Every finding on record at Curo Health Services, LLC

Upon patient record review, 1 of 19 (Patient #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 #14 - SN visit note 01/17/24 "Patient took last dose of Z-PAC today" medication was never added to medication profile.

Upon patient record review, 1 of 19 (Patient #7) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family Patient #7 - Facility called on 01/18/24 regarding painful urination and hematuria and requested UA - nurse on call approved UA but no visit made to patient until 01/23/24.

Upon patient record review, 3 of 19 (Patient #7, 16,19) did not have evidence the plan of care must 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 #7 - Vol visit frequency effective 11/21/23 1wk1, 1 PRN Patient #16 - POC MSW visit frequency 1wk1, 6 PRN Patient #19 - POC MSW visit frequency 1wk1, 6 PRN

Upon patient record review, 2 of 19 (Patient #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 #13 - No order for PT/INR completed on 12/14/23. Patient #14 - POC dated 12/25/23 - no order for type of foley catheter or when to change.

Upon client record review, 1 of 19 (Patient #18) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #18 - MSW visit frequency 1 within every 30 days - MSW made visit on 12/10/23 then again on 01/05/24 - 2 visits made within 29 days.

Upon patient record review, 2 of 19 (Patient #2, 4) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient #2, 4 - Did not have evidence that the bereavement services (calls and letters) were provided as developed in the POC.

Upon patient record review 2 of 19 (Patient #16, 17) 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 #16 - Aide care plan task change linen 1 x week but aide completed 2 x week - week of 01/14/24 and 01/21/24. Patient #17 - Aide care plan to weigh patient first week of the month - no weights documented in December or January.

Upon patient record review 1 of 19 (Patient #17) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient #17 - Aide supervisory visit completed on 12/19/23 then again on 01/03/24 - 15 days between supervisory visits.

Upon personnel record review, 3 of 16 (Personnel #8, 9, 10) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Employee #8, 9, 10 did not have evidence of a skills competency assessment.

Upon patient client record review, 2 of 19 (Patient #9, 16) 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 #9 - VC visit 1x1 - Visit note only contained that visit was made. Patient #16 - VC visit 1x1 - Visit note only contained that visit was made.

Based on clinical record review, nursing home clinical record review, nursing home staff interview and hospice staff interview, the hospice failed to ensure the nursing home received copies of all required documents including physician certification of terminal illness specific to the patient, hospice benefit election form, interdisciplinary group plan of care updates, and names and contact information for hospice personnel for 1 of 1 sampled patients (Patient #1) with home observation visit in the nursing home. Failure to ensure the hospice staff provided the required documentation to the nursing home staff placed the patient at risk for receiving inadequate care and/or treatments needed to meet the individual needs of the patient. --- Findings include: Patient #1 had a hospice admission date of 11/30/22 and received routine home care hospice services while residing in a nursing home. Clinical record review revealed: a. An initial certification of terminal illness (CTI) form, dated 11/30/22, and subsequent CTI form, dated 2/17/23. b. A Medicare Benefit Election form, dated 11/30/22. c. Interdisciplinary group (IDG) plan of care updates, dated 12/9/22, 12/23/22, 1/6/23, 1/20/23, 2/3/23, 2/17/23, 3/3/23, 3/16/23 and 3/31/23. On 4/11/23 at 8:30 AM, during a home visit observation with Staff C, Registered Nurse (RN), the surveyor reviewed the patient nursing home record and identified IDG plan of care updates, dated 12/9/22, 1/6/23 and 3/31/23. Staff C, RN, provided the surveyor with the nursing home hospice binder, that contained hospice documents for multiple patients in the nursing home. The surveyor identified Patient #1 hospice Medicare benefit election form, dated 11/30/23, printed 4/11/23 at 7:52 AM, and the subsequent CTI, dated 2/17/23, printed 4/11/23 at 9:11 AM. The surveyor was unable to locate names and contact information for hospice personnel for Patient #1. Staff C RN reviewed the patient nursing home record and nursing home hospice binder and confirmed no other documents available. The hospice printed a copy of the Medicare benefit election form and subsequent CTI on 4/11/23, after the surveyor had scheduled the nursing home visit on 4/10/23 at 4:40 PM with Staff B, Senior Director of Professional Services. During an interview on 4/11/23 at 10:15 AM, Staff B, Senior Director of Professional Services, reported IDG plan of care updates are printed weekly by team coordinator who placed printed document in RN case manager (CM) folder. RN CM is responsible for checking folder weekly for printed documents, hand deliver the printed documents to nursing home and files the documents in patient nursing home record. On 4/11/23 at 4:14 PM, the surveyor spoke with the nursing home medical record coordinator and requested copies of the IDG plan of care updates and the initial CTI, dated 11/30/22. Medical record coordinator will review thinned documents, nursing home patient record and nursing home hospice binder for missing documents. On 4/12/23 at 2:45 PM, nursing home medical record coordinator reported able to locate IDG plan of care updated, dated 12/23/22, but unable to locate the IDG plan of care update, dated 1/20/23; and the initial CTI, dated 11/30/22. The hospice failed to provide the nursing home with the required documents that included the initial and subsequent CTIs, Medicare benefit election form, the IDG plan of care update, dated 1/20/23, and names and contact information for hospice personnel. Staff B, Senior Director of Professional Services, received the above findings and hospice staff provided no further information prior to the end of the survey.