Every finding on record at Delicate Care Hospice, Inc.

Upon observation, there was no evidence of contracts/agreements with other facilities/agencies/hospices to receive patients in the event the hospice cannot provide care to their patients during an emergency.

Upon observation during home visit #3, there was no evidence the personnel had an agency generated photo identification for the patient to able to identify visiting personnel.

Upon patient record review, 4 of 14 (Patient's #3,4,11&12) did not have evidence in the patient records that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. Patient # 3 Clear Eyes Eye drops did not indicate for which eye. Patient #4 Oxygen did not include the method of administration. Patient #11 Cyclosporin Eye drops did not indicate for which eye, Melatonin was entered as 8 mg in Plan of care and 5 mg in medication profile, Tylenol 500mg in plan of care was entered as 1 tab 2times a day PRN, in the medication profile it was listed as 1 tablet every 6-8 hours. In addition, Diclofenac 1% ointment was entered in plan of care as administered via oral route. Patient #12 Melatonin did not include any dose/strength, Preservision eye drops did not indicate which eye, Tylenol 500mg in plan of care was entered as 1 tab 2times a day PRN, in the medication profile it was listed as 1 tablet every 6-8 hours.

Upon patient record review, 5 of 14 (Patient #'s 3,4,11,12,13) 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 Clear Eyes Eye drops order did not indicate for which eye. Patient #4 Oxygen order did not include the method of administration. Patient #11 Cyclosporin Eye drops did not indicate for which eye, Melatonin was entered as 8 mg in Plan of care and 5 mg in medication profile, Tylenol 500mg in plan of care was entered as 1 tab 2times a day PRN, in the medication profile it was listed as 1 tablet every 6-8 hours. In addition, Diclofenac 1% ointment was entered in plan of care as administered via oral route. Patient #12 Melatonin did not include any dose/strength, Preservision eye drops did not indicate which eye, Tylenol 500mg in plan of care was entered as 1 tab 2times a day PRN, in the medication profile it was listed as 1 tablet every 6-8 hours. Patient #13 Medications Atropine 1.5%, Lorazepam 2mg, Morphine Sulfate 0.25ml were not included in the reviewed plan of care.

Upon personnel record review, 1 of 14 (Personnel #5) did not have evidence in the personnel file that the competency assessment was performed by the aide with a patient or pseudo patient.

Upon patient client record review, 1 of 14 (Patient #5) did not have evidence the effective date of the election was included in the signed election statement which may be the first day of hospice care or a later date, but may be no earlier than the date of the election statement.

Upon client record review, 1 of 14 (Patient #11) did not have evidence that when the patient revoked the election of hospice care and was discharged from hospice in accordance with §418.26, the hospice forwarded to the patient's attending physician: a copy of the hospice discharge summary and patient's clinical record, if requested.

Upon client record review, 1 of 14 (Patient #11) did not have evidence that the discharge summary includes all required information; • A summary of the patient's stay, including treatments, symptoms and pain management • The patient's current plan of care • The patient's latest physician orders • Any other documentation that will assist in post-discharge continuity of care or that is requested by the attending physician or receiving facility