Every finding on record at Cn Palliative Care LLC

Upon observation, there was not evidence that the Emergency Preparedness Plan included established strategies, for addressing those highest-risk emergency events, as identified by the Hazard Vulnerability Risk Assessment activity, that would affect the Hospice's ability to continue to provide care/services.

Upon patient record review, 3 of 14 (Patients #1, 2, and 6) did not contain a complete Medication Profile. Each of these patients' clinical records reflected that they had Physician-ordered Oxygen. Such Oxygen was not included on these patients' Medication Profiles.

Upon patient record review, 1 of 14 (Patient #9) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. A verbal order was obtained on 05/28/21 for, "Pressure Ulcer State III both heels. Cleanse with Normal Saline, flush with Normal Saline, pack with Medi-Honey, apply gauze, and apply Kerlix." The wound order does not include a frequency.

Upon patient record review, 3 of 14 (Patient #5, 7, and 9) did not contain evidence that the IDG had ensured that the care and services had been provided in accordance with the Plan of Care: Patient #5: Social Work visits were made on 09/23/21 and 10/22/21. There were no Physician orders located to support these SW visits. The IDG POC dated 09/17/21, nor any subsequent IDG Plans of Care, included such visit orders. Patient #7: The RN Initial Assessment noted, "Volunteer 1x per week from today's date." The Physician-signed POC dated 04/05-07/06/21 continued to document the need for Volunteer care/services. There was no documented evidence that this necessary service provision had been provided. Patient #9: A verbal order was obtained on 05/28/21 for, "Change colostomy bag 1x per week, and teach in-home caregivers." The nursing documentation in the next subsequent SN visits of 05/29, 06/02, and 06/04/21, did not reference the patient's colostomy site, or any such bag change. The same 05/28/21 verbal order included, "Change Foley Catheter 1x per month 16F 10cc balloon." None of the nursing visits made between 05/29/21 and the 07/01/21 (date of Revocation) demonstrated that such Foley Catheter change occurred.

Upon patient record review, 1 of 14 (Patient #3) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs.The RN Initial Assessment noted that, "Provider Assistance Services are to be established with the State for provider assistance in the home." There were no documented notes in the record to support that this intervention had been followed through with.

Upon observation, there was not documented evidence that the Board of Directors/Governing Body had approved the frequency and detail of the 2022 QAPI data collection plan.

Upon patient record review, 4 of 9 applicable (Patients #2, 7, 12, and 14) did not contain evidence that the Hospice Aide POC was individualized, including all pertinent assignments and other pertinent details. For each of these patients, they had evidence of a D.N.R. order within their clinical record. This pertinent Advance Directive information was not included on these patients' Aide Plan(s) of Care.

Upon patient record review 5 of 9 applicable (Patients #1, 2, 5, 6, and 12) did not contain documented evidence that the Hospice Aide had provided services that were ordered by the IDG and included in the plan of care. Patient #1,2,5,6,12: None of these Aide Plan(s) of Care assigned the task of obtaining T, P, R, and BP. However, the Aide did obtain and documented such vitals on all of the visit reports reviewed.

Upon patient record review, 1 of 1 applicable (Patient #2), transferred to another Hospice, did not contain documented evidence that the Hospice had forwarded a Transfer Summary, and a copy of the patient record, if requested, to the receiving Hospice. Patient #2 was transferred to another Hospice on 06/08/2021. The Clinical Manager was not able to locate evidence of such Transfer Summary having been forwarded to the receiving Hospice.

Upon patient record review, 1 of 2 applicable (Patient #9) did not contain evidence that if a patient revokes their Election of Hospice care, or is discharged from Hospice in accordance with §418.26, that the Hospice must complete, and forward to the patient's Attending physician, if any: • A copy of the hospice Discharge Summary • The patient's clinical record, if requested Patient #9 revoked their Hospice election on 07/01/2021. There was no DC Summary located within the clinical record.

Upon SNF contract review, 1 of 1 (HNH) did not contain evidence that specified the provision of Hospice services in the Facility, to include: A provision that the SNF immediately notifies the Hospice if: • When a need to transfer a patient from the SNF arises, and the Hospice makes arrangements for, and remains responsible for, any necessary Continuous Care or In-patient care necessary, related to the terminal illness and related conditions • A patient dies

Upon SNF contract review, 1 of 1 (HNH) did not contain evidence of a provision stating that the Hospice assumes responsibility for determining the appropriate course of Hospice care, including the determination to change the Level of Care/services provided.

Upon SNF contract review, 1 of 1 (HNH) did not contain evidence of a provision stating that it is the SNF's responsibility to continue to furnish 24 hour room and board care, meeting the personal care and nursing needs at the same level of care that would have been provided by the Facility before Hospice care was elected.

Upon SNF contract review, 1 of 1 (HNH) did not contain evidence that it is the Hospice's responsibility to provide services at the same level, and to the same extent, as those services would be provided if the SNF Resident were in his or her own home.

Upon SNF contract review, 1 of 1 (HNH) did not contain a delineation of the Hospice's responsibilities, which include, but are not limited to the following: Providing medical direction and management of the patient; nursing; counseling (including spiritual, dietary and bereavement); social work; provision of medical supplies, durable medical equipment and drugs necessary for the palliation of pain and symptoms associated with the terminal illness and related conditions; and all other hospice services that are necessary for the care of the resident's terminal illness and related conditions.

Upon SNF contract review, 1 of 1 (HNH) did not contain a provision that the Hospice may use the SNF nursing personnel where permitted by state law, and as specified by the SNF, to assist in the administration of prescribed therapies included in the Hospice Plan of Care; only to the extent that the Hospice would routinely use the services of a Hospice patient's family in implementing the Plan of Care.

Upon SNF contract review, 1 of 1 (HNH) did not contain a provision stating that the Hospice must report all alleged violations involving mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property, by anyone unrelated to the Hospice, to the SNF Administrator within 24 hours of the Hospice becoming aware of the alleged violation.

Upon SNF contract review, 1 of 1 (HNH) did not contain a delineation of the responsibilities of the Hospice and the SNF to provide Bereavement services to SNF personnel.