Every finding on record at Care and Support Hospice Inc.

Upon patient record review, 1 of 6 (Patient #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. 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 #3-SN visit on 2/10/25 states patient is taking an antibiotic for URI and on 2/24/25 the antibiotic was completed, no evidence of medication on medication profile.

Upon patient record review, 2 of 6 (Patient #4,5) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #4-Orders dated 2/7/25 for MSW and SC visits 1x/month, no evidence of either discipline visiting since eval on 2/10/25. Patient #5-Orders dated for 3/7/25 to change MSW and SC visits to 1x/month no evidence of visit since MSW on 2/2/25 and SC on 2/14/25.

Upon patient record review, 2 of 6 (Patient #1,#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-SN visit on 4/2/25 stated that patient reported Imodium was ordered, no evidence of orders from MD. Patient #3-SN visit on 2/10/25 states patient is taking an antibiotic for URI and on 2/24/25 the antibiotic was completed, no evidence of medication orders.

Upon patient record review 2 of 6 (Patient #2, #4) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient #2-SN visit on 3/25/25 stated that patient requested anti-fungal cream, no evidence of collaboration or orders from MD. Patient #4-MSW visit on 2/10/25 states son requested information on Advance Directives and MSW collaborated with "hospice team" to provide to the son via e-mail, no evidence that the son was provided the information from any discipline.

Upon patient client record review, 1 of 6 (Patient #1) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #1-Elected to receive "Notice of non-covered items" upon admission, no evidence that this was provided to patient.

Upon patient record review, 14 of 14 (Patient #1,2,3,4,5,6,7,8,9,10,11,12,13, and 14) did not have evidence that the hospice obtained the patient's or representative's signature confirming that they received a copy of the Patient's Rights and Responsibilities.

Upon patient record review 1 of 14 (Patient #5) 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 5 was admitted to service on 6/12/23. SC did not complete his portion of the comprehensive assessment until 6/19/23.

Upon patient record review, 14 of 14 (Patient #1,2,3,4,5,6,7,8,9,10,11,12,13,14) did not have evidence 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 did not have a complete medication profile. Upon home visit, a bottle of OTC Ibuprofen gel caps were visible to the surveyor and LVN completing the home visit. Upon interview with patient and caregiver, it was confirmed that patient had been taking this medication regularly for pain management. No evidence in record of this medication on the medication profile. Patients #1-14 all had oxygen orders written as follows: "Oxygen 2-5 liters prn shortness of breath- give 2 liters for mild, 3 liters for moderate and 4-5 liters for severe." No route of administration is listed. These orders are not present on the medication profile but are listed under treatments.

Upon patient record review, 1 of 14 (Patient #6) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual's attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient's progress toward desired outcomes • Reassessment of the patient's response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient #6 had ordered RN frequency of "1 every 2 weeks and 3 prn symptom management". RN completed visit on 6/26/23 to complete aide supervisory visit but did not complete full assessment, last updated comprehensive assessment was completed on 6/12/23. No evidnec eof an updated comprehensive assessment within 15 days of 6/12/23.

Upon patient record review, 1 of 14 (Patient #3) did not have evidence that each patient and family received education and training provided as appropriate to their responsibilities for the care and services identified in the plan of care. Patient #3 received new treatment orders for use of nebulized medication following a PRN visit on 5/12/23 by LVN. No evidence that patient and family received education and training on the safe use of this.

Upon patient record review, 1 of 14 (Patient #6) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #6 was admitted to service with an indwelling Foley catheter in place. No evidence that the hospice developed a care plan that addressed this genitourinary problem.

Upon patient record review, 1 of 14 (Patient #5) 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 #5 has ordered LVN and Volunteer frequency of " as needed". No evidence of complete order for scope and frequency.

Upon patient record review, 14 of 14 (Patient #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14) 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. Patients #1-14 all had oxygen orders written as follows: "Oxygen 2-5 liters prn shortness of breath- give 2 liters for mild, 3 liters for moderate and 4-5 liters for severe." No route of administration is listed.

Upon patient record review, 2 of 14 (Patient #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 equipment and supply needs. Patient #2 had an APP mattress pad in place during surveyor home visit. No evidence in record of this DME. Patient #3 had a nebulizer in place during surveyor home visit. No evidence in record of this DME.

Upon patient record review, 1 of 14 (Patient #2) did not have evidence that the IDG documents the sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement. Patient #2 requested podiatry services upon admission on 10/18/22, as documented in communication note in medical record written by hospice team member. The IDG did not address this request in any IDG meeting notes and service is still pending.

Upon patient record review 2 of 14 (Patient #1 and 3) 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 #1 Aide has ordered frequency order of 2x week but did not provide 2 visits during week of 5/23/23. Patient #3 has ordered aide frequency of 2x week but did not provide 2 visits during week of admission 4/28/23.

Upon patient client record review, 4 of 14 (Patient #1,4,6,7) 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 record review did not have evidence of plan of care and signatures on IDG meeting for 5/23/23, 6/12/23 and 6/26/23 by SC and MSW. Patient #4 RN credentials were not included in the record for this same consent document. Patient #6 record review did not have evidence of hospice medical director signature for meeting of 6/26/23. Patient #7 consents were signed by RN who did not include her credentials.