Every finding on record at Curo Health Services, LLC

Upon patient record review 1 of 16 (Patient #7) 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 #7 The patient was admitted on 9/16/21. The psychosocial evaluation was completed on 10/8/21.

Upon patient record review, 2 of 16 (Patients #8, 10) 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 #8 The medication profile included Amonium Lactate 12% in the plan of care does not include a site application. Patient #10 The medication profile included Voltaren 1% topical gel, apply as needed daily for pain. The order does not specify the site of application or the frequency of the application. Medication profile included Amonium Lactate 12% lotion "apply liberally to affected areas twice daily & PRN, there is no specified application site in the order. The patient has Ambien 5 mg listed in her medication profile twice with orders received on 3/16/22 & 4/5/22.

Upon patient record review, 4 of 16 (Patients #5, 6, 7, 15) 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 patient was admitted on 6/21/22. The bereavement assessment was completed on 7/1/22. Patient #6 The patient was admitted on 1/13/22. The bereavement assessment was completed on 3/16/22. Patient #7 The patient was admitted on 9/16/21. The bereavement assessment was completed on 10/8/21. Patient #15 The patient was admitted on 6/10/21. The bereavement assessment was completed on 7/27/21.

Upon patient record review, 2 of 16 (Patients #8, 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 #8 The POC includes and order for Amonium Lactate 12% apply liberally to affected areas 4 times per day for itching. The order does not indicate a specific site of application. Patient #10 The plan of care includes orders for Voltaren 1% gel, apply topically as needed daily. The order does not specify the application site or the frequency of application of the medication. The patient plan of care also included orders for Amonium Lactate 12% lotion to be applied liberally to affected areas twice daily & PRN. The order does not include the site of application for the medication.

Upon patient record review, 5 of 16 (Patients #2, 5, 7, 11, 12,) 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 #2 The patient reported changes/symptoms to the RN on 7/19 & 7/26 that he was getting up 5-6 times per night to urinate and was not able to go "much." There is no evidence in the plan of care that information from the comprehensive assessment was updated to include this information during IDG or during the plan of care update. Patient #5 There is evidence in the patient record of an injury to the LFA with treatment orders obtained on 7/8, the POC was not updated to include the problem statement, interventions or goals. Patient #7 The patient has wound care orders entered 6/2/22 with no problem statement, interventions or goals. The patient has additional symptoms of insomnia, nausea, constipation/diarrhea and a urostomy which are not included in the problems statements with interventions or goals. Patient #11 The patient has symptoms of anxiety requiring medication changes/interventions effective 7/5 & 7/20/22. There is no problem statement, interventions or goals in the plan of care. The patient is also noted to have a wound to his left F/A with changes to wound care orders on 8/3/22 and a history of multiple wounds per his records with no history of problem statements, interventions or goals listed in the plan of care. The patient is currently noted to be wearing sleeve protectors on his arms. Patient #12 Plan of care did not include problems, goals and interventions for identified skin problems, nausea, and pain. Patient with cellulitis on 5/5/21 and altered skin integrity to her buttocks, requiring treatment for both. Increased nausea reported on 5/26/21 and increased pain on 6/25/21. The POC does not reflect goals or interventions during the period of time that the patient was receiving physical therapy.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #1 Upon arrival to the patient home, the RN did not complete hand washing. During her assessment, she utilized a single pocket bag that did not have space or separation of clean or dirty tools. The nurse did not clean/sanitize her nursing tools except for her stethoscope (blood pressure cuff, thermometer, O2 sensor) before or after patient use, they were removed from her bag and returned to the same bag.