Every finding on record at Curo Health Services, LLC

Upon patient record review, 2 of 19 (Patient #7,#8) 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#7: The medication profile contained lidocaine 4% topical patch with no specified area of application. Corrected on site. Patient#8: The record indicates that RN documented on 4/11/25 visit that patient was starting to take CBD oil gummies to assist with ongoing issues with insomnia. There is no evidence of this remedy listed on medication profile. Corrected on site.

Upon patient record review, 3 of 19 (Patient #2,#8,#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#2: The record indicates patient requires foley catheter and compression boots. There is no evidence of goals and interventions for these items noted on plan of care. Corrected on site. Patient#8: The record indicates the patient has bleeding precautions noted on aide plan of care but there is no evidence of this on plan of care. Additionally, it is documented on RN visit 4/11/25 and 4/8 that patient is having recurrent issues with insomnia and started CBD gummies, There is no evidence of problems with goals or interventions related to this issue noted on plan of care. Corrected on site. Patient#9: The record indicates that patient requires use of suction. There is no evidence of goals or interventions related to this. Additionally, the aide plan of care indicates the need for respiratory and fall precautions. There is no evidence of goals and interventions for these precautions on the plan if care. Corrected on site.

Upon patient record review, 4 of 19 (Patient #1,#6,#9,#11) 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: The record indicates that oxygen was discontinued. There is no evidence of an order to discontinue oxygen. Corrected on site. Patient#6: The record indicates that wound care was discontinued and that patient was placed on a pureed diet with thickened liquids. There is no evidence of an order for these needs. Corrected on site. Patient#9: The record indicates the patient requires ensure as a nutritional supplement. There is no evidence of an order for this. Corrected on site. Patient#11: The record indicates the patient requires boost as a nutritional supplement. There is no evidence of an order for this. Corrected on site.

Upon patient record review, 2 of 19 (Patient #2,7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient#2: The record indicates SN frequency is ordered at 2 times per week. There is only evidence of one SN visit for the week of 12/22/24. In addition, the record indicates that the foley was discontinued. There is no evidence of an order to discontinue the foley. Foley order-Corrected on site. Patient#7: The record indicates that the foley was discontinued. There is no evidence of an order to discontinue the foley. Corrected on site.

Upon patient record review 1 of 19 (Patient #2) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient#2: Documentation in IDG noted 1/28/25 indicates daughter of patient requested referral to podiatrist. There is no evidence this was followed up on or that podiatrist visit occurred.

Upon patient record review, 1 of 19 (Patient #12) 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#12: The aide plan of care states for aide to shave patient "per patient request as needed". Corrected on site.

Upon patient record review 1 of 19 (Patient #2) 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#2: The aide supervisory visit on 11/18/24 states that no aide services provided and did not complete the supervisory visit. However an aide documented a completed visit on 11/17/24.

Upon observation, there was no evidence the hospice documented the cost savings achieved through the use of volunteers. Documentation must include the following: • The identification of each position that is occupied by a volunteer • The work time spent by volunteers occupying those positions • Estimates of the dollar costs that the hospice would have incurred if paid employees occupied the positions identified in paragraph (d)(1) of CFR 418.78 for the amount of time specified in paragraph (d)(2) of CFR 418.78 There is no evidence of a completed cost savings report.

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 evidence shows that the volunteer hours equaled 0% for 2024.

Upon patient record review, 1 of 19 (Patient #2) 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: An aide supervisory visit was completed on 1/21/25 however, there were no aide services at this time. Additionally, an aide supervisory visit was made on 2/4/25 states that yes an aide visit was completed in that last 14 days. There were no aide services provided during the last 14 days.

Upon patient record review, 5 of 13 records (Patients #1,#2,#3,#7,#8) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient 1, 2, 3, 7, and 8: The medical record contains election of benefit form identifying patient chose to elect a community physician as their attending. There is no evidence of agency adherence to patient choice of attending physician after admission. All orders received for medication and treatment changes were received from the hospice nurse practitioner or medical director.

Upon patient record review, 3 of 13 records (Patients #5,#11,#13) did not have evidence in the patient record that a review was completed of all prescription and nonprescription medications, including herbal remedies that could affect drug therapy. Patient 5: The plan of care identifies oxygen concentrator as DME. There is no evidence of oxygen listed on the medication profile. Corrected on site. Patient 11: The medication list contained oxygen with a frequency of daily. There was no defined frequency of continuous or as needed and no defined delivery method. Patient 13: The medical record contained nursing documentation 9/18/22 and 9/20/22 identifying patient use of oxygen. There was no evidence of oxygen included on the medication profile.

Upon patient record review, 6 of 13 records (Patients #2,#3,#9,#10,#12,#13) 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 2: The medical record contains an initial bereavement assessment dated 5/9/22. Patient admission to hospice was 2/1/22. Patient 3: The medical record contains an initial bereavement assessment dated 1/21/22. Patient admission to hospice was 1/13/22. Patient 9: The medical record contains an initial bereavement assessment dated 2/17/22. Patient admission to hospice was 1/20/22. Patient 10: The medical record contains an initial bereavement assessment dated 2/23/22. Patient admission to hospice was 9/11/21. Patient 12: The medical record contains an initial bereavement assessment dated 2/17/22. Patient admission to hospice was 12/13/21. Patient 13: The medical record contains an initial bereavement assessment dated 9/29/21. Patient admission to hospice was 9/8/21.

Upon patient record review, 3 of 13 records (Patients #1,#3,#7) 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 contains active problem for patient need for wound care. There is no evidence of goals and interventions related to wound care. Corrected on site. Patient 3: The medical record contains nursing documentation 3/24/22 identifying patient has colostomy requiring care. There is no evidence of problems, goals, and interventions related to colostomy care. The plan of care also included an active aide care plan and patient was not receiving aide services. Corrected on site. Patient 7: The plan of care includes problems, goals, and interventions related to patient need for continuous care. There is no evidence patient received continuous care. Corrected on site.

Upon patient record review, 2 of 13 records (Patients #5,#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 5: The plan of care identifies oxygen concentrator as DME. There is no evidence of an order for oxygen in the medical record. Corrected on site. Patient 13: The medical record contained nursing documentation 9/18/22 and 9/20/22 identifying patient use of oxygen. There was no evidence of an order for oxygen.

Upon patient record review, 3 of 13 records (Patients #1,#7,#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 equipment and supply needs. Patient 1: The medical record contains nursing documentation 4/27/22 identifying patient use of hospital bed. There is no evidence of a hospital bed included as DME on the plan of care. Corrected on site. Patient 7: The medical record contains nursing documentation 4/30/22 identifying patient has pleurix drain requiring maintenance and supplies. There is no evidence of pleurix drain supplies included on the plan of care. Corrected on site. Patient 13: The medical record contained nursing documentation 9/18/22 and 9/20/22 identifying patient use of oxygen. There was no evidence of oxygen included as DME on the plan of care.

Upon client record review, 2 of 13 records (Patients #2,#6) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 2: The medical record contains social work visit frequency order of once every 30 days. There is no evidence of a March visit completed or documentation of a missed visit for non-adherence to the frequency. Corrected on site. Patient 6: The medical record contained an order 3/7/22 for volunteer coordinator to evaluate patient needs. There is no evidence of a volunteer assessment completed.

Upon patient record review 1 of 8 applicable records (Patient #6) 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 6: The medical record contains aide visit frequency order for twice weekly. There is no evidence of a second visit completed the week of 4/17/22 or documentation of a missed visit for non-adherence to the frequency. Corrected on site.

Upon observation, there was no evidence the organization follows their policies and procedures to maintain the the patient's clinical record in confidential manner. Patient 12: The medical record contained an attached certification of terminal illness for the wrong hospice patient. Corrected on site.

Upon patient record review, 1 of 3 applicable (Patient #1) did not have evidence that the hospice assumes responsibility for professional management of the resident's hospice services in accordance with the hospice plan of care. The hospice is responsible for providing all hospice services including: • Ongoing assessment, care planning, monitoring, coordination and provision of care by the Hospice IDG • Assessment, coordination and provision of any needed general inpatient or continuous care • Consultation about the patient's care with facility staff • Coordination by the hospice RN for the implementation of the plan of care for the patient • Provision of hospice aide services, if these services are determined necessary by the IDG to supplement the nurse aide services provided by the facility • Provision, in a timely manner, of all supplies, medications, and DME needed for the palliation and management of the terminal illness and related conditions • Financial management responsibility for all medical supplies, appliances, medications and biologicals related to the terminal illness and related conditions • Determination of the appropriate level of care to be given to the patient (routine homecare, inpatient, or continuous care) • Arranging any necessary transfers from the facility, in consultation with the facility personnel Patient 1: The medical record contains nursing documentation identifying cranial wound onset date of 11/30/21 and sacral wound onset of 12/28/21. There is one cranial measurement and assessment recorded 2/26/22 and one sacral measurement and assessment 12/28/21. There is no evidence of weekly measurements and assessment as required per agency wound care management guidelines.

Upon client record review, 1 of 3 applicable (Patient #1) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient 1: The medical record contains nursing visit documentation repeatedly stating scalp and sacrum wound care rendered by facility wound care nurse and order to reflect facility responsibility. There is no evidence of physician orders to define wound care being received for the scalp wound. The medical record also contains nursing documentation 4/22/22 identifying indwelling catheter is changed monthly by facility staff. There is no evidence of physician order for indwelling size, maintenance, and who is providing the care. Foley order corrected on site.