Every finding on record at Citadel Hospice Inc.

Upon patient record review, 5 of 14 (Patient #1, 2, 6, 9, 10) 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 Patient 1: Oxygen does not appear on the medication list. (corrected onsite) Patient 2: The medication list indicates BenGay pain relief cream 4% apply 2mL topically bid PRN mild pain; however, no location is specified for use of this topical cream on the medication list. (corrected onsite) Patient 6: The medication list indicates Mycolog topical ung 0.1% 1 application bid for candidiasis; however, no location is specified for use of this topical ointment on the medication list. (corrected onsite) Patient 9: The medication list indicates diclofenac topical gel 1% apply 2g qid PRN pain; however, no location is specified for use of this topical gel on the medication list. (corrected onsite) Patient 10: The medication list indicates diclofenac topical gel 1% apply 1-2g bid PRN pain; however, no location is specified for use of this topical gel on the medication list. (corrected onsite)

Upon patient record review, 3 of 14 (Patient #5, 7, 8) 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 5: A registered nurse visited the patient and updated the comprehensive assessment on 10.28.2023, then not again until 11.29.2023, and then not again until 12.22.2023. Comprehensive assessments have been completed at least every 15 days by a registered nurse on an ongoing basis since that time. To clarify, the patient was seen according to orders by a LPN continuously from 10.28.2023 until 12.22.2023 and appropriate ongoing patient care was provided; however, there was no evidence the RN visited as required every 15 days to update the comprehensive assessment. Patient 7: A registered nurse visited the patient and updated the comprehensive assessment on 12.30.2023, then not again until 01.27.2024. Comprehensive assessments have been completed at least every 15 days by a registered nurse on an ongoing basis since that time. To clarify, the patient was seen according to orders by a LPN continuously from 12.30.2023 until 01.27.2024 and appropriate ongoing patient care was provided; however, there was no evidence the RN visited as required every 15 days to update the comprehensive assessment. Patient 8: A registered nurse visited the patient and updated the comprehensive assessment on 12.21.2023, then not again until 01.11.2024. Comprehensive assessments have been completed at least every 15 days by a registered nurse on an ongoing basis since that time. To clarify, the patient was seen according to orders by a LPN continuously from 12.21.2023 until 01.11.2024 and appropriate ongoing patient care was provided; however, there was no evidence the RN visited as required every 15 days to update the comprehensive assessment.

Upon patient record review, 14 of 14 (Patient #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. Patient 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14: All patients have visit orders for MSW and chaplain ordered as needed for crisis management only. (corrected onsite for all active patients)

Upon client record review, 7 of 14 (Patient #1, 3, 5, 7, 8, 9, 10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: The chaplain made a visit with the patient on 01.14.2024. There was no evidence of a physician order for this visit. Patient 3: The chaplain made a visit with the patient on 12.14.2023. There was no evidence of a physician order for this visit. Patient 5: The chaplain made visits with the patient on 12.17.2023 and 01.15.2024. There was no evidence of a physician order for these visits. Patient 7: The chaplain made a visit with the patient on 01.01.2024. There was no evidence of a physician order for this visit. Patient 8: The chaplain made a visit with the patient on 01.09.2024. There was no evidence of a physician order for this visit. Patient 9: The chaplain made visits with the patient on 12.08.2023 and 01.06.2024. There was no evidence of a physician order for these visits. Patient 10: The chaplain made a visit with the patient on 12.15.2023. There was no evidence of a physician order for this visit.

Upon patient client record review, 4 of 14 (Patient #1, 4, 6, 7) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient 1, 4, 6, 7: The signed election statement did not indicate the effective date for hospice services.