Every finding on record at Desert Wind Hospice, Inc.

Upon patient record review, 3 of 14 Records Reviewed (Patient #1, #2, #9) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #1: The record indicated the patient chose Dr. Grier as his choice for the attending physician. There was no evidence of this physicians full name being written on the form as the form indicated the "Physicians full name". COS. Patient #2: The record indicated the patient chose Dr. Igbal as her choice for the attending physician. There was no evidence of this physicians full name being written on the form as the form indicated the the "Physicians full name". COS. Patient #9: The record indicated the patient chose Dr. Igbal as his choice for the attending physician. There was no evidence of this physicians full name being written on the form as the form indicated the "Physicians full name". COS.

Upon patient record review 1 of 14 records reviewed (Patient #9) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient #9: The record indicated the patients start of care for hospice was on 03/22/24. There was no evidence of the spiritual needs being identified as part of the comprehensive assessment.

Upon patient record review, 10 of 14 records reviewed (Patient #1, #2, #3, #4, #5, #6, #7, #8, #9, #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 #1 through Patient #10: All records indicated medications listed on the MAR. There was no evidence of a review to include effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, and or drug therapy currently associated with laboratory monitoring. COS. #6: Upon home visit review, the MAR indicated the patient was taking Milk of Magnesia 1200mg/15mlPatient 30ml daily as needed if no BM. There was no evidence of this medication being available. COS. In addition: The MAR indicated the patient was taking Ondansetron Hydrochloride 4mg PO Q4hours as needed for N&V however, no evidence this was available in the home also. COS. Patient #3: The record indicated Pataday 0.1% one drop twice daily for itchy eyes. There was no evidence of which eye or eye(s) to administer the medication. COS. In addition: Cephalexin 500mg 4 times a day X 7 days was ordered on 4/29/24/ There was no evidence of this medication being discontinued. COS.

Upon patient record review, 3 of 14 records reviewed (Patient #8, #9, #10) 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 #8: The record indicated the start of care was on 06/11/24. There was no evidence of the Bereavement Risk Assessment being completed in 5 days. Patient #9: The record indicated the start of care was on 03/22/24. There was no evidence of the Bereavement Risk Assessment being completed in 5 days. Patient #10: The record indicated the start of care was on 01/28/23. There was no evidence of the Bereavement Risk Assessment being completed in 5 days.

Upon patient record review, 2 of 14 records reviewed (Patient #1, #8) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate 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 #1: The record indicated the patient was nauseated on 05/04/24, an LVN visit was made, then a call came in with complaints of severe constipation on 05/08/24, an LVN visit was made on 5/9/24 with an RN follow up visit on 05/14/24. There was no evidence of continuous RN assessment during these reported symptom management issues. Patient #8: The record indicated on 6/23/24 the patient was vomiting and complained of constipation, an LVN visit was made on 6/27/24. There was no evidence of continuous RN Assessment during this period of reported symptom management issues up until 7/1/24.

Upon patient record review, 1 of 14 records reviewed (Patient #3) 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 record indicated the patient had a self identified threshold of "2" during his initial pain assessment on 0/19/24. There was no evidence of specific pain goal of 2 for patient. COS.

Upon patient record review, 1 of 14 records reviewed (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 record indicated an MD order for Pataday 0.1% one drop twice daily for itchy eyes. There was no evidence of which eye or eye(s) to administer the medication. COS.

Upon patient record review, 3 of 14 records reviewed (Patient #1, #8, #13) 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 record indicated the patient had two reported falls on 06/03/24 and 6/26/24 (this fall required an X-Ray). There was no evidence of the plan of care being updated for these falls. COS. Patient #8: The record indicated on 6/15/24 the patient had no BM X 3 days, then on 6/23/24 she complained of vomiting and constipation. There was no evidence in the record of goals and interventions being updated in the plan of care. Patient #13: The record indicated the RN made a visit on 12/24/23 and determined the oxygen was at 80%, she changed the O2 mask which increased the O2 level to 85%. The daughter stated, "I don't think he will come out of this." There was no evidence the plan of care was updated with problems/goals/interventions for the imminence of death. The patient was not seen until the death pronouncement on 12/28/23.

Upon client record review, 3 of 14 records reviewed (Patient #6, #7, #9) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #6: The record indicated the SN was ordered by the IDG on 5/1/24 to visit 2 X W. There was no evidence in the record of a second nurse visit during 5/1/24 to 5/10/24. Patient #7: The record indicated the IDG on 05/01/24 ordered Spiritual Care 1 X M. There was no evidence of a spiritual care visit in the month of May 2024. Patient #9: The record indicated the IDG on 5/1/24 ordered Spiritual Care 1 X M. There was no evidence in the record of a spiritual visit during the month of May 2024 or June 2024.

Upon patient record review, 1 of 14 (Patient #6) 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 #6: The record indicated the IDG ordered hospice aide services on 5/1/24. There was no clear frequency number ordered for the Hospice Aide Services. COS.

Upon patient record review 1 of 14 records reviewed (Patient #1) 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 • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #1: The record indicated the IDG ordered hospice aide visits 2 X W starting on 5/1/24. There was no evidence of hospice aides visits from 5/1/24 to 6/23/24. COS.

Upon patient record review 2 of 14 records reviewed (Patient #1, #8) 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 #1: The record indicated a supervisory visit was due on 6/11/24. There was no evidence of which discipline is being supervised in the supervision assessment as the drop down was blank and not clear as to which discipline was being supervised. Patient #8: The record indicated hospice aide services started on 6/13/24, there was no evidence of RN supervisory visit as of survey date 7/2/24.

Upon patient client record review, 4 of 14 records reviewed (Patient #1,2,9,10) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #1: The record indicated the patient chose Dr. Grier as his choice for the attending physician. There was no evidence of this physicians full name being written on the election form as the form indicated the "Physicians full name". COS. Patient #2: The record indicated the patient chose Dr. Igbal as her choice for the attending physician. There was no evidence of this physicians full name being written on the election form as the form indicated the the "Physicians full name". COS. Patient #9: The record indicated the patient chose Dr. Igbal as his choice for the attending physician. There was no evidence of this physicians full name being written on the election form as the form indicated the "Physicians full name". COS. Patient #10: The record indicated the patient elected to receive a copy of hospice non covered items. There was no evidence the patient received this in 5 days from the start of care.