Every finding on record at Charise Hospice Care LLC

Upon patient record review, 3 of 8 (Patient #3, 4, 8) 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: Medication profile does not include PRN reason for Benzonalate 100 mg 1 cap tid prn. Patient #4: Oxygen is denoted on the medication profile however no dosage listed. Patient #8: No route documented on Oxygen on the medication profile.

Upon patient record review, 2 of 8 (Patient #3, 5) 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 #3: Patient SOC 4/1/22 and Bereavement risk assessment performed by chaplain late- on 4/7/22. Patient #5: Patient SOC 4/28/22 and Bereavement risk assessment performed by chaplain late- on 5/4/22.

Upon patient record review, 2 of 8 (Patient #3, 4, 8) 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 #3: Order does not include PRN reason for Benzonalate 100 mg 1 cap tid prn. Patient #4: Order for Oxygen however no dosage included. Patient #8: Order for Oxygen no route included.

Upon client record review, 5 of 8 (Patient #3, 4, 5, 6, 8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #3: Chaplain performed visit on 4/7/22. MSW documented visits on 4/5/33, 5/4/22. No evidence of an order for SC or MSW visits. Patient #4: POC dated 2/1/22 SN ordered 1xwk and 2 prn. Visits performed 2/1/22 and 2/4/22. Neither denoted prn. Patient #5: POC dated 2/1/22 SN ordered 1xwk and 2 prn. Visits performed 2/9, 2/11/22- none marked prn nor additional order written to cover frequency. Patient #6: POC dated 3/25/22 SN order 3xwk, visit performed 3/25. No evidence of missed visits or orders for correct frequency for this week. Patient #8: POC dated 4/28/22 SN ordered 1xwk. Visits performed 5/4, 5/16. No evidence of missed visit week of 5/8. Chaplain ordered 1xmonth on POC dated 4/28/22. No evidence of a visit for April. No evidence of a missed visit or order.

Upon patient record review 2 of 4 applicable (Patients #2, 4) 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 #2: Aide performed the following that were not listed on the aide care plan: Ambulation: performed 5/16, 5/17, 5/18, 5/19. Transfer: performed 5/16-5/21/22. Assist with exercise: performed 5/16-5/21/22. Assist with meal prep: performed 5/16 and 5/17. Patient #4 Aide ordered 2xwk on poc dated 2/1/22. Aide visits started on 2/8/22 with no existence of missed visits or orders.