Every finding on record at Curo Health Services, LLC

Upon patient record review, 4 of 14 (Patients #1,#4,#6,#10) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 1: Upon home visit medication reconciliation, the facility and hospice medication profiles did not match. The facility profile identified oxygen to be administered while patient sleeping and hospice stated as needed. The hospice agency's profile also contained guaifenesin and simethicone PRNs that were not on the facility profile. Corrected on site with order clarification to discontinue guaifenesin and simethicone and change oxygen instructions. Patient 4: The medication profile contained duplicative lorazepam PRN listing for three times a day as needed and every two hours as needed, both with same indications. After agency investigation, one PRN was supposed to be every five minutes up to three doses for seizure protocol and every two hours as needed for agitation. Corrected on site with order clarifications and correction of medication profile. Patient 6: The medication profile contained duplicative senna PRNs dated 5/21/25 and 7/29/25. Corrected on site with update of medication profile. Patient 10: The medication profile contained Mirilax oral powder with no instructions to mix with a diluent. Corrected on site with order clarification and correction of medication profile.

Upon patient record review, 1 of 14 (Patient #5) 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 5: The initial bereavement assessment was completed 1/6/25 with admission 12/31/24.

Upon patient record review, 3 of 14 (Patients #1,#4,#10) 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: During home visit medication reconciliation, the facility had orders for oxygen while the patient was sleeping. The hospice order for oxygen was PRN. Corrected on site with order clarification. Patient 4: The medical record contained duplicative lorazepam PRN orders for three times a day as needed and every two hours as needed, both with same indications. After agency investigation, one PRN order was supposed to be every five minutes up to three doses for seizure protocol and every two hours as needed for agitation. Corrected on site with order clarification. Patient 10: The medical record contained an order for Miralax oral powder with no instructions to mix with a diluent. Corrected on site with order clarification.

Upon client record review, 2 of 14 (Patients #3,#7) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient 3: The election form identified patient choice of a community physician as their attending physician. There was no evidence of plan of care collaboration with the attending since admission. Patient 7: The medical record contained documentation of a change in attending to a community NP. There was no evidence of plan of care collaboration with the attending.

Upon patient record review, 1 of 14 (Patient #11) 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. • Ensuring that bereavement services reflect the needs of the bereaved Patient 11: The bereavement care plan contained tasks for a 6 month follow up call to the son and a 6 month reassessment for the daughter-in-law. There was no evidence of these tasks being completed.

Upon patient record review, 2 of 14 (Patients #3,#5) did not have evidence in the patient record that hospice aide assignments and duties are specific to patient needs. Patient 3: The medical record contained nursing documentation regarding wound care with dressings to the right hip. There was no evidence of instructions regarding the wound included in the aide care plan. Corrected on site with aide care plan update. Patient 5: The medical record contained nursing documentation identifying patient is a total assist for transfers. There was no evidence of transfer instructions included on the aide care plan. Corrected on site with aide care plan update.

Upon patient client record review, 1 of 14 (Patient #11) did not have evidence that each patient record contains Advance Directives. Patient 11: The plan of care identified the patient as DNR. There was no evidence of supporting evidence for the code status such as a POLST or living will.

Upon patient client record review, 1 of 14 (Patient #3) 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 3: The medical record contained nursing documentation upon admission identifying patient use of a CPAP. After agency inquiry after request for orders, the patient was not using a CPAP and the documentation was in error.

Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the hospice provided the following information: • Physician certification and recertification of the terminal illness specific to each patient Patient 1: During home visit observation, the facility did not have the CTIs with the hospice information provided by the agency.

Upon client record review, 1 of 8 (Patient #1) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1 Order dated 5/23 for SC stated 4x within 30 days and 3 prn: visits on 6/2, 6/17 and 6/24. One visit missing and one late (6/24). No evidence of missed visit documentation nor order to correct frequency.

Upon patient record review, 1 of 3 applicable (Patient #3) 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 #3: Aide care plan dated 5/27/22 assigned tasks emotional support and make bed however no frequency assigned.