Every finding on record at Compassus Milwaukee

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current: Prescription and over-the-counter (OTC) drugs; Supplements; Herbal remedies; Other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: The effectiveness of drug therapy; Drug side effects; Actual or potential drug interactions; Duplicate drug therapy; Drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by clinical record review and interview. In 1 of 7 (14%) clinical records reviewed, in which oxygen was ordered, it was revealed that the agency did not ensure that the drug profile included all of the patient's current medications that could affect drug therapy. CLINICAL RECORD 10: The patient was admitted on 03/18/2025 with Chronic Obstructive Pulmonary Disease and a history of lung cancer. The initial nursing assessment documented the patient required continuous oxygen at 10L per face mask. Oxygen was not included in the patient’s medication profile, thus was not included in the review of medications that could affect drug therapy. Reviewed clinical record with Area Director of Clinical Services on 04/01/2025 who confirmed and agreed that oxygen was not included on the medication profile.

It is required that each patient’s individualized written plan of care include drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 1 of 7 (14%) clinical records reviewed, in which oxygen was ordered, it was revealed that the agency did not ensure that the plan of care included all of drugs and treatment necessary to meet the needs of the patient. CLINICAL RECORD 10: The patient was admitted on 03/18/2025 with a diagnosis of Chronic Obstructive Pulmonary Disease and a history of lung cancer. The initial nursing assessment dated 03/18/2025, documented that the patient was using continuous oxygen at 10 L/per minute per face mask. The plan of care, effective 03/18/2025 to 06/15/2025, included oxygen safety interventions but did not include oxygen as a medication or treatment. The Area Director of Clinical Services confirmed findings in an interview on 03/31/2025 and 04/ 01/2025.

It is required that each patient’s individualized written plan of care include the medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 2 of 19 (11%) clinical records reviewed revealed that the agency did not ensure that the needed medical equipment and supplies were listed on each individualized plan of care. CLINICAL RECORD 9: The patient was admitted on 03/07/2025 with a diagnosis of malignant neoplasm of the breast. The nursing assessment on 03/07/2025 documented that the patient had a wound on the left heel with dressing changes, a Foley catheter in place and required a Hoyer lift. The plan of care (POC), effective 03/07/2025 to current, listed “NONE” under durable medical equipment (DME) and supplies. The POC did not include the Hoyer lift, wound care supplies, or the Foley catheter supplies necessary to meet the needs of the patient. CLINICAL RECORD 10: The initial nursing assessment, dated 03/18/2025, documented the patient had Chronic Obstructive Pulmonary Disease and required continuous oxygen at 10L per face mask, had a g-tube, a wound on the coccyx, a nebulizer, a suction machine, and requested a Hoyer lift. The plan of care, dated 03/18/2025-06/15/2025, included a Hoyer lift but did not include oxygen supplies, g-tube supplies, suction supplies, nebulizer supplies, or wound care supplies. The Area Director of Clinical Services stated in an interview on 03/31/2025, "I see that, it will be updated in IDG (interdisciplinary group) tomorrow."

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. Each patient’s record includes, at a minimum, physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed revealed that the agency did not ensure that the clinical record contained current physician orders for to meet he needs of the patient. CLINICAL RECORD 6: A skilled nursing note on 03/26/2025 read in part, "Patient reports since taking more morphine he is constipated and going a little bit with hard pellets, education completed on how to relieve constipation. His wife gave him a dose of MiraLAX while the nurse was in the home." The record did not include orders for MiraLAX. The Area Director of Clinical Services stated in an interview on 03/31/2025, "The nurses struggle with getting orders for over-the-counter medications."

Based on record review and interview, the agency nurses failed to meet the nursing needs for wound assessment and measurement in hospice patients with wounds in 2 of 5 wound patients (Patient #1 and #2) in a total of 11 hospice patient records reviewed. --- Findings include: Review of agency policy titled ";Wound Management" (dated 11/30/2018) revealed in part, ";Procedure: At each nursing visit: 2. Visualize any known wounds at least 1 time per week and more often if required for wound management. a. Size- length by width by depth, in centimeters. b. Appearance of the wound bed and wound margins. c. Presence of odor. d. Presence of exudate. e. Signs/symptoms of infection at the wound site. f. Stage of the wound if it is a pressure related wound. 3. Wound Care d. If the patient is in a facility, collaborate with the individual at the facility responsible for wound management (the hospice nurse is responsible for inspecting the wound at least 1 time per week and should plan accordingly to work with the facilitys personnel to accomplish this). During an interview on 11/13/2023 at 11:50 AM with Area Executive of Clinical Operations E, and Director of Clinical Services B and C, when asked about the agencys process for wound assessment and care of wound, Director of Clinical Services B replied, ";Once a week at a minimum do an assessment. We enter in wound care orders. May train family or staff member to do wound care but at a minimum we do once per week." Area Executive of Clinical Operations E stated, ";Wound measurements are done every 7 days by an RN." During an interview on 11/13/2023 at 3:20 PM with RN D, when asked the agencys process for wound assessment and care of wound, RN D replied, ";Weekly visits done every 7 days. We coordinate with facility if patient in a facility to do care and assess and measure. On admission, will assess wound and measure if a wound is known and also do skin checks." Record review of Patient #1s ";Hospice IDG (Interdisciplinary Group) Comprehensive Assessment and POC (Plan of Care) Update Report" with start of care 10/15/2023 revealed Patient #1 had a primary diagnosis of ";Malignant Neoplasm of Overlapping Sites of Bladder" and secondary diagnoses of ";Type 2 Diabetes Mellitus without Complications." The POC update/orders revealed in part, ";SN (Skilled Nurse) 3 times per week for 1 week, 2 times per week for 8 weeks. SN to observe and assess of integumentary status. Care for wound of left heel. Details: Patient also has a wound to left heel that is a venous stasis ulcer." Record review of Patient #1's record of SN visit documentation for ";Left Heel-Venous stasis Ulcer" wound assessments 10/15/2023 to 11/13/2023 revealed: 10/15/2023: ";Wound assessed- yes. Measurements taken- No. Reason- Not due." 10/20/2023: ";Wound assessed- yes. Measurements taken- No. Reason- Not due. Patient was seen by writer today for nurse visit as patients daughter called reporting...to assess left heel wound as it is looking worse." 10/27/2023: ";Wound assessed- No. Caregiver completed care." 10/31/2023: ";Wound assessed- No. Caregiver completed care." 11/03/2023: ";Wound assessed- No. Caregiver completed care." 11/08/2023: ";Assessed- yes. Length 5.0 cm (centimeters) x Width 3.0 cm x Depth 0.3 cm." 11/10/2023: ";Assessed- No. Measurements taken- No. Reason- Not due." Record review of Patient #2s ";Hospice IDG Comprehensive Assessment and POC Update Report" with start of care 10/06/2023 revealed Patient #2 had primary diagnoses of ";Acute on Chronic Diastolic Congestive Heart Failure" and secondary diagnoses of ";Pressure Ulcer of Unspecified Heel Stage 4" and ";Pressure Ulcer of Right Heel, Unspecified Stage." The POC update/orders revealed in part, ";SN frequency 2 times per week for 1 week, 1 time per week for 13 weeks. SN for administration of decubitus wound care. Details: During [Patient #2s] stay in rehab, developed a pressure injury on bilateral heels. Right heel is unstageable at this time. The left heel was recently debrided and has exposed bone showing." Record review of Patient #2's record of SN visit documentation for ";Left Heel- Pressure Ulcer" wound assessments 10/06/2023 to 11/07/2023 revealed: 10/06/2023: ";Wound assessed- no. Measurements taken- No. Reason- Not due." 10/07/2023: ";Wound assessed- yes. Length 4.5 cm x Width 3.6 cm x Depth 0.5 cm." 10/13/2023: ";Wound assessed- No. Caregiver completed care." 10/19/2023: ";Wound assessed- yes. Length 4.5 cm x Width 3.5 cm x Depth 0.5 cm." 10/21/2023: ";Patient refused care." 10/24/2023: ";Wound assessed- yes. Length 2.3 cm x Width 4.2 cm x Depth 0.6 cm." 10/27/2023: ";Wound assessed- yes. Length 2.0 cm x Width 4.0 cm x Depth 0.5 cm." 11/01/2023: ";Wound assessed- No. Caregiver completed care." 11/07/2023: ";Wound assessed- yes. Length 2.0 cm x Width 4.0 cm x Depth 0.5 cm." Record review of Patient #2's record of SN visit documentation for ";Right Heel- Pressure Ulcer" wound assessments 10/06/2023 to 11/07/2023 revealed: 10/06/2023: ";Wound assessed- no. Measurements taken- No. Reason- Not due." 10/07/2023: ";Wound assessed- yes. Length 2.0 cm x Width 0.9 cm x Depth 0.2 cm." 10/13/2023: ";Wound assessed- No. Caregiver completed care." 10/19/2023: ";Wound assessed- yes. Length 2.0 cm x Width 0.9 cm x Depth 0 cm." 10/21/2023: ";Patient refused care." 10/24/2023: ";Wound assessed- yes. Length 1.1 cm x Width 1.7 cm x Depth 0.5 cm." 10/27/2023: ";Wound assessed- yes. Length 2.0 cm x Width 1.0 cm x Depth 0.5 cm." 11/01/2023: ";Wound assessed- No. Caregiver completed care." 11/07/2023: ";Wound assessed- yes. Length 2.0 cm x Width 1.0 cm x Depth 0.5 cm." Record review of Patient #2's record of SN visit documentation for ";Right Lower Buttock-Pressure Ulcer" wound assessments 10/06/2023 to 11/07/2023 revealed: 10/06/2023: ";Wound assessed- no. Measurements taken- No. Reason- Not due." 10/07/2023: ";Wound assessed- no. Measurements taken- No. Reason- Wound care not provided." 10/13/2023: ";Wound assessed- No. Caregiver completed care." 10/19/2023: ";Wound assessed- No. Caregiver completed care." 10/21/2023: ";Patient refused care." 10/24/2023: ";Wound no longer open." Findings were reviewed with Area Executive of Clinical Operations E and Director of Clinical Services B on 11/13/2023 at 4:30 PM regarding Patient #1 missing wound assessments and/or measurement the week of 10/15/2023, 10/22/2023, and 10/29/2023, and Patient #2 missing wound assessments and/or measurements the week of 10/08/2023 and 10/29/2023. During an interview with Area Executive of Clinical Operations E on 11/14/2023 at 11:15 AM, when asked if there was any additional wound assessments and/or measurements or documentation for Patient #1s and #2s wounds, Area Executive of Clinical Operations E replied, ";No, we were not able to find anything. We had our QA (Quality Assurance) look and agreed on [not finding additional information for wound assessments and/or measurements]."

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs. The medication review process includes the identification of the effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, and drug therapy associated with lab monitoring. The assessment includes evidence that common side effects of medication in hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when a new medication is added or changes are made to existing medication. This standard was not met as evidenced by a review of clinical records and interview. 1 of 4 (25%) 25% clinical records reviewed the medication list had not been updated to include the patient medications of Over the Counter (OTC) drugs. Clinical Record 1: Election of the Hospice Benefit, dated 6/6/2022. An 82-year-old, female with a diagnosis that included Alzheimer’s Disease and COVID-19. On 6/29/2022, the nurse documented that the daughter had been giving her mother Imodium for complaints of abdomen pain. The nurse had been administering Bisacodyl suppositories weekly as needed. Also, in the review of the documentation covering the Skilled Nurse visit dated 8/10/2022, the RN documented “The patient used Magnesium Citrate over the week to assist with bowels.” There was no documented evidence that the RN had updated the medication profile to include either Imodium or Magnesium Citrate, both being OTC drugs. During an interview with the Administrator/Director of Nurses (DON) on 11/01/2022, they confirmed the finding and that they were aware that the OTC drugs should have been added to the Medication list.

It is required that the update of the comprehensive assessment is completed by the hospice Interdisciplinary Group, who, in collaboration with the individual’s attending physician, if any, consider the changes that have taken place since the initial assessment. The update of the comprehensive assessment includes: Information on the patient’s progress toward desired outcomes; Reassessment of the patient’s response to care. The assessment update is completed: as frequently as the condition of the patient requires; No less frequently than every 15 days. This standard was not met as evidenced by a review of clinical records and interview. 1 of 4 (25%) clinical records reviewed the agency had failed to ensure that updates from the Comprehensive Nursing Assessment had been updated by the hospice IDT/IDG to include progress for desired outcomes as well as response to care. Clinical Record 1: Election of Hospice Benefit dated 6/6/2022. An 82-year-old female with the diagnosis of Alzheimer’s Disease and COVID-19. On 6/29/2022, the nurse documented the daughter had been giving her mother Imodium for complaints of abdominal pain. The nurse had been administering Bisacodyl suppositories weekly as needed. There was no documented evidence that the RN had updated the Interdisciplinary Team Meetings dated 6/29/2022 and 7/13/2022 to discuss the use of Imodium, an OTC drug. There were no communication notes regarding the Imodium documented. Also, in the Skilled Nurse visit dated 8/10/2022, the RN documented “The patient used Magnesium Citrate over the week to assist with bowels.” There was no documented evidence that the RN had updated the Interdisciplinary Team Meetings, dated 8/17/2022, to discuss the use of Magnesium Citrate, an OTC drug. There were no communication notes regarding Magnesium Citrate. In an interview with the Administrator/Director of Nursing (DON) on 11/01/2022, it was stated that she was not aware that the Comprehensive Nursing Assessment had not been discussed and documented at IDG/IDT.

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. 2 of 13 (15%) clinical records reviewed revealed the hospice did not ensure that initial spiritual assessments were completed. Record #67971: the patient was admitted to hospice on 5/10/2022 and declined chaplain. The clinical record did not evidence an initial spiritual assessment. Record #14716: the patient was admitted to hospice on 4/13/2022 and declined chaplain on 4/27/2022. The clinical record did not evidence an initial spiritual assessment. The Director of Quality Outcomes was interviewed on 6/15/2022 and stated the RN is expected to complete in a coordination note but there were no spiritual assessments in the records identified. The Administrator was interviewed on 6/15/2022 and confirmed the finding.

It is required that a hospice aide provides services are ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. 1 of 12 (8%) records reviewed with a hospice aide ordered revealed the hospice did not ensure that the hospice aide followed the plan of care as ordered. Record #68864: the record evidenced hospice aide visits documented on 2/4/2022 and 2/11/2022. The aide plan of care assigned a shampoo every visit. The hospice aide documentation on 2/4/2022 and 2/11/2022 revealed the shampoo was not completed with a note, “not required this visit.” There was no documented evidence that the hospice aide notified the registered nurse. The Administrator was interviewed on 6/15/2022 and stated, the aide did not follow the plan of care.

It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. This standard was not met as evidenced by clinical record review and interview. 2 of 12 (16%) records reviewed with a hospice aide ordered revealed the hospice did not ensure the hospice aides reported a change in condition to the registered nurse(s). Record #45462: the record evidenced a hospice aide visit on 1/7/2022. The aide plan of care assigned shaving and oral care every visit. The hospice aide documentation on 1/7/2022 revealed the patient refused shaving and oral care. There was no documented evidence that the hospice aide notified the registered nurse. Record #89922: the record evidenced a hospice aide visit on 1/18/2022. The aide plan of care assigned a shower every visit. The hospice aide documentation on 1/18/2022 revealed the patient refused the shower. There was no documented evidence that the hospice aide notified the registered nurse. The Administrator was interviewed on 6/15/2022 and stated the aide should have notified the registered nurse but there is nothing documented to say it was done.

Based on record review and interview, the agency staff failed to ensure patient rights were upheld in 1 of 1 patient (Patient #1) who was subjected to Cardiopulmonary Resuscitation (CPR) when his/her wishes were for Do Not Resuscitate (DNR) due to facility failure to communicate DNR orders and in 4 of 4 Discharged (Patient #2, #3, #4, and #5) and 5 of 5 current (Patient #6, #7, #8, #9 and #10) records reviewed where DNR orders were not communicated for patients that established an Advanced Directive/DNR Order on admission out of a total of 10 records reviewed. Findings Include: Patient #1 was provided CPR when his/her wishes were for DNR because the family/patient was not provided the DNR orders or bracelets that communicate patient wishes. See Tag L503. The agency failed to provide patients/family with DNR orders or bracelets that communicate patient wishes for DNR. See Tag L503. The cumulative effects of this systemic failure have the potential to affect all patients receiving services at this Hospice Agency.

Based on record review and interview, the agency staff failed to ensure patient rights were upheld in 1 of 1 patient (Patient #1) who was subjected to Cardiopulmonary Resuscitation (CPR) when his/her wishes were for Do Not Resuscitate (DNR) due to facility failure to communicate DNR orders and in 4 of 4 Discharged (Patient #2, #3, #4, and #5) and 5 of 5 current (Patient #6, #7, #8, #9 and #10) records reviewed where DNR orders were not communicated for patients that established an Advanced Directive/DNR Order on admission out of a total of 10 records reviewed. Findings Include: Review of policy "Advance Directives" dated 10/3/2017 revealed in part, "Advance Directive - A written directive that pertains to treatment preferences and specific instruction, prepared in advance, and the designation of a surrogate decision maker in the event that a patient should become unable to make medical decisions on their own behalf. Includes living will, DNR orders, state-identified portable treatment orders, Power of Attorney for healthcare, 5 wishes and other such documents as recognized by state statute where applicable." An interview was conducted with Admission Registered Nurse B on 2/15/2022 at 11:12 AM. Admission Registered Nurse B asked to explain the process of obtaining the DNR on admission. Admission Registered Nurse B stated "The DNR is signed by the patient or power of attorney, the packet of legal papers is brought back to the office for Medical Doctor signature, after that I have no idea what happens, personally I do not know about the bracelets/orders and how they get back to the patients." An interview was conducted with Director of Quality C on 2/15/2022 at 11:19 AM. Director of Quality C was asked who was responsible to return the DNR order and bracelet to the patient. Director of Quality C stated "The social workers are responsible to get the bracelet and DNR order signed and back to the patient/family. If the family's not wanting the order/bracelet, then it is brought back to the office." An interview was conducted with Director of Quality C on 2/15/2022 at 11:44 AM. Director of Quality C was asked where in the medical record would the documentation of the patient receiving the signed DNR order and bracelet be found. Director of Quality C stated "it would be the expectation that the social worker would document either in the visit note or communication note. On 12/1/2021 Patient #1 was admitted to this hospice with a diagnosis of Pulmonary Fibrosis. Discussion of Cardiac Pulmonary Resuscitate (CPR) occurred on admission, and review of document titled "Hospice Certification and Plan of Care" dated 12/1/2021 - 2/28/2022 revealed under "Advance Directive, Do Not Resuscitate." There was no documentation in Patient #1's visit notes or communication notes to show Patient #1 received a signed order for DNR or DNR bracelet. On 12/19/2021 at 13:29 PM Registered Nurse E received a call from Patient #1's daughter who stated "Patient #1 had a seizure and passed, paramedics are doing CPR on Patient #1 due to Patient #1 not having the appropriate DNR bracelet or DNR order available in the home." On 12/19/2021 at 13:31 PM Registered Nurse E placed a call to the hospice office. Registered Nurse E informed the office the family of Patient #1 needs a copy of the DNR order to show the paramedics. The office will attempt to send the DNR order via text message. The family did not receive the DNR and Patient #1 was transported to the hospital. On 12/19/2021 at 13:40 PM Registered Nurse E placed a call to Hospital Charge Nurse F. Hospital Charge Nurse F was updated that Patient #1 does have a signed DNR order and Registered Nurse E will attempt to text the order to Hospital Charge Nurse F. On 12/19/2021 at 13:47 Registered Nurse E attempted to send Patient #1's DNR order via text, and at 13:49 via fax, both were not successful. On 12/19/2021 at 14:04 Registered Nurse E received confirmation from Hospital Charge Nurse F they received the DNR order, and Patient #1 was pronounced deceased. On 10/26/2021 Patient #2 was admitted to this hospice with a diagnosis of Senile Degeneration of the Brain. Discussion of CPR occurred on admission, and review of document titled "Hospice Certification and Plan of Care" dated 10/26/2021-1/23/2022 revealed under "Advance Directive, Do Not Resuscitate." There was no documentation in Patient #2's visit notes or communication notes to show Patient #2 received a signed order for DNR or DNR bracelet. On 1/4/2022 Patient #3 was admitted to this hospice with a diagnosis of End Stage Renal Disease. Discussion of CPR occurred on admission, and review of document titled "Hospice Certification and Plan of Care" dated 1/4/2022-4/3/2022 revealed under "Advance Directive, Do Not Resuscitate." There was no documentation in Patient #3's visit notes or communication notes to show Patient #3 received a signed order for DNR or DNR bracelet. On 10/22/2021 Patient #4 was admitted to this hospice with a diagnosis of Metastatic Disease. Discussion of CPR occurred on admission, and review of document titled "Hospice Certification and Plan of Care" dated 10/22/2021-1/19/2022 revealed under "Advance Directive, Do Not Resuscitate." There was no documentation in Patient #4's visit notes or communication notes to show Patient #4 received a signed order for DNR or DNR bracelet. On 5/21/2021 Patient #5 was admitted to this hospice with a diagnosis of Dementia. Discussion of CPR occurred on admission, and review of document titled "Hospice Certification and Plan of Care" dated 5/21/2021-8/18/2021 revealed under "Advance Directive, Do Not Resuscitate." There was no documentation in Patient #5's visit notes or communication notes to show Patient #5 received a signed order for DNR or DNR bracelet. On 1/25/2022 Patient #6 was admitted to this hospice with a diagnosis of Severe Chronic Lung Disease. Discussion of CPR occurred on admission, and review of document titled "Hospice Certification and Plan of Care" dated 1/25/2022-3/16/2022 revealed under "Advance Directive, Do Not Resuscitate." There was no documentation in Patient #6's visit notes or communication notes to show Patient #6 received a signed order for DNR or DNR bracelet. On 2/8/2022 Patient #7 was admitted to this hospice with a diagnosis of Senile Degeneration of Brain. Discussion of CPR occurred on admission, and review of document titled "Hospice Certification and Plan of Care" dated 2/8/2022-5/8/2022 revealed under "Advance Directive, Do Not Resuscitate." There was no documentation in Patient #7's visit notes or communication notes to show Patient #7 received a signed order for DNR or DNR bracelet. On 1/25/2022 Patient # 8 was admitted to this hospice with a diagnosis of Heart Failure. Discussion of CPR occurred on admission, and review of document titled "Hospice Certification and Plan of Care" dated 1/25/2022-4/24/2022 revealed under "Advance Directive, Do Not Resuscitate." There was no documentation in Patient #8's visit notes or communication notes to show Patient #8 received a signed order for DNR or DNR bracelet. On 1/19/2022 Patient #9 was admitted to this hospice with a diagnosis of Acute Respiratory Failure. Discussion of CPR occurred on admission, and review of document titled "Hospice Certification and Plan of Care" dated 1/19/2022-4/18/2022 revealed under "Advance Directive, Do Not Resuscitate." There was no documentation in Patient #9's visit notes or communication notes to show Patient #9 received a signed order for DNR or DNR bracelet. On 2/9/2022 Patient #10 was admitted to this hospice with a diagnosis of Parkinson's Disease. Discussion of CPR occurred on admission, and review of document titled "Hospice Certification and Plan of Care" dated 2/9/2022-5/9/2022 revealed under "Advance Directive, Do Not Resuscitate." There was no documentation in Patient #10's visit notes or communication notes to show Patient #10 received a signed order for DNR or DNR bracelet. An interview was conducted with Executive Clinical Operations D on 2/15/2022 at 12:00 PM. Executive Clinical Operations D was asked what the expectation for the patients to receive the DNR order and DNR bracelet. Executive Clinical Operations D stated "the expectation is that someone should be bringing the patient's DNR bracelet and DNR order back to the patient's home once the Medical Doctor has signed the order."