Every finding on record at Celestial Care Hospice, LLC

Upon observation, there was no evidence the Emergency Plan communication plan includes contact information for Federal, state, tribal, regional, or local emergency preparedness staff.

Upon patient record review, 2 of 8 (Patient #1, #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 1 medication profile included Miralax, MOM, and Bisacodyl no instructions on when to take which medication. Also had Lactulose in the home and Lactulose was not on the medication profile. Patient 3 had Lortadine and Midodrine in the home and these were not on the medication profile.

Upon patient record review, 3 of 8 (Patient #1, 2, 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 1 RN comprehensive assessment completed on 3/26/24, and the next RN comprehensive assessment was completed on 4/27/24. Patient 2 RN initial comprehensive assessment completed on 4/4/24 and no updated comprehensive assessment after admission. Patient 3 RN comprehensive assessment completed on 3/25/24 and no updated comprehensive assessment after that.

Upon patient record review, 2 of 8 (Patient #1 and 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 orders for Miralax, MOM, and Bisacodyl no instructions on when to take which medication. Also, had Lactulose in the home and Lactulose was not ordered. Patient 3 had Lortadine and Midodrine in the home and these were not ordered.

Upon patient record review, 1 of 8 (Patient #2) 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 Nursing visits since admission document the use of a hoyer lift in the home, there is not evidence of an order for the hoyer lift.

Upon patient client record review, 7 of 8 (Patient #1, 2, 3, 4, 5, 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, 2, 3, 4, 5, 6, 7 Medical Director signature on the CTI and initial POC is 2 lines and is not legible as to who is signing, signature does not include the discipline either. Patient 1 nursing visits on 4/6/24, 4/10/24, and 4/20/24 do not include the discipline, these were for the LPN. Patient 4 nursing visits from 3/18/24 to 5/1/24 do not include the discipline, these were for the RN.