.

Upon patient record review, 2 of 5 applicable (Patient #5,7) 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 #5 has vital signs direction on aide care plan without parameters to report to RN. Patient #7 has vital signs direction on aide care plan without parameters to report to RN.

Upon patient record review 3 of 5 applicable (Patient #2,5,11) 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, Aide frequency 1x/every 2 weeks, visits completed 2x/week. Patient #5, Aide frequency 1x every 2 weeks, visits completed on 2/17/22, and then again the following week. And 2x/week for each week for weeks 2-4 on 2/21/22, 2/24/22, 2/28/22, 3/4/22, 3/7/22, 3/11/22. Aide care plan states to brush teeth, on 3/11/22 task was not completed. Patient #11, Aide frequency 1x/week, no visits completed by aide, no order to d/c aide visits.