Every finding on record at Curo Health Services, LLC

Upon patient record review, 1 of 5 (Patient #4) 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 nursing visit on 10/22/24 documents g-tube flush 60ml water x2, no evidence of an order for g-tube flush.

Upon patient record review, 1 of 5 (Patient #3) 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 3 oxygen order on 10/30/24, no evidence of a DME order for oxygen. Nursing visit on 10/22/24 documents wheelchair in use, no evidence of a DME order for the wheelchair.

Upon client record review, 2 of 5 (Patient #1, 3) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1 IPOC includes facility (ALF) will obtain PT/INR every 2 weeks and results will be reported to physician, no documentation of a PT/INR since admission. Patient 3 order on 10/24/24 for SC frequency effective 10/24/24 for initial and then 2 visits every 30 days and 3prn. SC visits completed on 10/24 and 10/31.

Upon patient record review 2 of 19 records (Patient #8,#13) 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 #8: The patient was admitted on 4/19/24. The record indicated that the spiritual assessment was completed on 4/25/24. Patient #13: The patient was admitted on 6/26/24. The record indicated that the spiritual assessment was completed on 7/8/24.

Upon patient record review 2 of 19 records (Patient #7,#14) did not have evidence in the patient record that the comprehensive assessment identifies the 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 #7,#14: There was not evidence of a spiritual assessment.

Upon patient record review, 7 of 19 records (Patient #5,#8,#9,#10,#11,#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 #5: The medication profile contained Insulin Aspart 100u/ml sliding scale per facility requirements. Corrected on site. Patient #8: Upon visit, the facility MAR included Multi-vitamins, Acetaminophen, Cyclobenzaprine, Ibuprofen, Loperamide and Salonpas which were not in the medication profile of the hospice. Corrected on site Patient #9: Upon visit, the hospice medication profile listed Atorvastatin, Metoprolol, and Miralax which were not on the MAR at the facility. Corrected on site. Patient #10: Upon visit, the hospice medication profile listed Mirtazapine. There was not evidence that this was in the patient home. Corrected on site. Patient #11: Upon visit, Miralax was in the patient home. There was not evidence that this was on the hospice medication profile. Corrected on site. In addition, nursing documentation indicated that the patient wears oxygen 4-4.5L/min via nasal cannula. There was not evidence that this was in the medication profile. Corrected on site. Patient #13:The record indicated that the patient had oxygen intermittent at 2L/min via nasal cannula. There was not evidence that this was in the medication profile. Corrected on site. Patient #14: The medication profile contained Polyethylene Glycol 17 GM, 1 packet, mix with 30 ml water. Corrected on site.

Upon patient record review, 1 of 19 records (Patient #11) 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 #11: The patient was admitted on 7/12/24. The bereavement risk assessment was completed on 8/16/24.

Condition of Participation: Interdisciplinary Group, Care Planning, and Coordination of Services. L536

Upon patient record review, 6 of 19 records (Patient #6,#7,#9,#12,#13,#14) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient that reflects 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 #6: The patient was admitted with a diagnosis of COPD. She also had a dementia diagnosis and resided in a Memory care unit. She had dysphagia, intermittent anxiety and required assistance with all ADLs. There was not evidence that the care plan included patient/family goals and interventions related to her neurological or cognitive problems. Corrected on site. Patient #7: The patient was on Eliquis 5m po BID. There was not evidence that the care plan included safety regarding bleeding precautions. Corrected on site. Patient #9: The patient was admitted with a diagnosis of Alzheimer's Disease. She had non-sensible speech, required assistance with all ADLs, was disoriented, had a history of aggression and falls. There was not evidence that the care plan included patient/family goals and interventions related to her neurological, Alzheimer's or cognitive problems. Corrected on site. Patient #12: The record indicated that the patient had a colostomy. There was not evidence that this was addressed in the plan of care. Corrected on site. In addition, the record indicated that the patient was on Plavix 75mg daily. There was not evidence that bleeding precaution or safety was in the plan of care. Corrected on site. Patient #13: The record indicated that the patient was on Plavix 75mg daily. There was not evidence that bleeding precaution or safety was in the plan of care. Corrected on site. Patient #14: The record indicated that the patient had a trach. There was not evidence that the care plan included goals and interventions related to the trach. Corrected on site.

Upon patient record review, 8 of 19 records (Patient #6,#7,#8,#9,#10,#11,#12,#13) did not have evidence the plan of care 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 #6,#7,#8,#9,#10,#11,#12,#13: The initial visit frequency for both the social worker and the spiritual care counselor was 1 prn.

Upon patient record review, 5 of 19 records (Patient #5,#8,#11,#13,#14) did not have evidence the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #5: The record contained an order for Insulin Aspart 100u/ml sliding scale per facility requirements. Corrected on site. Patient #8: The facility MAR included Multi-vitamins, Acetaminophen, Cyclobenzaprine, Ibuprofen, Loperamide and Salonpas. There was not evidence of an order in the hospice record. Corrected on site. Patient #11: Miralax was in the patient home. There was not evidence of an order in the hospice record. Corrected on site. In addition, nursing documentation indicated that the patient wears oxygen 4-4.5L/min via nasal cannula. There was not evidence of an order. Corrected on site. Patient #13:The record indicated that the patient had oxygen intermittent at 2L/min via nasal cannula. There was not evidence of an order. Corrected on site. Patient #14: The record indicated Polyethylene Glycol 17 GM, 1 packet, mix with 30 ml water. Corrected on site.

Upon patient record review, 2 of 19 records (Patient #10,#14) did not have evidence the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient #10: The Plan of care did not list any DME. Upon observed home visit, the patient stated that the hospice got him a medical bed upon admission. Corrected on site. Patient#14: DME and supplies were listed as none on the initial plan of care. The record indicated that the patient had a trach, G-tube, Supra-pubic tube, oxygen continuously, Feedings and a wheelchair. Corrected on site.

Upon patient record review, 1 of 19 records (Patient #13) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #13: The record indicated that the patient's level of care was changed to respite from 8/19/24-8/23/24. There was not evidence that the care plan was revised for the respite stay.

Upon client record review, 6 of 19 records (Patient #6,#7,#9,#11,#12,#13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #6: The spiritual care counselor visit frequency was 2 every 2m2, 2m2. The record indicated that the spiritual care counselor conducted visits on 7/24/24, 8/5/24, 8/23/24, and 9/11/24. Patient #7: The visit frequency for the social worker was 1 every 2m2, 1m1. The record indicated that visits were conducted on 7/12/24 and 8/27/24. Patient #9: The visit frequency for the social worker and the spiritual care counselor was 1 every 2m2, 1m1. The record indicated that the spiritual care counselor conducted visits on 6/5/24, 7/2/24, and 8/1/24. The social worker conducted visits on 6/7/24, 7/5/24, and 8/1/24. Patient #11: The visit frequency for the skilled nurse was 2w1, 3w1, 2w11. Visits were conducted on 7/12/24 for week 1 and 7/14/24, and 7/17/24 for week 2. In addition, the visit frequency for the social worker was 1 every 2m2, 1m2. visits were conducted on 7/17/24 and 8/15/24. Patient #12: The skilled nurse visit frequency was 2w1, 1w12. The record indicated only 1 visit during week 1. In addition, The social worker visit frequency was 1 every 3m3, 1m1. Visits were conducted on 6/26/24, 7/23/24, and 8/23/24. Also, the spiritual care counselor visit frequency was 2 every 2m2, 2m2. Visits were conducted on 6/24/24, 7/8/24, 7/26/24, 8/9/24 and 8/22/24. Patient #13: The visit frequency for the social worker and the spiritual care counselor was 1 every 2m2, 1m1. The spiritual care counselor conducted visits on 7/8/24, 8/7/24, and 9/16/24. The social worker conducted visits on 7/5/24 and 8/7/24.

Upon observation, 1 of 4 visits with agency staff (Patient #11) did not contain evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #11, RN: The staff member used a bar of soap in the patient bathroom to wash her hands prior to providing care.

Upon observation there was no evidence the hospice physicians providing care, receive oversight while working under the hospice medical director who is responsible for the palliation and management of the terminal illness and conditions related to the terminal illness. This is demonstrated by any of the following: 1. All physician employees and those under contract must function under the supervision of the hospice medical director. 2. All physician employees and those under contract shall meet this requirement by either providing the services directly or through coordinating patient care with the attending physician. 3. If the attending physician is unavailable, the medical director, contracted physician, and/or hospice physician employee is responsible for meeting the medical needs of the patient.

Upon patient record review, 2 of 19 records (Patient #5,#13) did not have evidence in the patient record that hospice aide assignments and duties are: • Written patient care instructions including alerts and precautions 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 specifically 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 #5: The aide plan of care dated 7/7/24 indicated for dressing and shaving every visit, offer - if wanted. Corrected on site. Patient #13: The record indicated that the patient was on Plavix 75mg daily. There was not evidence of bleeding precautions on the aide plan of care. Corrected on site.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. The documented usage of volunteers for the year 2023 was 3%.

Upon patient client record review, 2 of 19 records (Patient #9,#14) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #9: The benefit election statement (dated 6/3/24) indicated that the patient/caregiver wished to receive the Patient Notification of Hospice Non-Covered Items, Services, and Drugs. There was not evidence that this document was furnished. Patient #14: The benefit election statement (dated 6/28/24) indicated that the patient/caregiver wished to receive the Patient Notification of Hospice Non-Covered Items, Services, and Drugs. There was not evidence that this document was furnished.

Upon patient client record review, 1 of 19 records (Patient #1) 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. Patient #1: The patient was admitted 7/27/24 and was a Full Code at that time. On 8/28/24, the patient signed an OOHDNR for a no code. All IDG plans of care from admission listed the patient as a NO code.

Upon client record review, 2 of 19 records (Patient #5,#14) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #5: The skilled nurse frequency for the benefit period beginning 7/17/24 was 1 every 2w2, 1w7. The record indicated that visits were conducted on 7/22/24, 7/9/24 and 8/5/24. Patient #14:The skilled nurse visit frequency was 2w13. The record indicated only 1 visit for week 1 (on 6/28/24). In addition, the social work visit frequency was for an evaluation then 1 every 2m2, 1m1. The evaluation was conducted on 7/2/24 with subsequent visits on 8/1/24 and 9/3/24.

Upon client record review, 1 of 19 records (Patient #3) 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 record indicated wound care orders to an abrasion on the patient's left forearm, cleanse with wound cleanser, pat dry, skin prep to peri wound, apply xeroform cut to size to wound bed,cover with border foam. change daily. Wound care to be performed by hospice nurse or facility nurse. There was not evidence specifically which provider was to perform the wound care.

Based on observation and interview, the agency failed to complete hand hygiene upon entering the patient's home and handling the patient's personal items, and failed to ensure the patient was protected from potentially contaminated items for 2 of 4 patients observed during home visits. (Patients #8, 15) Findings include: --- 1. A review of the agency's "Home Care Infection Prevention and Control Program 2023 " indicated " ... Perform hand hygiene ... A. Immediately before having direct contact with a patient ... I. Immediately after removing gloves." 2. On 03/08/24 at 10:20 AM, Registered Nurse, RN 4 was observed entering the home of Patient #4, where she picked up the patient's binder from a dresser and reviewed the contents. After greeting the patient, RN 4 completed hand hygiene, donned gloves, assessed the patient, discarded the gloves, and exited the room. RN 4 failed to complete hand hygiene upon entering the patient's home and handing personal items, and after removing her gloves. When asked about hand hygiene, RN 4 indicated she should have performed hand hygiene upon entry and after removing her gloves, 3. On 03/12/24 at 11:05 AM, Home Health Aide, HHA 1 was observed providing bathing and personal care to Patient #15. During the application of lotion and Vaseline to the patient's skin, HHA 1 placed the lotion bottle and the Vaseline tube on the floor. HHA 1 completed hand hygiene, donned gloves, and retrieved the lotion bottle from the floor. The aide rested the base of the lotion bottle, which was just previously in contact with the facility floor, on her leg, and dispensed some lotion into her hand. After placing the bottle back on the floor, HHA 1 obtained the Vaseline tube, which was resting in an inverted position with its cap touching the floor, opened the contaminated cap with her gloved hand, dispensed Vaseline onto the palm of the same hand, then closed the tube and returned it to the floor. HHA 1 repeated the process several times as she applied lotion and Vaseline to the patients limbs and trunk. When asked about infection control, HHA 1 was unable to identify any concerns until the bottles on the floor were pointed out, at which point she indicated the bottles should not be placed on the floor.

Based on record review and interview the agency failed to provide effective and timely pain and symptom management in 1 of 7 records reviewed. (Patient #1). Findings include: --- A review of a policy titled ";POLICY 620...PAIN MANAGEMENT" received from the Administrator on 09-06-2023 at 4:15 PM, contained but was not limited to "; All patients have the right to appropriate assessment and management of pain." A review of a policy titled ";670-H...MANANGEMENT AND DISPOSAL OF CONTROLLED SUBSTANCES AND ON OTHER MEDICATIONS IN PATIENTS HOME" received from the Administrator on 09-06-2023 at 4:15 PM, contained but was not limited to "The individual receiving the order records, signs and forward to the prescribing practitioner for signature...." A review of the clinical record for Patient #1 evidenced a discharge from a hospital stay to Entity B, an assisted living facility, and an election of benefit of 08-03-2023 with diagnoses including but not limited to chronic diastolic (congestive) heart failure (inability of the heart to pump effectively), unspecified dementia, and chronic atrial fibrillation (irregular heartbeat). The medication orders contained but was not limited to Lorazepam Intensol as needed every 2 hours for agitation, anxiety, and restlessness, and Morphine Concentrate as needed every 4 hours for pain and or shortness of breath. A review of a document titled ";Visit Note Report" dated 08-03-2023 indicated the visit was for start of Hospice care and the time began at 5:51 PM and ended at 6:49 PM electronically signed by Registered Nurse (RN) 7. The report indicated but was not limited to all ordered medications were not available and medications were sent to the pharmacy. A section titled ";Pain" contained a question asking if Patient #1 was uncomfortable because of pain. The patient response stated ";yes" and rated the pain as a 4 out of 10 (on a scale of 0-10 with 0 being no pain and 10 the most severe). A review of nurses notes from Employee K, Licensed Practical Nurse at Entity B, dated 08-04-2023 at 1:41 AM indicated a phone call was made to Promedica to report Patient #1 had fallen and the document indicated at 1:49 AM hospice had returned the call and was made aware Patient #1 did not have ";comfort" medications. A review of a Promedica client coordination note dated 08-04-2023 at 4:52 AM, evidenced a coordination note from Entity B to report Patient #1 had fallen was in pain ";every where" [sic} and Entity B does not have scripts. (referring to medications or orders to send to a pharmacy). The note reported a nurse will visit to assess patient and address scripts. A review of a document titled "Complaint Report" dated 08-04-2022 at 8:22 AM indicated but was not limited to Patient #1s family called to report the patient had been in pain for ";24 hours" and the facility (Entity B) does not have the medications to give the patient. The on-call personnel reported a nurse will visit and medications will be addressed. A review of a Promedica note titled "; Client Coordination Note Report" dated 08-04-2023 with no time stamp indicated RN 1 followed up and called a local pharmacy at 9:00 AM regarding scripts sent. RN 1s assessment of Patient #1 stated, ";PT [sic] ON ASSESSMENT WAS AGITATED, RESTLESS, AND MOANING, CALLING OUT, COMBATIVE. MEDICATION WAS ADMINISTERED BY FACILITY NURSE (NAME OF NURSE), AS SOON AS MEDICATIONS ARRIVED. MEDICATIONS EFFECTIVE."

Upon patient record review 1 of 13 records (Patient #8) did not have evidence in the patient record that the hospice interdisciplinary group completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient 8: The medical record contained evidence of initial psychosocial assessment completed 10-11-21 with hospice start of care 10-5-21. Missed visit coordination note by social worker stated visit rescheduled for 10-11-21 due to visit not populated until after the scheduled week.

Upon patient record review, 8 of 13 records (Patients #1,#2,#3,#4,#5,#6,#7,#12) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 1: The current medication list contained atropine PRN for secretions with route of opthalmic and glycolax oral powder without evidence of instructions for a diluent. Corrected on site. Patient 2: The current medication list contained methyl salicate topical without evidence of a defined area for administration. Corrected on site. Patient 3: The current medication list contained atropine PRN for secretions with route of opthalmic and polyethylene glycol powder without evidence of instructions for a diluent. Corrected on site. Patient 4: The current medication list contained ammonium lactate topical without evidence of a defined area for administration. Corrected on site. Patient 5: The current medication list contained nystatin powder without evidence of a defined area for administration. Corrected on site. Patient 6: The current medication list contained oxygen without evidence of instructions for a delivery method. Corrected on site. Patient 7: The current medication list contained atropine PRN for terminal secretions with route of opthalmic, topical eucrisa and triamcinolone medications without evidence of defined areas for administration, and two oxygen medications listed with different dosages, 2-4 LPM per nasal cannula, and 4LPM without evidence of instructions for a delivery method. Corrected on site. Patient 12: The medication list as documented on the discharge summary contained oxygen without evidence of instructions for a delivery method and voltaren topical without evidence of a defined area for administration.

Upon patient record review, 10 of 13 records (Patients #2,#3,#4,#5,#6,#7,#8,#9,#10,#12) 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 2: The medical record contained nursing documentation upon admission identifying patient issue with compromised cardiac function. There was no evidence of problems, goals, and interventions related to cardiac included in the plan of care. Corrected on site. Patient 3: The medical record contained nursing documentation upon recent recertification 9-9-21 identifying patient was incontinent of bowel and bladder. There was no evidence of problems, goals, and interventions related to incontinence included in the plan of care. The plan of care also contained active need for social work services. There was no evidence of social work frequencies ordered or visits completed. Corrected on site. Patient 4: The medical record contained nursing documentation upon recertification 9-22-21 identifying patient was incontinent of bowel and bladder. There was no evidence of problems, goals, and interventions related to incontinence included in the plan of care. Corrected on site. Patient 5: The plan of care contained active need for aide and social work services and active problems, goals, and interventions for social work. There was no evidence of social work or aide frequencies ordered or visits completed. Corrected on site. Patient 6: The medical record contained nursing documentation 8-7-21 identifying patient issues with frequent diarrhea, nausea, bladder incontinence and difficulty remember if insulin administered. There was no evidence of problems, goals, and interventions related to gastrointestinal issues, incontinence, or endocrine system included in the plan of care. Corrected on site. Patient 7: The medical record contained nursing documentation upon admission identifying patient was incontinent of bowel and bladder. There was no evidence of problems, goals, and interventions related to incontinence included in the plan of care. Corrected on site. Patient 8: The medical record contained nursing documentation 10-6-21 identifying patient issues with constipation, need for self catheterization related to retention, and treatment of home for bed bugs. There was no evidence of problems, goals, and interventions related to constipation, genitourinary deficits, and infection control measures necessary to prevent infestation included in the plan of care. Corrected on site. Patient 9: The medical record contained a physician order for physical therapy to evaluate and treat 9-8-21. There was no evidence of the need for physical therapy and related problems, goals, and interventions included in the plan of care. Corrected on site. Patient 10: The medical record contained a physician order for physical therapy to evaluate and treat 4-8-21. There was no evidence of the need for physical therapy and related problems, goals, and interventions included in the plan of care. Patient 12: The medical record contained nursing documentation 1-15-21 identifying patient was incontinent of bladder. There was no evidence of problems, goals, and interventions related to incontinence included in the plan of care. The plan of care contained active need for spiritual care and social work services and active problems, goals, and interventions for spiritual care and social work. There was no evidence of chaplain or social work frequencies ordered or visits completed.

Upon patient record review, 4 of 13 records (Patient #1,#2,#7, #12) 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 medical record contained nursing documentation upon admission identifying patient use of cane and walker. There was no evidence of the related equipment included in the plan of care. Corrected on site. Patient 2: The medical record contained nursing documentation upon admission identifying patient use of cane and rollator. There was no evidence of the related equipment included in the plan of care. Corrected on site. Patient 7: The medical record contained nursing documentation upon admission identifying patient use of oxygen, rollator, and nebulizer. There was no evidence of related equipment included in the plan of care. Corrected on site. Patient 12: The medical record contained nursing documentation 1-15-21 identifying patient use of oxygen and 4-18-21 identifying use of walker. There was no evidence of related equipment included in the plan of care.

Upon client record review, 2of 13 records (Patients #3,#7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 3: The medical record contained chaplain frequency for visit every 30 days. There was no evidence of visits completed or missed visit documentation for June, July, August, and September. Patient 7: The medical record contained chaplain frequency for visits every other week. There was no evidence of a visit completed or missed visit documentation the weeks of 10-3-21, 10-10-21 and 10-17-21.

Upon patient record review, 6 of 9 applicable records (Patients #2,#3,#4,#7,#9,#13) did not have evidence in the patient record that hospice aide assignments and duties are 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 2: The current aide care plan contained task to change linens every visit as needed. Corrected on site. Patient 3: The current aide care plan contained task of offer fluids every visit as patient tolerates. Corrected on site. Patient 4: The current aide care plan contained tasks to clean or file nails every visit as needed and offer fluids every visit as needed and tolerated. Corrected on site. Patient 7: The current aide care plan contained tasks to both shower and give bed bath every visit. Corrected on site. Patient 9: The current aide care plan contained tasks to shampoo every visit as tolerated, clean or file nails every visit or as needed, ambulate per patient tolerance, and partial bed bath every visit per patient preference, can be bed, chair, or shower bathing. Corrected on site. Patient 13: The aide care plan contained tasks to set up meal and do laundry per request.

Upon patient client record review, 2 of 13 (Patient #12, 13) did not evidence that each patient record contains physician orders. Patient 12: The medical record contained documentation for discharge due to patient no longer terminally ill. There was no evidence of a physician order to discontinue hospice services included in the plan of care. Patient 13: The medical record contained documentation for discharge due to patient no longer terminally ill. There was no evidence of a physician order to discontinue hospice services included in the plan of care.

Upon patient client record review, 2 of 13 records (Patient #1,#8) 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. Patient 1: The medical record contained nursing documentation upon admission identifying patient choice of community physician as elected attending. The election of benefit form indicated patient chose not to elect an attending. Patient 8: The medical record contained nursing documentation upon admission identifying patient choice of community physician as elected attending. The election of benefit form indicated patient chose not to elect an attending.