Every finding on record at Circle of Care Hospice LLC

Upon patient record review, 3 of 19 (Patient #4,#6,#13) 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 4: The medical record includes an entry on the medication profile for oxygen 3 liters per minute. There is no evidence of the the frequency for the delivery of the oxygen, PRN or continuous, included on the profile. Patient 6: The medical record includes an entry on the medication profile for Metamucil 52 grams (2 caps full) daily for constipation. There is no evidence of a type and amount of diluent included in the entry. Patient 13: The medical record includes an entry on the medication profile for oxygen 2-3 liters per minutes via nasal cannula. There is no evidence of instructions for titration of oxygen included in the entry.

Upon patient record review, 2 of 19 (Patient #4,#9) 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 4:The medical record includes an order dated 11/13/23 for podiatrist consult. There is no evidence of completion of the consult or documentation of any follow up of podiatry order. Patient 9:The medical record includes nursing documentation on 12/6/23 of the caregiver request for a visit due to patient with tongue bleeding. There is no evidence of documentation of visit completed or further communication regarding bleeding of tongue.

Upon patient record review, 2 of 19 (Patient #6,13) 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 6: On admission, the medical record includes an order on the plan of care for Metamucil 52 grams (2 caps full) daily for constipation. There is no evidence of a type and amount of diluent included in the order Patient 13: On admission, the medical record includes an order on the plan of care for oxygen 2-3 liters per minutes via nasal cannula. There is no evidence of instructions for titration of oxygen included in the order.

Upon patient record review, 3 of 19 (Patient #1,#6,#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 equipment and supply needs. Patient 1: The medical record includes nursing documentation on admission of the patient's use of siderails and walker. There is no evidence of siderails and walker on the DME/supplies list. Patient 6:The medical record includes nursing documentation on admission of the patient's use of heel protectors and an gel mattress overlay. There is no evidence of heel protectors and gel mattress overlay on the DME/supplies list. Patient 8:The medical record includes nursing documentation on admission of the patient's use of a pressure relieving mattress. There is no evidence of a pressure relieving mattress on the DME list.

Upon patient record review, 2 of 19 (Patient #6,#10) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient 6:The medical record includes nursing documentation on 11/22/23 that physician was contacted regarding symptoms of a urinary tract infection and an order for Cipro 500 mg twice daily x 5 days was obtained. Subsequently on 11/25/23 an order was obtained to change the frequency of Cipro 500 po to every 6 hours x 5 days. There is no evidence of an update to the plan of care to include problems, goals and interventions regarding infection. Patient 10:The medical record includes nursing documentation on 8/25/23 that the patient presented with signs and symptoms of cellulitis to bilateral lower extremities and the physician ordered Cipro 500 mg twice daily x 5 days. There is no evidence of an update to the plan of care to include problems, goals and interventions regarding infection.

Upon patient client record review, 1 of 19 (Patient #2) 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 2:The medical record includes an initial comprehensive assessment with a visit date of 10/26/23. The signature of completion of the assessment is 2/8/23.

Upon patient record review, 1 of 19 (Patient #3) did not have evidence that the hospice provided the following information: • The most recent hospice plan of care specific to each patient • Hospice election form and any Advance Directives specific to each patient • Physician certification and recertification of the terminal illness specific to each patient • Names and contact information for hospice personnel involved in hospice care of each patient • Instructions on how to access the hospice's 24-hour on-call system • Hospice medication information specific to each patient • Hospice physician and attending physician (if any) orders specific to each patient Patient 3:Upon review of the patient's facility record, there is no evidence that the hospice provided a copy of the hospice election form. Corrected on site.