Every finding on record at C-Port LLC, Series B-Hospice

Upon patient record review, 4 of 19 (Patient #4,5,6,8) 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 #4: Order dated 5/29/24 include wound care: Using aseptic technique....cleanse with NS and gauze and pat dry... There is no NS reflected on the medication profile. Patient #5: POC reflects Tessalon Pearles 100 mg capsule- take 1 tab po 3xday as needed- No prn reason listed on the medication profile. Patient #6: 5/5/22 order reflects Ondansetron 4 mg dissolving tab 1 tab po q8 hrs prn- No prn reason listed on the medication profile Patient #8: 7/15/24 Order written for Bacitracin 500 mg topically to right index finger BID- as of review, there is no wound to the patient's right index finger. The medication should be discontinued on the medication profile.

Upon patient record review, 3 of 19 (Patient #5,6,8) 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 medications and treatments. Patient #5: Order does not reflect prn reason for Tessalon Pearles 100 mg capsule take 1 tab po 3xday as needed. Patient #6: Order does not reflect prn reason for Ondansetron 4 mg dis. tab take 1 tab po q 8 hrs prn. Patient #8: Order dated 7/15/24 Bacitracin 500 topically to R index finger bid- There is currently no wound to the patient's right index finger and the Bacitracin was not discontinued as of 10/9/24

Upon observation, there was no evidence the hospice investigates all adverse events, incidents, accidents. Patient #5: 10/3/24 SNV states family reports to SN that 12 Hydrocodone are missing from patient's medication. No evidence of incident report found.

Upon patient record review, 2 of 19 (Patient #5,6) 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: Aide Care Plan dated 8/5/24 denotes Purewick checked. It is not clear if the aide or family maintains. Patient #6: Aide Care Plan dated 9/11/24 assigned oral care "as allowed" by pt, clean nails and file them (without frequency listed).

Upon patient record review 1 of 19 (Patient #5) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient #5: The SNV dated 10/3/24 the SN noted that the aide was performing the tasks as assigned but in reality the aide had not performed any services 10/1-10/3/24 as patient refused all tasks/services and RN had not provided oversight of aide services.

Upon patient record review, 4 of 13 (Patient #2, #7, #10, #11) 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 #2, 7, 10, 11: There was no evidence in the record of a Spiritual comprehensive assessment.

Upon patient record review, 3 of 13 (Patient #1. #2, #3) 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. Patient #1: The medication profile included Voltaren Arthritis Pain 1% topical gel - apply BID. No location listed. Corrected on site. Patient #2: The medication profile included Lasix 40mg po daily prn. No indication given. Corrected on site. Patient #3: The medication profile included Travoprost 0.004% eye drops - instill one drop in affected eye daily. No indication of which eye is affected. The medical record included information that the patient required oxygen, oxygen was not listed on the medication profile. The medication profile included potassium chloride ER 20meq - take one tablet by mouth as needed when PRN Lasix is given. PRN Lasix was not listed on the medication profile. Corrected on site.

Upon patient record review, 1 of 13 (Patient #9) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #9: The patient was admitted on 10/11/21, the bereavement assessment was completed on 10/18/21.

Upon patient record review, 3 of 13 (Patient #1, #2, #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 medications and treatments. Patient #1: Order dated 7/26/2021 for Voltaren Arthritis Pain 1% topical gel - apply BID. No location listed. Corrected on site Patient #2: Order dated 10/2/2021 for Lasix 40mg po daily prn. No indication given. Corrected on site Patient #3: Plan of care dated 8/17/2021 included an order for Travoprost 0.004% eye drops - instill one drop in affected eye daily. No indication of which eye is affected. The initial plan of care listed oxygen concentrator as DME. No evidence of an order for oxygen. Order dated 9/8/2021 for potassium chloride ER 20meq - take one tablet by mouth as needed when PRN Lasix is given. No evidence of an order for PRN Lasix. Corrected on site

Upon patient record review, 9 of 13 (Patient #1, #2, #3, #4, #7, #9, #10, #11, #12) 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 initial Plan of Care dated 7/24/21 included a SW frequency of 2 times every 4 weeks. SW visits documented 7/27, 8/26 and 9/27/21. The Plan of Care also included SN 2 times per week. SN documented 1 visit the weeks of 8/8, 8/15, 8/22 and 8/29/21. There was an order dated 9/10/21 to decrease the SN frequency to 1 time per week. SN documented 2 visits the weeks of 10/3 and 10/17/21. Patient #2: The initial Plan of Care dated 8/1/21 included a SW frequency of 2 times every 4 weeks. SW visits documented 8/3, 9/2 and 9/28/21. SN frequency of 7 times a week. The week of 8/1/21: 3 SN visits documented, week of 8/14/21: 2 SN visits documented. SC frequency of 2 times every 4 weeks. Missed visits documented on 8/3, 8/17 and 8/26/21. Patient #3: The initial Plan of Care dated 8/17/21 included a SN frequency of 2 times a week. SN documented 1 visit the weeks of 8/17, 8/23, 9/19, 10/3 and 10/10/21. Patient #4: The initial Plan of Care dated 8/6/21 included a SW frequency of 1 time every 4 weeks. SW visits documented on 8/10, 9/21 and 10/13/21. There was more than 4 weeks between 8/10 and 9/21 visits. SN frequency of 2 times per week. There were no visits documented by SN the week of 8/15/21 and only 1 visit documented the week of 8/29/21. On 9/23/21, there was an order to increase the SN frequency to 3 times per week. Week of 10/21/2021, only 2 SN visits were documented. Patient #7: The initial Plan of care dated 9/12/21 included a SC frequency of 1 time every 4 weeks. Week of 9/19/21 2 SN visits were documented. Patient #9: Initial plan of care included a SN frequency of 3 times a week. The week of 10/11/2021, only 2 SN visits were documented. The SN admission note referenced a Stage II pressure wound to the spine. SN documentation included wound care being provided at each visit. There was no evidence of an order for wound care. Patient #10: Order dated 9/14/21 included SN frequency of 2 times a week. There was only evidence of 1 SN visit documented the weeks of 9/19 and 9/26/21.

Upon patient record review, 1 of 13 (Patient #1) 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 #1: Patient admitted on 7/26/2021. The IDT note dated 10/14/2021 stated that funeral arrangements were needed. No evidence that the SW provided end of life and funeral arrangement assistance.

Upon patient record review, 2 of 10 applicable (Patient #9, #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 #9, 10: The patient had aide services ordered 5 times a week effective 10/11/2021. No evidence of an aide care plan in the record.

Upon patient record review, 9 of 10 applicable (Patient #1, #2, #3, #4, #6, #9, #10, #11, #12) did not have evidence in the patient record that a hospice aide provides services that are ordered by the interdisciplinary group and included in the plan of care Patient #1: Aide ordered 5 times a week effective 8/2/21. Evidence of 4 aide visits the week of 8/16, 9/5, 9/27 and 10/4/21. Aide care plan included bed bath on Monday, Wednesday and Friday. On Thursday 10/14, 10/19 and 10/21/21 aide documented a bed bath. The week of 10/11 and 10/18/21 aide documented a bed bath at every visit. Patient #2: Aide ordered 4 times a week effective 8/1/21. Evidence of 5 aide visits the week of 8/1/21, 6 visits the week of 8/22/21 and 2 visits the week of 8/29/21. Patient #3: Aide ordered 5 times a week effective 8/25/21. Evidence of aide visit on 8/24/21 prior to order. Evidence of 4 aide visits the week of 8/25/21. On 9/17/21 there was an order to discontinue aide. The aide continued to perform visits each week. The aide care plan included a shower every Monday, Wednesday and Friday and a bed bath on Tuesday and Thursday. On Tuesday, 10/5, 10/12 and 10/19/21 the aide documented giving a shower. Patient #4: Aide ordered 5 times a week effective 8/9/21. No evidence of aide visits provided the week of 8/9 - 8/15/21. Evidence of 2 aide visits documented each day for the following: 8/18 , 8/20 , 8/23 , 8/25 , 8/27 , 8/29, 8/30, 9/1/21. Order to discontinue aide 9/8/21, then a resume order dated 9/23/21 for 5 times per week. Aide visit was performed on 9/22 prior to the order. Evidence of 4 aide visits the week of 10/17/21. Aide visit note dated 8/16/21 was blank, with no interventions documented. Patient #6: Aide ordered 5 times a week effective 9/6/21. Evidence of 4 aide visits the week of 10/3/21 and 6 visits the week of 10/10/21. The aide care plan included shower on Mondays and Fridays and a bed bath on Tuesday, Wednesday and Thursday. Aide visit note dated 10/5/21 (Tuesday) documented a shower was given. Aide visit notes dated 10/12, 10/14 and 10/21/21 included documentation of both a bed bath and shower. Patient #9: Aide ordered 5 times a week effective 10/11/21. Evidence of 4 aide visits the week of 10/11 and 2 visits the week of 10/24/21. Aide visit notes dated 10/12, 10/13, 10/14, 10/15, 10/18, 10/19, 10/20, 10/21 and 10/22/21 included a start and finish time, but no other content was completed. No evidence to support any assigned tasks were performed. Patient #10: Aide provided care to the patient on 10/13, 10/19 and 10/21/21. No evidence of an order for aide services. Patient #11:Aide ordered 5 times a week effective 5/7/21. No evidence visits were provided week of 5/7/21, only 4 visits documented weeks of 5/9, 6/13, 7/4 and 7/18/21. The aide care plan included bath and shampoo at every visit. The aide visit note dated 7/9, 7/13 and 7/14/21 were left blank for bath and shampoo. Patient #12: The aide care plan included shave and catheter care at each visit. The aide visit noted dated 7/22 and 7/23 were left blank for shave and catheter care.

Upon patient record review, 2 of 13 (Patient #1, #7) 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 #1: The Election of Benefits form had both "I do" and "I do not" checked in the section pertaining to Advance Directives, Power of Attorney and DNR. Patient #7: The Election of Benefits form in the section pertaining to the Right to choose an attending MD; an MD name had been written in and crossed out with a single line. The name of the hospice medical director was written to the side. No initials or date were evident to appropriately notate the error and correction. The record contained aide visit notes for 10/13, 10/14, 10/15, 10/18, 10/19 and 10/20/21. There was no evidence of an order or an identified need for aide services. Leadership confirmed that the aide documented on the wrong patient.