Every finding on record at Curo Health Services, LLC

Upon patient record review, 2 of 14 (Patient #3,#6) 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 3: Patient admitted with secondary dx of heart failure and currently takes ASA daily. No evidence that intervention and goals for cardiac status or risk for bleeding related to the ASA usage included in the current plan of care. Patient 6: Patient admitted with secondary dx of heart failure and currently takes ASA daily. No evidence that intervention and goals for cardiac status or risk for bleeding related to the ASA usage included in the current plan of care.

Upon patient record review, 1 of 14 (Patient #9) 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 9: Initial POC orders for SW and SC written as 1 PRN, without evidence of defined scope and frequency.

Upon patient record review, 1 of 14 (Patient #9) 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 9: Medication profile has an order for oxygen at 2LNC continuously. The record shows that the patient titrates the oxygen as needed to control shortness of breath. No evidence that titration instructions were added to the current medication order

Upon patient record review, 1 of 14 (Patient #7) 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 7: The record shows that the patient has refused SW services on 08/05/2024. The SW documented such and placed that information in her IDG documentation. The SW continued to attempt to make visits/phone calls at the ordered frequency even though the patient continues to refuse SW services. No evidence that an order was received to discontinue visits or that the plan of care was updated to reflect the patient no longer having a need for social services.

Upon client record review, 1 of 14 (Patient #10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 10: Plan of care indicates SN frequency as twice a week. The record did not indicate that the patient received a 2 visits during the week of June 2nd. Missed visit note entered stated that the visit was missed due to time constraints. No evidence that the visit was missed at the request of the patient/caregiver or that an order was obtained to miss visit at the time that chart was reviewed.

Upon patient record review 1 of 14 (Patient #8) 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 8: Aide POC had orders for nail care and shampoo to be completed once a week. Aide visit frequency is ordered as twice a week. The record indicated that the patient received nail care and shampoo at every visit on the following weeks: 07/21, 8/4, 8/11, 8/18, 09/01, 09/8, 9/15, and 9/22.

Upon patient client record review, 2 of 14 (Patient #7,9) 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 7: The record shows a missed visit note entered by the SW on 08/02/2024 that was incomplete. The note did not list the date that the actual visit was missed and did not list who she notified that the visit was missed. Patient 9: The record shows a missed visits note entered by the RN on 09/13/2024 that was incomplete. The note did not list the date that the actual visit was missed. SC entered a missed visit note on 07/18 that was incomplete. The note did not indicate who he notified that the visit was missed.

Upon patient record review, 1 of 13 (Patient #5) 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 record indicated 3 active medication orders for Percocet. On 9/22/2021, Percocet 5/325mg po QAM was ordered, on 9/24/2021 Percocet 5/325mg po BID for pain greater than 4 was ordered and on 10/19/2021 Percocet 5/325mg po Q4 hour PRN pain was ordered. It was unclear which orders were correct and no evidence to support that any of the previous active orders had been discontinued. Corrected on site.

Upon patient record review, 1 of 13 (Patient #3) did not have evidence that a Registered Nurse ensured 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 #3: Upon admission, the record indicated that the patient had an active groin rash that was being treated with Calmoseptine cream and Nystantin powder. No evidence to indicate any further assessment or follow up for the rash was performed.

Upon patient record review, 1 of 13 (Patient #5) 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 #5: The record indicated 3 active medication orders for Percocet. On 9/22/2021, Percocet 5/325mg po QAM was ordered, on 9/24/2021 Percocet 5/325mg po BID for pain greater than 4 was ordered and on 10/19/2021 Percocet 5/325mg po Q4 hour PRN pain was ordered. No evidence to support that an order to discontinue the previously ordered doses existed. Corrected on site.

Upon patient record review, 2 of 2 applicable (Patient #12, #13) 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 Patient #12: The Bereavement Care Plan indicated that the patient was to be sent a sympathy card by 7/31/2021, a memorial event mailing by 8/16/2021, a 3 month support group invite by 10/15/2021 and a 3 month quarterly newsletter by 10/15/2021. No evidence to support if and when these items were sent. Patient #13: The Bereavement Care Plan indicated that the patient was to be sent a sympathy card by 7/11/2021, a memorial event mailing by 7/27/2021, a 3 month support group invite by 9/25/2021 and a 3 month quarterly newsletter by 9/25/2021. No evidence to support if and when these items were sent.

Upon patient record review, 1 of 12 (Patient #10) did not have evidence in the patient record that hospice aide assignments and duties are: • 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; specifically indicate what tasks are to be done by the Aide and the frequency of these tasks. Patient #10: Record indicated SN notes dated 10/7/2021 and 10/14/2021 that the patient "no longer attempts to get out of bed". The aide care plans dated 10/5/2021 and 10/20/2021 indicated that the aide was to assist patient at each visit from Chair/Bed. No evidence that the plan of care was updated to reflect the patients inability to get in and out of bed.

Upon patient record review 1 of 12 (Patient #9) 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 Patient #9: Initial Hospice Plan of Care ordered for HHA 1w12 effective 7/25/2021. No evidence that a visit by the HHA was performed that week. The first documented visit occurred on 8/6/2021.

Upon patient client record review, 2 of 13 (Patient #2, #10) 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 #2: Initial nurses note dated 3/30/2021 indicated that the patient did not want to receive the Addendum Statement for Non-covered items. Upon further review of the electronic medical record, the Addendum Election Statement had been requested on 3/30/2021. It was unclear if the Addendum was requested or not. (Staff indicated that the patient did not want it) Patient #10: Record indicated in the SN visit note dated 10/19 "spoke with nurse practitioner Carrie about this and we are immigrants and it could possibly be due to aspiration.." The meaning of this statement is unclear.

Upon client record review, 1 of 3 applicable (Patient #3) 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 #3: Upon review, the Initial Plan of care dated 9/15/2021 ordered for the foley catheter to be changed by the hospice skilled nurse every 30 days. No evidence that this occurred up to and including the date of survey (10/20/2021).