Every finding on record at Bright Sky Hospice Care, Inc.

Upon patient record review, 1 of 14 (Patient # 1) 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 # 1: Patient's medication list stated Acetaminophen 500 mg tabs oral, patient's at home medications included only Acetaminophen 650 mg tabs, oral. In addition, the patient's medication list stated Ibuprofen 600 mg, 1 tab oral as needed for pain. The patient did not have this medication among the home medications.

Upon patient record review, 5 of 14 (Patients # 2, 4, 6, 8, 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 current aide plan of care dated 10/7/25 stated nail care as needed. Patient # 4: The current aide plan of care dated 10/22/25 stated nail care and shave as needed. Patient # 6: The current aide plan of care dated 10/5/25 stated nail care and shave as needed. Patient # 8: The current aide plan of care dated 10/9/25 stated nails as needed. Patient # 10: The current aide plan of care dated 7/1/25 stated shampoo weekly, nail care, and shave as needed.

Upon inpatient contract review, 1 of 4 (Arrowhead CHLF) did not have evidence that the hospice retains responsibility for ensuring that the training of personnel who will be providing the patient's care in the inpatient facility has been provided and that a description of the training and the names of those giving the training are documented. The Arrowhead CHLF contract for SNF/GIP/Respite did not contain evidence that the inpatient facility personnel were provided training, and documentation of the names of the trainers.

Upon SNF/NF contract review, 1 of 4 (Arrowhead CLHF) did not have a provision stating that the hospice reports all alleged violations involving mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property by anyone unrelated to the hospice to the SNF/NF administrator within 24 hours of the hospice becoming aware of the alleged violation. The Arrowhead CLHF contract for SNF/GIP/Respite care, did not contain evidence of a provision stating the hospice will report all reported/alleged violations of mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of an unknown source, misappropriation of patient property by anyone unrelated to the hospice to the SNF administrator within 24 hours of the hospice becoming aware of the alleged violation.

Upon patient record review, 3 of 11 (Patient #1, #2 and #3) 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: This patient had a walker and shower chair. These items were not included on the Plan of Care. Patient #2: This patient had an oxygen concentrator, O2 tanks and nebulizer. These items were not included on the Plan of Care. Patient #3: This patient had a walker, cane, wheelchair, BSC, Hospital Bed with Side Rails, Oxygen Concentrator, O2 tanks and raised toilet seat. These items were not included on the Plan of Care.

Upon client record review, 4 of 11 (Patients #1, #2, #3 and #4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1: The POC listed the SC visit frequency of, 1-2Xs per month. There were no visits for August 2022. Patient #2: The POC listed the MSW visit frequency of, 1X per month. There were no visits for April 2022. Patient #3: The POC listed the MSW and SC visit frequency of, 1X per month. There were no visits for MSW in August 2022. There were no visits for SC in June 2022. Patient #4: The POC listed the MSW visit frequency of, 1X per month. There were no visits for June 2022.

Upon patient record review 3 of 5 applicable (Patients #1, #2 and #10) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group Patient #1: Hospice aide services ordered for twice weekly. During the week of 8-21-22, the aide made only one visit, on 8-27-22; no missed visits were indicated in EMR. Patient #2: Hospice aide services ordered for one-time weekly on 3-22-22. There were no visits made through end date order of 6-20-22; no missed visits indicated in EMR. Patient #10: Hospice aide services ordered for twice weekly. During the first benefit week, the aide only made one visit, on 8-5-22; no missed visits were indicated in EMR.

Upon patient client record review, 6 of 11 (Patients #2, #3, #4, #6, #9 and #10) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patients #2, #3, #6, #9 and #10: The Beneficiary elected to receive the "Patient Notification of Hospice Non Covered Items" addendum at SOC. There was no evidence in the patient record that the Hospice furnished this addendum within 5 days as requested at SOC. Patient #4: The patient Start of Care (SOC) was 5-7-22. The Election benefit indicated 4-7-22 as SOC. The agency did not have correct SOC in space provided on Election Statement.