Every finding on record at Cipher Hospice

Upon patient record review, 9 of 14 (Patients # 1, 2, 3, 4, 5, 6, 7, 13, 14) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patients # 1, 2, 3, 4, 5, 6, 7, 13, 14: The initial comprehensive assessment for these patients, did not contain evidence of consideration related to the imminence of death.

Upon patient record review, 14 of 14 (Patients # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14) 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. Patients # 1 - 14: The POC for each medical record contained orders for the LVN visits PRN without a scope, and the MD visits without a frequency or a scope.

Upon patient record review, 1 of 14 (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: Patient had supplies in the home that included moisture barrier sheets, gloves, and wipes. There were not supplies listed on the patient's POC dated 9/15/25.

Upon client record review, 2 of 14 (Patients # 1, 2) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient # 1: The POC dated 9/6/25 did not contain the Chaplains signature for participation with the IDG. Patient # 2: The POC dated 9/1/25 did not contain the MSW's signature, and 9/15/25 did not contain the Chaplain's signature for participation with the IDG.

Upon personnel record review, 1 of 11 (Personnel # 8) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel # 8: The hospice aide 2024 competency did not contain evidence of an evaluation of the competency for communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff.

Upon patient record review, 1 of 14 (Patient # 11) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • 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 # 11: The hospice aide care plan dated 6/23/25 contained an order to "change bed linens". The task did not have a frequency.

Upon observation, there was no evidence the hospice is directed by a Board of Directors/governing body which assumes full legal authority and responsibility for the operation of the hospice. Agency was unable to produce contracts and personnel files for review until day 2 of survey.

Upon personnel record review, 3 of 11 (Personnel # 1, 2, 3) 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 # 1, 2, 3: The personnel files did not contain evidence of an initial competency assessment being conducted upon hire.

Upon client record review, 1 of 14 (Patient # 4) did not have evidence that the hospice forwarded a summary and a copy of the patient record, if requested, to a facility when transferring the patient to that facility. Patient # 4: The patient record did not contain evidence that a copy of the transfer summary or a copy of the patient record was sent to the facility where the patent was transferred.

Upon client record review, 3 of 14 (Patients # 5, 6, 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 Patients 5, 6, 7: The patient's record did not contain evidence of a discharge summary or patient record being forwarded to the attending physician following the revocation of hospice services.

Upon patient record review, 1 of 5 records (Patient #1) 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: On SOC patient terminal diagnosis of CAD, with comorbidities of Parkinson's Disease and history of stroke. SOC assessment notes weakness, tremors, garbled speech, grips unequal. Patient has neuro care plan that includes address medication administration. There was no evidence of a Care Plan/problem/interventions related to Parkinson's Disease/Stroke.

Upon patient record review, 2 of 5 records (Patient #4, #5) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • 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 4: On SOC RN assessment patient is documented as fall risk, with increasing weakness, decreased muscle strength, decreased ROM, requires assistance for ambulation. Aide POC/Assignment sheet notes patient is prone to fractures, there was no evidence of Fall risk or prevention on the aide POC. Patient 5: On SOC RN assessment patient is documented as fall risk, with increasing weakness, decreased muscle strength, decreased ROM, requires assistance for ambulation. Aide POC/Assignment sheet notes patient is prone to fractures, there was no evidence of Fall risk or prevention on the aide POC.