Every finding on record at Calmedix Hospice, Inc.

Upon home visits and patient record review, 2 of 14 (Patient #2,4) 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 #2 resides in a Board and Care home and was a home visit. The facility MAR did not "mirror" the medications on the HSP POC and med profile dated 8/21/24. The facility MAR included the following meds that were not on the HSP POC: Triamcinolone 0.1% ointment, apply to affected area topically after each incontinence. Diclofenac Sodium apply topically to affected area 3x daily as needed for pain. The HSP POC included the following meds that were not on the facility MAR: Triple antibiotic ointment apply topically daily and as needed and prn for soiled or dislodged dressing . (proper wound care orders in instruction), Oxygen 2L/min via N/C as needed for shortness of breath. The following medications on the HSP POC had discrepancies in the dose &/or frequency on the facility MAR as follows: Ipratropium Bromide/Albuterol sulfate 0.5mg-3mg/3ml for inhalation, one vial via nebulizer every 4 hours as needed for wheezing. The facility order stated every 6 hours as needed. Lorazepam 2mg/ml give 0.25ml (0.5mg) Sublingual every 4 hours as needed for anxiety. Facility order stated every 6 hours as needed. Morphine Sulfate 20mg/ml give 0.25ml (5mg) every 2 hours as needed for pain or dyspnea. Facility order stated every 4 hours as needed. Ondansetron 8mg ODT every 6 hours as needed for N/V. Facility order stated 4mg . Amlodipine Besylate 5mg tablet oral once daily. Facility order states 10mg daily. Docusate Sodium 50mg/5ml give 5ml oral twice daily. Facility order states 10ml twice daily. corrected on site Patient #4 resides in a Board and care home and was a home visit. Facility MAR did not "mirror" the medications on the HSP POC and med profile. HSP POC included the following meds that were not on the facility MAR: Ipratropium Bromide/ Albuterol Sulfate0.5mg-3mg/3ml solution for inhalation 1 vial per nebulizer every 4 hours as needed for wheezing. The following medications on the HSP POC had discrepancies in the dose &/or frequency on the facility MAR as follows: Lactulose solution 10G/15ml give 15ml oral once daily as needed for constipation. Facility order states to give 30ml oral twice daily as needed. Lorazepam 2mg/ml give 0.25ml (0.5mg) Sublingual every 4 hours as needed for anxiety. Facility order stated take 0.5mg (0.25mg) every 2 hours as needed. Morphine Sulfate 20mg/ml give 0.25ml (5mg) every 4 hours as needed for pain or dyspnea. Facility order stated every 2 hours as needed. Ondansetron 8mg ODT every 6 hours as needed for N/V. Facility order stated 4mg every 4 hours as needed. Acetaminophen Suppository 650mg Rectal every 6 hours as needed for pain or fever > 100 degrees F. Facility order stated every 4 hours as needed. corrected on site

Upon home visits and patient record review, 2 of 14 (Patient #2,4) 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 #2 resides in a Board and Care home and was a home visit. The facility MAR did not "mirror" the medications on the HSP POC and med profile dated 8/21/24. The facility MAR included the following meds that were not on the HSP POC: Triamcinolone 0.1% ointment, apply to affected area topically after each incontinence. Diclofenac Sodium apply topically to affected area 3x daily as needed for pain. The HSP POC included the following meds that were not on the facility MAR: Triple antibiotic ointment apply topically daily and as needed and prn for soiled or dislodged dressing . (proper wound care orders in instruction), Oxygen 2L/min via N/C as needed for shortness of breath. The following medications on the HSP POC had discrepancies in the dose &/or frequency on the facility MAR as follows: Ipratropium Bromide/Albuterol sulfate 0.5mg-3mg/3ml for inhalation, one vial via nebulizer every 4 hours as needed for wheezing. The facility order stated every 6 hours as needed. Lorazepam 2mg/ml give 0.25ml (0.5mg) Sublingual every 4 hours as needed for anxiety. Facility order stated every 6 hours as needed. Morphine Sulfate 20mg/ml give 0.25ml (5mg) every 2 hours as needed for pain or dyspnea. Facility order stated every 4 hours as needed. Ondansetron 8mg ODT every 6 hours as needed for N/V. Facility order stated 4mg . Amlodipine Besylate 5mg tablet oral once daily. Facility order states 10mg daily. Docusate Sodium 50mg/5ml give 5ml oral twice daily. Facility order states 10ml twice daily. corrected on site Patient #4 resides in a Board and care home and was a home visit. Facility MAR did not "mirror" the medications on the HSP POC and med profile. HSP POC included the following meds that were not on the facility MAR: Ipratropium Bromide/ Albuterol Sulfate0.5mg-3mg/3ml solution for inhalation 1 vial per nebulizer every 4 hours as needed for wheezing. The following medications on the HSP POC had discrepancies in the dose &/or frequency on the facility MAR as follows: Lactulose solution 10G/15ml give 15ml oral once daily as needed for constipation. Facility order states to give 30ml oral twice daily as needed. Lorazepam 2mg/ml give 0.25ml (0.5mg) Sublingual every 4 hours as needed for anxiety. Facility order stated take 0.5mg (0.25mg) every 2 hours as needed. Morphine Sulfate 20mg/ml give 0.25ml (5mg) every 4 hours as needed for pain or dyspnea. Facility order stated every 2 hours as needed. Ondansetron 8mg ODT every 6 hours as needed for N/V. Facility order stated 4mg every 4 hours as needed. Acetaminophen Suppository 650mg Rectal every 6 hours as needed for pain or fever > 100 degrees F. Facility order stated every 4 hours as needed. corrected on site

Upon personnel record review, 1 of 13 (Personnel #5) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- (C) Shampoo, sink, tub, and bed The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel #5 only demonstrated "Shampoo". The list did not include "Shampoo, sink,tub,bed.