Every finding on record at Central Arizona Home Health Care, Inc.

Upon patient record review, 5 of 11 (Patient #2,#3,#5,#6,#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 The interim order dated 8/12/22 ordered Thyroid Compound 3mg capsule, 1 cap by mouth daily without evidence on the Medication Profile. Corrected on site. Patient #3 The Medication Profile dated 8/5/22 included, Mupirocin 2% topical ointment, apply dime size topically every day to affected areas without a location. Corrected on site. Patient #5 The interim order dated 8/2/22 ordered Thick-it, add to fluids to nectar thickness per product instructions without evidence on the Medication Profile. Leadership confirmed that this additive should have been evident on the Medication Profile. Corrected on site. Patient #6 SNV 9/14 documented O2 @ 7L. Medication Profile dated 6/27/22 included O2 @ 5L. Corrected on Site. Patient #9 The interim order dated 7/6/22 ordered Thick-it, in oral fluids to nectar consistency without evidence on the Medication Profile. Leadership confirmed that this additive should have been evident on the Medication Profile. Corrected on site.

Upon patient record review, 2 of 11 (Patient #5,#11) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #5 The patient was admitted 7/27/22. The Bereavement Assessment was dated 8/3/22. Patient #11 There was no evidence in the record of an initial Bereavement Assessment.

Upon patient record review, 1 of 11 (Patient #3) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #3 The Care Coordination triage note dated 8/17/22 at 8:54pm documented request for visit due to patient having difficulty breathing. The next visit by the RN evident in the record was 8/19/22 at 12 noon which documented water in the oxygen concentrator turns cloudy or brown, new concentrator to be delivered. "Pt states sometimes issues with SOB". The Care Coordination triage note dated 9/17/22 documented a UTI concern from the facility, urine dark with a foul odor without any evidence of follow up. Corrected on Site.

Upon patient record review, 4 of 11 (Patient #2,#5,#7,#9) 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 #2 The patient has a diagnosis of Malignant Neoplasm of the Frontal Lobe, medication for comfort, and oxygen. POC dated 8/10/22 did not have evidence of goals and interventions related to neurological wellbeing, altered comfort, medication administration or oxygen therapy. Corrected on site. Patient #5 The record includes a diagnosis of dysphagia with choking, yet no choking goals or interventions are evident on the POC. Corrected on site. Patient #7,#9 No bleeding goals or interventions were evident in the POC yet the patient was taking Eliquis. Corrected on site.

Upon patient record review, 5 of 11 (Patient #2,#3,#5,#6,#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 The interim order description dated 8/12/22 included Thyroid Compound 3mg capsule, 1 cap by mouth daily without evidence that it was ever entered as an order on the POC. Corrected on site. Patient #3 The POC Medication list dated 8/5/22 ordered, Mupirocin 2% topical ointment, apply dime size topically every day to affected areas without a location. Corrected on site. Patient #5 The interim order dated 8/2/22 ordered Thick-it, add to fluids to nectar thickness per product instructions without evidence on the POC Medication List. Corrected on site. Patient #6 SNV 9/14 documented O2 @ 7L. POC Medication List dated 6/27/22 included O2 @5L. Corrected on Site. Patient #9 The interim order dated 7/6/22 ordered Thick-it, in oral fluids to nectar consistency without evidence on the POC Medication List. Corrected on site.

Upon client record review, 2 of 11 (Patient #2, #3) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2 The Interim order dated 9/11/22 ordered daily RN visits. The recorded indicated that PRN visits were made on 9/17 and 9/18 without evidence of routine visits on those days. Patient #3 The POC dated 8/5/22 ordered, SN visit frequency at 2w12. The record showed evidence of only one visit the week of 9/4 - 9/10 on 9/7 without evidence of a missed visit in the record. Corrected on site.

Upon patient record review, 5 of 10 applicable (Patient #1,#3,#5,#7,#9) did not have evidence in the patient record that hospice aide assignments and duties are: • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable. Patient #1 The IDG note dated 8/31/22 documented, "Unable to get to shower in Hoyer lift due to safety concerns, patient now getting bed bath, HHA plan adjusted" without any evidence that the Aide POC had been updated. Corrected on site. Patient #3 The Aide POC dated 8/5/22 ordered, Assist to bedside commode every visit as needed. Corrected on site. Patient #5 The record includes a diagnosis of dysphagia with choking, yet no choking precautions are evident on the Aide POC. Corrected on site. Patient #7,#9 No bleeding precautions were evident in the Aide POC yet the patient was taking Eliquis. Corrected on site.

Upon patient record review 6 of 10 applicable (Patient #1,2,3,8,9,10) 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 Patient #1 Aide visit note dated 9/1/22 documents bed bath, aide care plan was for shower. Patient #2 The Aide POC dated 9/4/22 ordered visit frequency at 1w1, 2w8, 1w1. There was no evidence in the record of a visit or missed visit 9/11 - 9/17. An additional PRN visit for "shower today" was ordered 9/9/22, with no evidence of a visit or missed visit in the record for this day. Patient #3 The Aide POC dated 8/5/22 ordered visit frequency at 2w12. The record showed evidence of only one visit on 9/7, and one visit on 9/12. Corrected on site. Patient #8 The Aide POC dated 8/5/22 ordered visit frequency at 1w13. There was no evidence in the record of a visit or missed visit the week of 9/4 - 9/10. Corrected on site. Patient #9 The interim order to the Aide POC dated 8/1/22 ordered visit frequency at 4w5. There were only 3 visits documented in the record the weeks of 8/14- 8/20 and 8/28-9/3. Corrected on site. Patient #10 The Aide POC dated 3/18/22 ordered visit frequency at 1w12. There was no evidence in the record of a visit or missed visit the weeks of 3/20 - 3/26 and 3/27 - 4/2. Corrected on site.

Upon patient client record review, 1 of 11 (Patient #10) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #10 requested the Notification of Non-Covered Items, Services and Drugs on 3/17/2022. There is no indication in the record when the notice was furnished as the date is left blank. The document was signed 3/24/2022.

Upon patient client record review, 2 of 11 (Patient #5,#10) did not have evidence that each patient record contains Advance Directives. Patient #5 IDG note 8/10/22 documented "patient has DNR in place, no copy or copier available, wife will provide on next visit". There was no evidence in the record of the DNR form. Patient #10 The Advance Directive Information statement documented, "I do have Advance directives." There was no Advance Directive document evident in the record.

Upon patient client record review, 8 of 11 (Patient #1,#2,#3,#4,#5,#6,#7,#10) 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 The spaces at the bottom of the pages on the admission forms allocated for name and medical record number were left blank. Patient #5 a) The spaces at the bottom of the pages on the admission forms allocated for name and medical record number were left blank. b) The Consent to treat was appropriately signed but nothing was marked for do, or do not consent to treat. Patient #6, #7, #10 The Consent to treat was appropriately signed but nothing was marked for do, or do not consent to treat.