Every finding on record at Curo Health Services, LLC

Upon patient record review, 2 of 5 records (Patient #2,#3) 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 #2: The medication profile contained duplicate orders dated 3/5/25 for Acetaminophen rectal suppository 650mg 1, q8h prn pain or fever. Patient #3: The medication profile contained Acetaminophen rectal supp 650mg q8h prn pain or fever without evidence of a parameter for the fever.

Upon patient record review, 1 of 5 records (Patient #3) did not have evidence that a Registered Nurse ensured continuous assessment of the patient and family's needs and coordinated 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: A triage note dated 2/25/25 at 5pm indicated a call from the facility that the patient had had an unwitnessed fall, with no noted injuries. The documentation indicated that a visit was needed. There was not evidence of a visit by the nurse until 3/3/25 at 9:29am.

Upon patient record review, 1 of 5 records (Patient #3) did not have evidence the plan of care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #3: The record contained an order for Acetaminophen rectal supp 650mg q8h prn pain or fever without evidence of a parameter for the fever.

Upon patient client record review, 1 of 5 records (Patient #3) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #3: The record indicated that the patient/representative wished to receive the “Patient Notification of Hospice Non-Covered Items, Services, and Drugs.” There was not evidence that this document was furnished.

Upon observation, there was no evidence the Emergency Plan communication plan includes all of the following: • Names and contact information for the following: • Hospice employees • Entities providing services under arrangement • Patients' physicians • Other hospices Corrected on site.

Upon observation, there was no evidence the Emergency Plan communication plan includes contact information for Federal, state, tribal, regional, or local emergency preparedness staff. Corrected on site.

Upon observation, there was no evidence the Emergency Plan communication plan must includes a primary and alternate means for communicating with hospice's employees and Federal, state, tribal, regional, and local emergency management agencies. Corrected on site.

Upon observation, there was no evidence the agency has conducted exercises to test the emergency plan every two years. The agency recorded a real event in 2024 but there was no evidence of an exercise or drill completed prior to 2024.

Upon patient record review, 2 of 19 (Patients #3,#9) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable state law. Patients 3,9: There was no evidence the patient/responsible parties received information on advance directives.

Upon patient record review, 2 of 19 (Patients #3,#9) did not have evidence that the hospice obtained the patient's or representative's signature confirming that they received a copy of the Patient's Rights and Responsibilities. Patients 3,9: There was no evidence the patient/responsible party received a copy of the Patient's Rights and Responsibilities.

Upon patient record review, 4 of 19 (Patients #3,#5,#9,#10) did not have evidence that the patient chooses a health care provider, including an attending physician. Patients 3,9: There was no evidence the agency honored the patient choice of a community attending physician to be involved with the plan of care. Patients 5,10: There was no evidence the agency honored the patient choice of a community attending physician to be involved with the plan of care since admission.

Upon patient record review 1 of 19 (Patient #6) 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 6: The medical record contained a comprehensive spiritual assessment completed 1/13/25 with start of care 1/4/25.

Upon patient record review, 5 of 19 (Patients #3,#4,#7,#9,#10) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 3: The medication profile contained amoxicillin started 11/25/24 listed as current medication. Patient 4: The medication profile contained zinc oxide topical cream with no location identified for administration. Patient 7: The medical record contained an order for oxygen equipment but the oxygen rate, frequency and delivery method was not on the medication profile. Corrected on site. Patient 9: Upon observation during home visit, the facility and hospice medication profiles did not match. The facility medication profile did not have lorazepam and morphine PRNs dated 6/13/24 on the hospice profile, and hospice did not have cranberry capsules, mirtazepine, senna-s, synthroid, and systane eye drops that were listed on the facility profile. Patient 10: Upon observation during home visit, the facility and hospice medication profiles did not match. The facility medication profile had oxygen and levothyroxine not on hospice profile. The facility also had senna 2 tablets twice daily compared to hospice 1 tablet twice daily. The hospice profile also contained benzonate that was not on the facility profile. The oxygen was corrected on site.

Upon patient record review, 1 of 19 (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 medical record contained an initial bereavement assessment completed 1/18/25 with start of care 1/9/25.

Upon patient record review, 2 of 19 (Patients #3,#9) did not have evidence in the patient record that the written plan of care is developed by the IDG, in consultation with the patient's attending physician, which specifies the services necessary to meet the patient and family-specific needs identified in the comprehensive assessment as it relates to the terminal illness and related conditions. Patient 3,9: There was no evidence the plan of care was developed in consultation with the attending physician.

Upon patient record review, 2 of 19 (Patients #2,#4) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs. Patient 2: There was no evidence of sacrum wound measurements and assessments from 1/2/25 to 1/29/25 as required weekly per agency policy. Patient 4: There was no evidence of right ankle wound measurements since 12/6/24 and no assessments since 12/27/24 as required weekly per agency policy.

Upon patient record review, 5 of 19 (Patients #2,#3,#6,#9,#14) 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 the patient has a history of seizures. There was no evidence of problems, goals, and interventions related seizure precautions included in the plan of care. Patient 3: The medical record contained nursing documentation upon admission identifying the patient receives tube feeding. There was no evidence of problems, goals, and interventions related to tube feedings included in the plan of care. Patient 6: The medical record contained nursing documentation upon admission identifying the patient is a high risk for skin impairment and primary diagnosis was heart failure. There was no evidence of problems, goals, and interventions related to cardiac dysfunction and risk for skin impairment included in the plan of care. Patient 9: The medical record contained nursing documentation upon admission identifying patient issues with dysphagia. There was no evidence of problems, goals, and interventions related to dysphagia included in the plan of care. Patient 14: The plan of care identified the patient as full code in error. The MOLST on file identified the patient as DNR. The record also contained nursing documentation upon admission identifying the patient has dementia. There was no evidence of problems, goals, and interventions related to neurological dysfunction included in the plan of care.

Upon patient record review, 4 of 19 (Patients #2,#3,#4,#7) 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 2: The medical record contained nursing documentation since admission identifying the patient received tube feedings. There was no evidence of an order for formula type, rate, and frequency. Corrected on site. Patient 3: The medical record contained nursing documentation since admission identifying the patient received tube feedings. There was no evidence of an order for formula type, rate, and frequency. Patient 4: The medical record contained an order for zinc oxide topical cream with no location identified for administration. Patient 7: The medical record contained an order for oxygen equipment but no order for oxygen rate, frequency, and delivery method. Corrected on site.

Upon patient record review, 9 of 19 (Patients #1,#2,#3,#5,#6,#8,#9,#10,#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 medical record contained nursing documentation upon admission identifying patient use of a walker. There was no evidence of an order for the walker included in the plan of care. Corrected on site. Patient 2: The medical record contained nursing documentation 1/13/25 identifying patient use of bedrails. There was no evidence of an order for the rails included in the plan of care. Corrected on site. Patient 3: The medication profile contained a prescription administered with a nebulizer. There was no evidence of an order for the nebulizer included in the plan of care. Corrected on site. Patient 5: The medical record contained nursing documentation upon admission identifying patient use of a walker and 12/30/24 identifying use of a wheelchair and fall matt. There was no evidence of orders for the DME included in the plan of care. Corrected on site. Patient 6: The medical record contained nursing documentation upon admission identifying patient use of a hospital bed, APP mattress, and wheelchair. There was no evidence of orders for the DME included in the plan of care. Corrected on site. Patient 8: The medication profile identified the patient use of oxygen. There was no evidence of an order for oxygen equipment included in the plan of care. Corrected on site. Patient 9: The medical record contained nursing documentation upon admission identifying patient use of a hospital bed and over bed table. There was no evidence of orders for the bed and table included in the plan of care. Patient 10: The medical record contained nursing documentation 1/2/25 identifying patient use of a nebulizer. There was no evidence of an order for the nebulizer included in the plan of care. Corrected on site. Patient 14: The medication profile contained a prescription administered with a nebulizer and during the home visit, it was observed the patient had a hospital bed, over bed table, wheelchair, commode, trapeze, and grab bars on the bed. There was no evidence of orders for the DME included in the plan of care. Corrected on site.

Upon patient record review, 4 of 19 (Patients #3,#5,#9,#10) 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. Patients 3,5,9,10: There was no evidence of collaboration with the attending physician to update the plan of care no less frequently than every 15 days.

Upon patient record review, 3 of 19 (Patients #1,#9,#14) 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 1: The medical record contained a MOLST dated 12/17/24 identifying the patient code status was changed from full code to DNR. There was no evidence the plan of care was updated to reflect the patient is DNR. Corrected on site. Patient 9: The medical record contained nursing documentation 11/27/24 identifying the patient is a high risk for skin impairment. There was no evidence the plan of care was updated with problems, goals, and interventions related to skin. Patient 14: The medical record contained nursing documentation 12/20/24 identifying the patient is a high risk for falls. There was no evidence the plan of care was updated with problems, goals, and interventions related to fall safety.

Upon patient record review, 1 of 19 (Patient #8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 8: The medical record contained an order for nurse visits twice weekly. There was no evidence of second visits completed the weeks of 12/1/24, 12/8/24, and 12/15/24.

Upon patient record review, 3 of 19 (Patients #15,#16,#17) did not have evidence the hospice offers bereavement counseling that includes: • Ensuring that bereavement services reflect the needs of the bereaved Patients 15,16: The bereavement care plan contained incomplete tasks including memorial service invitation, support group invitations, and holiday letters. Patient 17: The bereavement care plan contained incomplete tasks including memorial service invitation and support group invitations.

Upon patient record review, 1 of 19 (Patient #13) did not have evidence in the patient record that hospice aide assignments and duties are specific to the patient's needs. Patient 13: The aide care plan contained transfer instructions 1 person assist. The medical record contained nursing documentation since 11/11/24 identifying patient requires a 2 person assist to transfer. Corrected on site.

Upon patient record review 4 of 19 (Patients #1,#8,#13,#14) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group Patient 1: The medical record contained an order for aide frequency of twice weekly visits. There was no evidence of aide visits completed the week of 12/15/24. Patient 8: The medical record contained an order for aide frequency of twice weekly visits. There was no evidence of a second visit completed the week of 12/22/24. Patient 13: The medical record contained an order for aide frequency of three weekly visits. There was no evidence of a third visit completed the weeks of 12/8/24, 12/15/24, and 12/22/24. Patient 14: The medical record contained an order for aide frequency of twice weekly visits. There was no evidence of a second visit completed the week of 12/8/24.

Upon patient record review 2 of 19 (Patients #3,#4) 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 3: There was no evidence of an aide supervisory visit from 12/16/24 to 1/14/25. Patient 4: There was no evidence of an aide supervisory visit from 12/27/24 to 1/17/25.

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 agency's volunteer utilization rate was 1.4% for 2024.

Upon personnel record review, 1 of 15 (Personnel #12) did not have evidence the hospice employees and contract employees have received orientation on the hospice philosophy. Personnel 12: There was no evidence of orientation in the personnel file.

Upon personnel record review, 2 of 15 (Personnel #4,#12) did not have evidence that the hospice employees have received orientation on their specific job requirements. Personnel 4: There was no evidence of orientation to the employee's current role. Personnel 12: There was no evidence of orientation in the personnel file.

Upon patient record review, 2 of 19 (Patients #3,#9) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 Patients 3,9: There was no evidence the patients/responsible parties received patient rights.

Upon patient record review, 2 of 19 (Patients #3,#9) did not have evidence that each patient record contains Physician certification and recertification of terminal illness. Patient 3,9: There was no evidence of initial certification of terminal illness received from the attending physician.

Upon patient record review, 4 of 19 (Patients #3,#4,#12,#13) did not have evidence that each patient record contains Advance Directives. Patient 3: The medical record contained social work documentation 12/23/24 identifying the patient is DNR. There was no evidence of a DNR order or MOLST form in the record. Patients 4,12: The plan of care identified patient as both full code and DNR. There was no evidence of a DNR order or MOLST form in the record. Patient 13: The medical record contained consent paperwork upon admission identifying the patient has a living will. There was no evidence of a copy of the will in the record.

Upon patient record review, 2 of 19 (Patients #4,#12) 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 4,12: The plan of care identified the patient a both full code and DNR.

Upon patient record review, 2 of 19 (Patients #3,#9) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed. Patients 3,9: There was no evidence the patients/responsible parties received policies for managing controlled drugs.

Upon patient record review, 1 of 19 (Patient #9) did not have evidence that the hospice provided the following information: • Physician certification and recertification of the terminal illness specific to each patient Patient 9: During observation on the home visit, there was no evidence the facility was provided the physician certification and recertifications of the terminal illness.

Upon personnel record review, 1 of 15 (Personnel #12) did not have evidence the hospice obtained a criminal background check on all contracted individuals who have direct patient care and access to patient records. Personnel 12: There was no evidence of a criminal background check in the personnel file.

Upon patient record review, 1 of 5 (Patient #1) 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 #1 The 4/13/22 plan of care reads SN to maintain and teach colostomy care however colostomy care interventions is not specified.

Upon patient record review, 3 of 13 records (Patients #8,#11) 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. Patient 7: The medication profile contained medihoney with instructions for application to sacral wound. The wound was inactivated 9-29-21 but medication was not removed from the profile. Corrected on site. Patient 8: The medication profile contained miralax without instructions for a diluent and oxygen without instructions for a delivery method. Corrected on site. Patient 11: The medication profile contained oxygen without instructions for a delivery method.

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

Upon patient record review, 7 of 13 records (Patients #1,#2,#4,#6,#7,#9,#11) 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 1: The plan of care included an active problem identified for need for continuous care. This problem was not accurate to the patient. Patient 2: The plan of care included an active problem for need for respite care. This problem was no longer appropriate as of 2-17-22 after discharge from respite. Corrected on site Patient 4: The plan of care included active need for skilled teaching and monitoring of oxygen and oxygen equipment listed on the plan of care. The patient was no longer on oxygen. Corrected on site. Patient 6: The medical record contained documentation identifying dysphagia with documented coughing episode witnessed while eating. There was no evidence of problems, goals, and interventions related to dysphagia or aspiration risk. Patient 7: The plan of care included active problems for need for wound care, altered skin integrity, need for feeding intervention and need for skilled teaching related to bowel incontinence and cancer. There was no evidence of goals and interventions for the problems identified in the plan of care. Corrected on site. Patient 9: The medical record contained nursing documentation 2-21-22 identifying patient at high risk for skin breakdown. There was no evidence of problems, goals, and interventions related to risk for skin impairment. Patient 11: The medical record contained nursing documentation identifying patient use of indwelling catheter. There was no evidence of problems, goals, and interventions related to catheter care and maintenance.

Upon patient record review, 4 of 13 records (Patients #7,#8,#11,#13) 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 7: The medical record contained nursing documentation by the RN 2-2-22 and by the NP 3-7-22 identifying patient diet restrictions to pureed in the first note and mechanical soft in the second. The medical record also contained a wound order 11-24-21 with no location of wound identified. Patient 8: The medical record contained nursing documentation identifying patient use of foley catheter. There was no evidence of an order for indwelling catheter size and maintenance. Corrected on site. Patient 11: The medical record contained nursing documentation upon admission identifying patient use of foley catheter. There was no evidence of an order for indwelling catheter size and maintenance. Corrected on site. Patient 13: The medical record contained nursing documentation upon admission identifying wounds to the buttocks and lower left extremity. There was no evidence of treatment orders to address care for the wounds.

Upon patient record review, 8 of 13 records (Patients #1,#5,#6,#8,#9,#10,#11,#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 the patient uses a walker for mobility. There was no evidence of the walker included as equipment on the plan of care. Corrected. Patient 5: The medication profile identified patient use of oxygen. There was no evidence of the oxygen equipment and supplies included on the plan of care. Corrected Patient 6: The medication profile identified patient use of oxygen and a nebulizer. There was no evidence of the oxygen equipment and supplies or nebulizer included on the plan of care. Corrected. Patient 8: The medical record contained nursing documentation upon admission identifying patient use of wheelchair and the medication profile identified use of oxygen. There was no evidence of the wheelchair and oxygen equipment included on the plan of care. Corrected. bed and air mattress. Patient 9: The medical record contained nursing documentation 3-2-22 identifying patient use of geri-chair. During home visit it was observed that the patient also was in possession of a hospital bed and air mattress. There was no evidence of the geri-chair, bed and mattress included on the plan of care. Corrected Patient 10: The medical record contained nursing documentation upon admission identifying patient use of chronic foley catheter. There was no evidence of the catheter supplies included on the plan of care. Patient 11: The medication profile identified patient use of oxygen. There was no evidence of the oxygen equipment and supplies included on the plan of care. Patient 12: The medical record contained nursing documentation upon admission identifying patient has a colostomy. There was no evidence of the colostomy supplies included on the plan of care.

Upon client record review, 3 of 5 applicable records (Patients #1,#2,#4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: The medical record contained nursing frequency orders of twice weekly. There was evidence of one visit completed the week of 1-30-22. The medical record also contained nursing documentation identifying that the nurse changed the patient's catheter 1-27-22. There was no evidence of an order to change catheter included in the plan of care. Patient 2: The medical record contained nursing frequency orders of once weekly. There was no evidence of a visit completed the week of 2-27-22. Patient 4: The medical record contained nursing frequency orders of twice weekly. There was evidence of one visit completed the week of 2-27-22. Patient 4: The medical record contained nursing documentation 3-6-22 identifying insertion of foley catheter. There was no evidence of an order for indwelling catheter size and maintenance. Corrected on site.

Upon patient record review, 1 of 11 applicable records (Patient #2) did not have evidence in the patient record that hospice aide assignments and duties indicate what tasks are to be done by the Aide and the frequency of these tasks. Patient 2: The medical record contained an aide care plan with two types of bathing tasks: shower weekly and bathing-chair every visit. Corrected on site.

Upon patient record review 2 of 11 applicable records (Patients #2,#4) 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 2: The medical record contained aide frequency order of twice weekly. There was no evidence of aide visits completed the weeks of 10-20-21 and 11-7-21 and one visit completed the weeks of 10-24-21 and 10-31-21. Patient 4: The medical record contained aide frequency order of twice weekly. There was evidence of one visit completed the week of 2-27-22.

Upon patient client record review, 2 of 13 records (Patients #1,#13) did not have evidence that each patient record contains signed election statement in accordance with 418.24. Patient 1: The medical record contained an election of benefit form with request to receive the Notice of Hospice Non-Covered Items. There was no evidence that the patient/family received the form. Patient 13: The medical record contained an election of benefit form with request to receive the Notice of Hospice Non-Covered Items. There was no evidence that the patient/family received the form.

Upon patient client record review, 1 of 13 (Patient # 11) 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 11: There was no evidence the initial plan of care and CTI were signed by the attending physician.

Upon client record review, 2 of 8 applicable records (Patient #5 #8) 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 medical record contained nursing frequency orders of twice weekly. There was evidence of one visit completed the week of 1-30-22. Patient 8: The medical record contained nursing documentation identifying catheter changes were completed 12-2-21 and 2-14-22. The facility order was for ordered frequency for change was once monthly and hospice nursing documented the order frequency, however no order was in the hospice records.

Upon personnel record review, 1 of 14 (Personnel #1) did not have evidence of criminal background checks being obtained in accordance with state requirements. Personnel 1: There was no evidence of a criminal background check in the personnel file.