Every finding on record at Cng International Inc.

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 in the patient record that the comprehensive assessment takes into consideration the imminence of death.

Upon patient record review, 4 of 10 (Patient #1,2,3,5) 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: Patient 1: The POC has an Oxygen concentrator listed in the DME. There is no evidence of Oxygen being included on the medication profile. Corrected on site. Patient 2: The nurse documented on 3/29/24 "Oxygen via NC administered". There is no evidence of Oxygen being included on the medication profile. Corrected on site. Patient 3: The POC has an Oxygen concentrator listed in the DME. There is no evidence of Oxygen being included on the medication profile. Corrected on site. Patient 5: The SN documented on 10/6/23 "patient on home Oxygen" in comprehensive assessment. On 5/9/24 the SN documented patient is on Oxygen at 3 liters. There is no evidence of an order for Oxygen. Corrected on site

Upon patient record review, 4 of 14 (Patient #1,2,3,5) 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 1: The POC has an Oxygen concentrator listed in the DME. There is no evidence of an order for oxygen dose, frequency or route. Corrected on site. Patient 2: The nurse documented on 3/29/24 "Oxygen via NC administered". There is no evidence of an order for Oxygen. Corrected on site. Patient 3: The POC has an Oxygen concentrator listed in the DME. There is no evidence of an order for oxygen dose, frequency or route. Corrected on site. Patient 5: The SN documented on 10/6/23 "patient on home Oxygen" in comprehensive assessment. On 5/9/24 the SN documented patient is on Oxygen at 3 liters. There is no evidence of an order for Oxygen. Corrected on site

Upon client record review, 2 of 14 (Patient #1,7) 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 POC contains an order for SN 2 times per week. Pt admitted on 2/9/24 and was only seen once in that Medicare week. Patient 7:On 4/27/24 the SN documented " bilateral buttock with open area, called MD and relayed message, initial Tx done". There is no evidence of an order for this treatment. Corrected on site

Condition of Participation: Hospice Aide and Homemaker Services. L607

Upon personnel record review, 1 of 13 (Personnel #5 ) 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.) Personnel 5: The personnel file contained an initial and annual competency performed by the aide that did not include: Shampoo per sink, tub, and bed.

Upon patient record review, 13 of 14 (Patient #1,2,3,4,5,6,8,9,10,11,12,13,14) 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 1: The aide POC 2/9/24 has orders to complete shower 2 times per week if tolerated. Patient 2: The aide POC 12/4/23 has orders for a complete shower if tolerated. Patient 3: The aide POC 3/21/24 has order for assist with transfers as needed. Patient 4: The aide POC 4/22/24 has order for assist with transfers as needed. Patient 5: The aide POC 4/3/24 has orders for completed bed bath as needed, assist with commode as needed, bed pan as needed, shave as needed. Patient 6: The aide POC 3/5/24 has orders for complete shower 1 time per week if tolerated. Patient 8: The aide POC 2/28/24 has orders for complete bed bath 2 times per week and partial shower and complete shower ordered every visit. Patient 9: The aide POC 3/5/24 has orders for complete shower if tolerated, complete bed bath and partial shower/bath both 2 times per week. The aide visit orders are for 3 times per week. Patient 10: The aide POC 2/13/24 has orders for complete shower if tolerated. Patient 11: The aide POC 12/23/23 has orders for assist with transfers as needed. Has both complete bed bath and partial shower/bath twice weekly. Patient 12: The aide POC 4/9/24 has ordered back rub as needed and complete shower if tolerated. Patient 13: The aide POC 4/21/23 has shave as needed. Patient 14: The aide POC 4/26/23 has complete bed bath and partial bath/shower twice weekly. Pt is seen twice weekly by the aide and has Transfers as needed.

Upon patient record review 13 of 14 (Patient #1,2,3,4,5,6,8,9,10,11,12,13,14) 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 1: The aide POC contains an order for partial bath/shower 2 times per week. There is evidence on May 6,7,8 the aide gave a partial bath shower three times that week. On May 7th the aide documented giving both a complete shower and partial shower. Patient 2: The aide POC 2/2/24 has orders for shampoo and complete bed bath 2 times per week. The aide documented on 3/25, 3/27,3/28,4/1 completing a complete bed bath. And performed shampooing 3/25, 3/27, 4/1. Patient 3: The aide POC 3/21/24 contains orders aide 4 times per week and for complete bed bath 2 times per week and partial shower 2 times per week. The week of May 11th there is evidence the aide performed a complete bed baths at all 4 of the documented visits. Patient 4: The aide completed visits on 4/19,4/22,4/23,4/24 and documented completion of a complete bed bath, partial/complete shower and complete shower. Patient 5: The aide completed 3 visits the week of 5/5-5/11/24 and completed a complete bed bath each visit. The POC has orders for a complete shower 1 time per week and partial bath shower 2 times per week. Shampooing was ordered 2 times per week and the aide documented shampooing at each of the 3 visits performed the week of 5/5-5/11. Patient 6: The aide documented a partial bath/shower was given on 5/8,5/10,5/13. The aide POC orders were for a completed bed bath 2 times per week and complete shower 1 time per week. Patient 8: The aide documented on 4/8,4/11,4/15,4/17,4/22,4/24 that all of the following were completed: complete bed bath, partial shower and complete shower. Patient 9: The aide documented on 4/23,4/25,4/27 that they completed shampooing all 3 days and this task is ordered for 2 times per week. On 4/16,4/18,4/20 the aide documented performing complete shower and shampoo all 3 visits. The POC has these tasked ordered twice a week. On 4/20 the aide documented they shaved the pt. This was not ordered on the aide POC. Patient 10: The aide documented on 5/6,5/8,5/10,5/11 performing a complete bed bath. This task was ordered 2 times per week and a partial bath/shower was ordered to be completed 2 times per week and was not completed. Patient 11: Aide POC has complete bed bath twice weekly. Aide performed 1/30,2/1,2/3 Patient 12: Aide POC has ordered complete bed bath every visit and it is marked not done by the aide on 4/25/24 with no evidence of refusal. Patient 13: Aide documents 4/27,4/26,4/25 completing both complete bed bath and partial bath/shower both visits. Patient 14: Aide documented 5/11, 5/9 documented completed a complete bed bath and partial bath/shower both visits.

Upon patient client record review, 1 of 14(Patient #7) 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 7: The SN documented wound care provided on 4/19/24, 4/22/24, 4/30/24 "cleanse with soap and water apply Calmoseptine and cover with foam dressing" the wound care is documented as restating the order and is not in past tense.

Upon client record review, 2 of 14 (Patient #11,12) 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: Patient 11 and 12: The medical records did not include: A copy of the hospice discharge summary.

Upon client record review, 3 of 14 (Patient #3,4,7) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient 3: The POC 3/28/24 contains an order for wound care to the coccyx, though does not state who is to perform the wound care. Pt is in a facility. Corrected on site. Patient 4: The POC 3/28/24 contains an order for wound care to the left and right heel and does not state who will perform the wound care and pt is in a facility. Corrected on site. Patient 7: The POC 4/17/24 contains an order for wound care to the right ankle and does not state who will perform the wound care and pt is in a facility. Corrected on site.