Every finding on record at Care Must Hospice

Upon patient record review, 8 of 19 (Patient #2, 3, 4, 6, 7, 9, 12, 14) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient's 2, 3, 4, 6, 7, 9, 12, 14, Physician choice is blank for Consent for Hospice Election Statement and not found in any part of the medical record.

Upon patient record review, 3 of 19 (Patient #1, 3, 8) 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: Developed symptomatic tooth infection 7/7/23 with subsequent order for antibiotic. The ordered antibiotic was added to med profile, but the POC/IDG problem list / goals were not updated to reflect symptoms/interventions and goals r/t infection. Patient #3: 7/10/23 SN Visit note: Patient had constipation with no BM since 6/22 >3 days. Education provided and medication initiated. IDG Care Plan problems/interventions/goals not updated to reflect updated assessment. Patient #8: 6/22/23 Episode of constipation with new orders for Miralax and Senna daily. There was no update to POC problems/interventions/ goals to reflect updated assessment.

Upon patient record review, 4 of 19 (Patient #1, 6, 10, 13) 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: Admitted 6/13/23 with POC MSW frequency "as needed" Patient #6: Admitted 6/5/23. IDG POC frequency for MSW_/MONTH and 1 prn. (frequency has blank) Patient #10: MSW 1 1 prn. Patient #13: IDG POC frequency for MSW_/MONTH and 1 prn. (frequency has blank)

Upon patient record review, 2 of 19 (Patient #11, 12) 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 #11: 1/13/23 SOC order for Foley catheter#18 fr (no balloon size) to gravity drainage change monthly and prn. There is no balloon size specified and there is no qualified for changing catheter. Patient #12: 6/18/23 order for Foley catheter 16 fr 10 cc to gravity. Change monthly and prn. There is no qualifier for prn cath change.

Upon patient record review, 6 of 19 (Patient #4, 5, 7, 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 equipment and supply needs. Patient #4: SOC 6/13/23. "needs walker" per initial comprehensive assessment. No order. Patient #5: SOC 6/9/23. "needs hospital bed with full rails" per initial comprehensive assessment. No order Patient #7: SOC 6/1/23 "needs walker" Patient #12: SOC 6/18/23 " Needs Oxygen concentrator and E-tank and suction. No order or follow up identified. Not included in POC. Patient #13. SOC 3/30/23. Needs wheel chair, shower chair, otb table. No order or follow up documented. Not included in POC. Patient #14: SOC 4-1-23. Needs walker, shower, chair, OTB, suction, oxygen concentrator and E-tank, suction. No order or follow up identified. Not included on POC. Prior to end of survey agency provided Hospice Source order form to demonstrate equipment prescribed, ordered and obtained prior to end of survey. Also obtained/documented verbal orders received prior to end of survey.

Upon personnel record review, 1 of 12 (Personnel # 8) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel #8: There is no documented skills competency on file at time of survey.

Upon patient client record review, 13 of 19 (Patient # 1, 2, 3, 4, 6, 7, 8, 9, 10, 11, 12, 13, 14) 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 Patients 1, 2, 3, 4, 6, 7, 8, 9, 10, 11, 12, 13, Effective date is blank for Consent for Hospice Election Statement Patient's 2, 3, 4, 6, 7, 9. 12, 14, Physician choice is blank for Consent for Hospice Election Statement Agency presented Policy 4-023.1 Hospice Election Statement that includes Patients who are eligible for hospice services under Medicare Part A or Medicaid and have met all other criteria will be required to sign a hospice election statement. The date Hospice Election Statement is signed will be the official service start date. If the start date will be different the signed date, then the actual start date needed to be put under the section (actual start date).

Upon patient client record review, 4 of 19 (Patient #1, 3, 4, 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 #1:7/7/23 SN Visit note: "Patient is complaining of tooth pain and when I checked his chick is swelling his toes right infected empty was notified with new order for antibiotics." Interview reveals nurse uses voice dictation and will be more diligent to proofread. Clarification note added to record. Patient #3: SN notes 7/10/23 and 7/14/23 documented patient's last BM was 6/22/23. However, 7/7/23 note documented patient's last BM 7/1/23. Clarification note added to record. Patient #4: Patient information sheet in EMR identified primary language to be English. However, the H/P uploaded in images, referenced that patient using services of language interpreter to communicate. Staff verified primary language is actually Vietnamese. Patient information sheet in EMR notes patient age of 62 years. 6/15/23 IDG Note referred to patient's age as 62 years. RN initial comprehensive assessment narrative and CTI narrative identify patient's age as 84 years old. Staff interview actual age is 62 years. Clarification note added to record prior to end of survey. Patient #7: 6/1/23 IDG POC Problem: Patient shows wound infection. (with no specific location). Initial Assessment shows patient assessment "normal" for integumentary and "normal" for infection. Patient's EMR info sheet shows age as 59. Initial comprehensive assessment says 69. IDG 6/15 refers to 59. IDG 7/13 says 69. MSW's 6/2 assessment note says 69. Staff interview actual age is 59. Clarification note added to medical record prior to end of survey.