Every finding on record at Curo Health Services, LLC

Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient 1: The medical record contained an election form identifying patient choice of an NP to act as attending physician. There was no evidence the agency received medication orders from the attending or included the attending in care planning.

Upon patient record review, 2 of 14 (Patients #3,#4) 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 a topical lidocaine patch with no area defined for administration and duplicative scheduled MS Contin instructions for 30 mg three times daily dated 2/1/24 and 15 mg twice daily 3/4/24. Corrected on site. Patient 4: The medication profile contained duplicative continuous oxygen instructions for 4LPM dated 1/5/24, and 6L 2/29/24. Corrected on site.

Upon patient record review, 4 of 14 (Patients #3,#4,#5,#9) 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: The medical record contained nursing documentation upon recertification 2/19/24 identifying dyspnea and circulatory issues. There was no evidence of problems, goals, and interventions related to circulatory and respiratory dysfunction included in the plan of care. Corrected on site. Patient 4: The plan of care contained problems, goals, and interventions to be completed by the social worker. Social work frequencies were order to be discontinued. Corrected on site. Patient 5: The medical record contained nursing documentation 2/16/24 identifying patient is at risk for aspiration. There was no evidence of problems, goals, and interventions related to dysphagia or risk of aspiration included in the plan of care. Corrected on site. Patient 9: The medical record contained nursing documentation upon recertification 1/11/24 identifying dysphagia with recurrent aspiration and risk for falls. There was no evidence of problems, goals, and interventions related to dysphagia or risk of aspiration and fall safety included in the plan of care. Corrected on site.

Upon patient record review, 1 of 14 (Patient #10) 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 10: The medical record contained a recertification visit frequency order for PRN visits only for social work and spiritual care. There was no evidence of an order for anticipated needs or declination of ongoing needs. Corrected on site.

Upon patient record review, 1 of 14 (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 medications and treatments. Patient 3: The medical record contained an order for a topical lidocaine patch with no area defined for administration. Corrected on site.

Upon patient record review, 4 of 14 (Patients #1,#3,#4,#8) 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 wheelchair. There was no evidence of an order for a wheelchair included in the plan of care. Corrected on site. Patient 3: The medical record contained nursing documentation upon admission identifying patient use of a walker. There was no evidence of an order for a walker included in the plan of care. Corrected on site. Patient 4: The medical record contained nursing documentation upon admission identifying patient use of a wheelchair, mechanical lift, nebulizer, and oxygen equipment. There was no evidence of orders for the listed equipment included in the plan of care. Corrected on site. Patient 8: The medical record contained nursing documentation upon admission identifying patient use of a walker. There was no evidence of an order for a walker included in the plan of care. Corrected on site.

Upon client record review, 3 of 14 (Patients #1,#6,#10) 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 an ordered social work visit frequency of two visits every 30 days. There were three scheduled visits completed in February on 2/1/24, 2/16/24, and 2/27/24. Patient 6: The medical record contained nursing documentation since recertification identifying oxygen was administered at 8LPM. The order for oxygen states 6.5LPM continuous. Patient 10: The medical record contained an ordered spiritual care frequency of one visit every 30 days. There were two scheduled visits completed in February on 2/7/24 and 2/27/24.

Upon personnel record review, 1 of 13 (Personnel #5) did not have evidence in the personnel file that the hospice aide had received at least l2 hours of in-service training during each 12-month period. In-service training may occur while an aide is furnishing care to a patient. Personnel 5: There was no evidence the aide received 12 hours of in-service training.

Upon patient record review, 1 of 14 (Patient #1) did not have evidence in the patient record that hospice aide assignments and duties are specific to patient needs. Patient 1: The aide care plan did not contain instructions on assistance needed for transfers. Corrected on site.

Upon patient record review 3 of 14 (Patients #1,#3,#7) 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 1: The medical record contained an ordered aide frequency of three times weekly. There was no evidence of third visits completed the weeks of 1/21/24, 1/28/24, 2/4/24, 2/11/24, and 2/25/24. The aide care plan contained a bathing task of bed bath. The aide documented giving showers from 1/18/24 to current during all visits and stated patient is 2 assist with transfer 1/18/24. There was no task with instructions for transfers. Patient 3: The medical record contained an ordered aide frequency of twice weekly. There was no evidence of a second visit completed the week of 2/25/24. Patient 7: The medical record contained an ordered aide frequency of three times weekly. There was no evidence of one visit completed the weeks of 2/18/24 and 2/25/24.

Upon personnel record review, 1 of 13 (Personnel #3) did not have evidence that the hospice employees have received orientation on their specific job requirements. Personnel 3: There was no evidence of orientation to specific job requirements as alternate DPCS.

Upon patient client record review, 2 of 14 (Patients #3,#5) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient 3: The medical record contained an election form identifying date of election 9/9/23 that was signed on start of care date 9/16/23. Agency notified corporate compliance for instructions on resolution during survey. Patient 5: The medical record contained documentation identifying the patient representative elected to receive the Notification of Non-Covered Items upon admission. There was no evidence the notification form was received.

Upon patient client record review, 1 of 14 (Patient #14) did not evidence that each patient record contains physician orders. Patient 14: There was no evidence of an order to discharge patient for extended prognosis.

Upon personnel record review, 1 of 13 (Personnel #13) did not have evidence that all Speech Therapy Services are provided by a qualified licensed Speech-Language Pathologist (SLP) or Audiologist in accordance with the state's Speech-Language Pathology Practice Act and the hospice's policies and procedures and/or job descriptions. Personnel 13: There was no evidence of current licensure for speech pathology.

Upon personnel record review, 1 of 13 (Personnel #13) 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 13: There was no evidence of a criminal background check.