Every finding on record at Cosmos Hospice of San Antonio, LLC

Upon patient record review 2 of 19 (Patient #9, #10) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #9: The patient was admitted 07/30/2022 however, the spiritual assessment was not completed until 07/14/2023. Patient #10: The patient was admitted 07/07/2022 however, the spiritual assessment was not completed until 07/20/2023.

Upon patient record review 1 of 19 (Patient #14) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient #14: There was no evidence that a spiritual assessment was completed for this patient.

Upon patient record review, 5 of 19 (Patient #4, #5, #6, #13, #14) 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 medication profile included Lasix 20mg 1 tab twice a day for 5 days ordered 07/28/2023 however was still active on the medication profile. Corrected on site. Patient #5: The medication profile included doxycycline 100mg, take 1 tablet twice a day for 7 days ordered 07/30/2023 however this was still active on the medication profile. Corrected on site. Patient #6: The medication profile included children's Tylenol 160mg/5mL as directed PRN pain/fever however, there was no evidence of specific directions. Corrected on site. Patient #13: The medication profile included oxygen at 3lpm as directed however, there was no evidence of a route or indicator. Corrected on site. Patient #14: The medication profile included Polytrim ED 1 drop to affected eye every 4 hours for 7 days ordered 08/30/2022 however was still active on the medication profile. Corrected on site.

Upon patient record review, 1 of 19 (Patient #14) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #14: There was no evidence of a bereavement assessment in the patient record.

Upon patient record review, 3 of 19 (Patient #7, #11, #13) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #7: The nursing notes indicated patient had been having nausea and vomiting since July however, there was no evidence of problems/interventions/goals added to POC. Corrected on site. Patient #11: The initial plan of care included problems/interventions/goals that were not individualized to the patient (i.e. suicide risk, facility coordination, discharge planning). Active patient problems were not identified on the plan of care. Corrected on site. Patient #13: The initial plan of care included problems/interventions/goals that were not individualized to the patient (i.e. suicide risk, facility coordination, discharge planning). Active patient problems were not identified on the plan of care. Corrected on site.

Upon patient record review, 5 of 19 (Patient #4, #5, #6, #13, #14) 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 #4: The order for Lasix 20mg 1 tab twice a day for 5 days ordered 07/28/2023 was still active on the medication profile. Corrected on site. Patient #5: The order for doxycycline 100mg, take 1 tablet twice a day for 7 days ordered 07/30/2023 was still active on the medication profile. Corrected on site. Patient #6: The order for children's Tylenol 160mg/5mL as directed PRN pain/fever however, there was no evidence of specific directions. Corrected on site. Patient #13: The order for oxygen at 3lpm as directed however, there was no evidence of a route or indicator. Corrected on site. Patient #14: The order for Polytrim ED 1 drop to affected eye every 4 hours for 7 days ordered 08/30/2022 was still active on the medication profile. Corrected on site.

Upon patient record review, 8 of 19 (Patient #1, #2, #3, #4, #5, #11, #12, #14) 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 record indicated patient was using a Hoyer lift and nebulizer however, there was no evidence of these on the plan of care. Corrected on site. Patient #2: The record indicated patient was using overbed table, oxygen, and wheelchair however, there was no evidence of these on the plan of care. Corrected on site. Patient #3: The record indicated patient was using a nebulizer and visit revealed suction unit however, there was no evidence of these on the plan of care. Corrected on site. Patient #4: The record indicated patient was using a rollator, wheelchair, bedside commode, and nebulizer however, there was no evidence of these on the plan of care. Corrected on site Patient #5: The record indicated patient was using a hospital bed, Hoyer lift, wheelchair, and cushion however, there was no evidence of these on the plan of care. Corrected on site. Patient #11: The record indicated patient was using oxygen and wheelchair however, there was no evidence of these on the plan of care. Corrected on site. Patient #12: The record indicated patient was using overbed table, oxygen, and hospital bed however, there was no evidence of these on the plan of care. Corrected on site. Patient #14: The record indicated patient was using a hospital bed however, there was no evidence of this on the plan of care. Corrected on site.

Upon client record review, 5 of 19 (Patient #7, #11, #12, #13, #14) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #7: The social work visit frequency 06/01/2023 was 1M2, 2 PRN however, there was no evidence of visits in June 2023 or July 2023. Corrected on site. Patient #11: The nurse visit frequency 05/01/2023 was 3W1, 2W12, 4 PRN however, the week of 07/23 there was only evidence of 1 visit on 07/27/2023. Corrected on site. Patient #12: The social work visit frequency 05/26/2023 was 1M2, 2 PRN, chaplain 05/26 2M1, 1M1, 2 PRN, and nurse 05/26 was 2 every 2W2, 2W7, 1W1, 4 PRN however, there was no evidence of visit by social work or chaplain in May 2023 and the nurse visited 05/31. Corrected on site. Patient #13: The nurse visit frequency 04/04/2023 was 1W13, 4 PRN. A new nurse frequency visit order was written 07/03/2023 for 1W13, 4 PRN, however, the week of 07/23 there was no evidence of any visits. Corrected on site. Patient #14: The nurse visit frequency 05/21/2023 was 1W9, 4 PRN however, the week of 07/02 there was no evidence of any visits. Corrected on site.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient visit #2: The HHA was observed obtaining clean linens for patient prior to performing handwashing. In addition, observed the HHA remove gloves part way through bathing but did not perform handwashing before completing bed bath and replacing gloves to remove old linens.

Upon patient record review 4 of 19 (Patient #2, #3, #11, #12) 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 #2: The aide visit frequency 06/15/2023 was 1W1, 3W8 however, for the week of 06/18 there was evidence of only 2 visits on the 6/19 and 6/23 and the for the week of 07/23 there was evidence of one visit on 07/28. Corrected on site. Patient #3: The aide visit frequency 06/03/2023 was 4W9 however, for the weeks of 06/11 through 07/30 there was only evidence of 2 visits per week with 2 aides present. Corrected on site. Patient #11: The aide visit frequency 07/27/2023 was 2 visits per week however, there was no evidence of visits from 7/27 to 08/05. Corrected on site. Patient #12: The aide visit frequency 05/26/2023 was 1W1, 3W8, 1W1 and 07/25 2W1, 3W8 however, for the week of 06/04 there was only evidence of 2 visits on the 6/5 and 6/7 and the for week of 07/23 there was only evidence of 1 visit on the 7/26. Corrected on site.

Upon inpatient contract review, 1 of 4 (HCH&R) did not have evidence that the inpatient provider has established patient care policies consistent with those of the hospice and agrees to abide by the palliative care protocols and plan of care established by the hospice for its patients.

Upon inpatient contract review, 1 of 4 (HCH&R) did not have evidence that the hospice patient's inpatient clinical record includes a record of all inpatient services furnished and events regarding care that occurred at the facility; that a copy of the discharge summary be provided to the hospice at the time of discharge; and that a copy of the inpatient clinical record is available to the hospice at the time of discharge.

Upon inpatient contract review, 1 of 4 (HCH&R) did not have evidence that the inpatient facility has identified an individual within the facility who is responsible for the implementation of the provisions of the agreement.