Every finding on record at Care Companion Hospice Inc

Upon patient record review, 5 of 10 (Patient #2,#5,#7,#8,#9) 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: Medication profile dated 1/28/2024 included Salon Pas pain relief topical patch 1 Q 8-12 hrs. for pain if not relieved add one more, should not be for more than 3 days in a row. No evidence of an area to apply patch. Corrected on site. Patient #5: Medication profile dated 4/18/2024 included Toradol 50mg 1 PO Q 6 hrs. PRN pain moderate or severe. Dated 4/5/2024 included Roxanol 20mg/ml give 0.25ml=5mg PO/SL Q 4Hrs. PRN pain or SOB. No evidence of parameters to give Roxanol. Patient #7: Medication profile dated 2/10/2024 included Hydrocortisone 1% cream topical apply 1 app. as needed to affected area. No evidence of area to apply. Patient #8: Medication profile dated 9/30/2023 include Acetaminophen 325 mg 2 tabs PO Q 6 Hrs. PRN mild pain or fever. Dated 9/30/2023 included Morphine Sulfate 20mg/ml 0.25ml=5mg PO/SL Q 4 Hrs. PRN pain or SOB. No evidence of parameters for when to give Morphine. Patient #9: Medication profile dated 12/10/2023 include Acetaminophen 325 mg 2 tabs PO Q 6 Hrs. PRN mild pain or fever. Dated 12/10//2023 included Morphine Sulfate 20mg/ml 0.25ml=5mg PO/SL Q 4 Hrs. PRN pain or SOB. No evidence of parameters for when to give Morphine for pain.

Upon patient record review, 1 of 10 (Patient #3) 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 #3: SN comprehensive visits occurred on SOC 8/26/2023 and 9/11/2023 (16 days apart).

Upon patient record review, 7 of 10 (Patient #1,#2,#3,#4,#6,#9,#10) 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 #1: Psychosocial assessment at SOC identified pt. "not open to funeral planning", no evidence on POC for problem/intervention/goals for funeral planning. Corrected on site.. Patient #2: Psychosocial assessment at SOC identified pt. "not ready to discuss funeral arrangements", no evidence on POC for problem/intervention/goals for funeral planning. Corrected on site. Patient #3: Psychosocial assessment at SOC identified pt. "do not have funeral plans in place", no evidence on POC for problem/intervention/goals for funeral planning. SN on SOC assessment identified need for aspiration precautions, no evidence on POC of problem/interventions/goals for risk of aspiration. Patient #4: Psychosocial assessment at SOC identified pt. "no final arrangements", no evidence on POC for problem/intervention/goals for funeral planning. SN on SOC identified pt. on Eliquis, and Braden score of 13 moderate risk for pressure ulcers. No evidence on POC for problems/interventions/goals for risk of bleeding or skin integrity/risk of pressure ulcers. Patient #6: Psychosocial assessment at SOC identified pt. "no funeral plans, pt. permission to phone son to discuss", no evidence on POC for problem/intervention/goals for funeral planning. Patient is on O2, no evidence on POC for problem/interventions/goals for O2 therapy. Patient #9: Psychosocial assessment at SOC identified pt. "no burial plans", no evidence on POC for problem/intervention/goals for funeral planning. Patient is on O2, no evidence on POC for problem/interventions/goals for O2 therapy. Patient #10: Psychosocial assessment at SOC identified pt. "not open to funeral planning", no evidence on POC for problem/intervention/goals for funeral planning.

Upon patient record review, 2 of 10 (Patient #1, #3) 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 #1: MSW and SC visits at SOC for 1x then PRN. No evidence of specificity to visit frequency. Corrected on site. Patient #3: Order dated 4/17/2024 included MSW with no visit frequency. Corrected on site.

Upon patient record review, 5 of 10 (Patient #2,#5,#7,#8,#9) 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: Order dated 1/28/2024 included Salon Pas pain relief topical patch 1 Q 8-12 hrs. for pain if not relieved add one more, should not be for more than 3 days in a row. No evidence of an area to apply patch. Corrected on site. Patient #5: Order dated 4/18/2024 included Toradol 50mg 1 PO Q 6 hrs. PRN pain moderate or severe. Order dated 4/5/2024 included Roxanol 20mg/ml give 0.25ml=5mg PO/SL Q 4Hrs. PRN pain or SOB. No evidence of parameters to give Roxanol for pain.. Patient #7: Order dated 2/10/2024 included Hydrocortisone 1% cream topical apply 1 app. as needed to affected area. No evidence of area to apply. Patient #8: Order dated 9/30/2023 include Acetaminophen 325 mg 2 tabs PO Q 6 Hrs. PRN mild pain or fever. Order dated 9/30/2023 included Morphine Sulfate 20mg/ml 0.25ml=5mg PO/SL Q 4 Hrs. PRN pain or SOB. No evidence of parameters for when to give Morphine for pain. Patient #9: Order dated 12/10/2023 include Acetaminophen 325 mg 2 tabs PO Q 6 Hrs. PRN mild pain or fever. Order dated 12/10//2023 included Morphine Sulfate 20mg/ml 0.25ml=5mg PO/SL Q 4 Hrs. PRN pain or SOB. No evidence of parameters for when to give Morphine for pain.

Upon client record review, 2 of 10 (Patient #3, #7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #3: Order dated 8/26/2023 included MSW initial and every certification. Visits were completed 9/27/2023, 12/20/2023, 1/20/2024, and 3/17/2024- not related to recertification and without orders. Patient #7: Order dated 2/5/2024 include SN 1x week and 3 PRN. Week of 3/25/2024 no evidence of a SN visit or missed visit.

Upon patient record review 1 of 10 (Patient #8) 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 #8: Order dated 1/23/2024 included HHA 2x week. Week of 2/4/22024 visit occurred on 2/6/2024,there was no evidence for a second visit or missed visit.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. The annual report for 2023 included 0% for volunteer hours.

Upon personnel record review, 1 of 11 (Personnel #8 ) did not have evidence the hospice employees and contract employees have received orientation on the hospice philosophy. Personnel #8: No evidence of orientation to the hospice philosophy.

Upon personnel record review, 1 of 11 (Personnel # 8) did not have evidence that the hospice employees have received orientation on their specific job requirements. Personnel #8: No evidence of orientation to specific job requirements.

There is no evidence that all patient records are retained for a minimum of six years from the date of the most recent discharge or the death of the patient, unless state law stipulates a longer period of time. Agency has access to 10 records, beginning 7/2/2022. There were 5 records from original ACHC survey in June of 2021, Agency does not have these records "consultant took them with him"

Upon client record review, 2 of 10 (Patient #5,#7) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patient #5: There is no evidence in the patient record that a discharge summary and a copy of patient record (if requested) was sent to that attending physician. Patient #7: There is no evidence in the patient record that a discharge summary and a copy of patient record (if requested) was sent to that attending physician.

Upon client record review, 1 of 10 (Patient #2) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed. Patient #2: No evidence of documentation in record that the written policies and procedures for managing controlled drugs was provided and discussed.