Every finding on record at Devoted Healthcare & Hospice Services, LLC

Upon patient record review 1 of 19 (Patient #4) 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#4: Patient was admitted on 12/01/25. There is no evidence that Spiritual comprehensive assessment was completed until 03/09/26.

Upon patient record review 1 of 19 (Patient #4) 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#4: There was no evidence of a psychosocial comprehensive assessment of the patient and family. Social Work services were declined. There is no evidence that the RN or SW completed this part of the assessment.

Upon patient record review, 2 of 19 (Patient #6,14) 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#6: The current medication record includes orders for Hydrocodone-Acetaminophen 10-325mg 1.5 tabs every 4 hours as needed for pain and Tylenol ES 500mg every 6 hours as needed for pain. The orders do not include a maximum daily dose for acetaminophen. Patient#14: The current medication record includes orders for Tylenol 650mg supp every 4 hours as needed and Tylenol 500mg po every 6 hours as needed. The orders do not include a maximum daily dose for acetaminophen.

Upon patient record review, 3 of 19 (Patient #9,11,14) 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#9: Current POC includes orders for Plavix. There is no evidence of of risk for bleeding care plan. Patient#11: Current POC includes orders for Warfarin Sodium. There is no evidence of a risk for bleeding care plan. Patient#14: Current POC includes orders for Aspirin. There is no evidence of a risk for bleeding care plan.

Upon patient record review, 2 of 19 (Patient #6,14) 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#6: The current POC includes orders for Hydrocodone-Acetaminophen 10-325mg 1.5 tabs every 4 hours as needed for pain and Tylenol ES 500mg every 6 hours as needed for pain. The orders do not include a maximum daily dose for acetaminophen. Patient#14: The current POC includes orders for Tylenol 650mg supp every 4 hours as needed and Tylenol 500mg po every 6 hours as needed. The orders do not include a maximum daily dose for acetaminophen.

Upon patient record review, 14 of 14 (Patient #1,#2,#3,#4,#5,#6,#7,#8,#9,#10,#11,#12,#13,#14) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patients 1-14: The medical record does not contain evidence that the comprehensive assessment takes in to consideration the imminence of death.

Upon patient record review, 10 of 14 (Patient #1,#2,#3,#4,#5,#9,#10,#12,#13,#14) 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: Patient 1: The nurse documented on 5-9-23 "Pain intervention Tylenol". There is no evidence of Tylenol on the medication profile. Upon home visit finding medication profile has Diltiazem 1 capsule daily, the medication is labeled for 2 capsules daily and caregiver confirms pt has always taken 2 capsules daily. The medication profile contains Ipratropium Bromide/Albuterol BID, box is labeled QID and pt is taking QID confirmed by caregiver. Corrected on site. Patient 2: The medication profile contains Xarelto, patient caregiver reports pt has not taken that medication since pt was admitted to hospice. Corrected on site. Patient 3: Upon home visit finding, pt is taking Melatonin gummies and Cranberry gummies and has for a "long time" according to caregiver these meds are not on the medication profile. Corrected on site. Patient 4: The medication profile contains Morphine Sulfate 20mg/ml, dose 1, 0.25ml-1ml every 4 hours prn pain. There is no evidence of an order for the range and the dose is incorrect. Corrected on site. Patient 5: The nurse documents on 3-18-23 and 3-22-23 "pt currently taking nystatin for a fungal infection to toes." There is no evidence of Nystatin on the medication profile. Corrected on site. Patient 9: The medication profile contains daily fiber oral powder 1 tsp daily, there is no evidence of a diluent. Corrected on site. Patient 10: The medication profile contains Tizanidine 4mg ordered 12-30-22, there is no evidence of this medication being on the medication profile. Corrected on site. Patient 12: The medication profile contains Atorvastatin 409 tabs daily, Myrbetriq 50 tabs daily, Naproxen 60 tabs daily, Furosemide 40 tabs daily, hydroxyzine 25 tabs daily all are incorrect doses. Patient 13: The medication profile contains Morphine Sulfate 20mg/ml 0.25-1ml every 4 hours prn. There is no evidence of an order for the range. Patient 14: The medication profile contains Morphine Sulfate 20mg/ml 0.25-1ml every 4 hours prn. There is no evidence of an order for the range. The medication profile contains Hyoscyamine 1-2 tabs every 4 hours prn, with no directive for the range. The POC contains orders for Regular diet, the Medication profile contains orders for regular diet and mechanical soft diet.

Upon patient record review, 9 of 14 (Patient #1,#2,#3,#4,#5,#9,#12,#13,#14) 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 nurse documented on 5-9-23 "Pain intervention Tylenol". There is no evidence of Tylenol on the POC. Upon home visit finding POC has Diltiazem 1 capsule daily, the medication is labeled for 2 capsules daily and caregiver confirms pt has always taken 2 capsules daily. The POC contains ipratropium bromide/albuterol BID, box is labeled QID and pt is taking QID confirmed by caregiver. Corrected on site. Patient 2: The POC contains Xarelto, patient caregiver reports pt has not taken that medication since pt was admitted to hospice. Corrected on site. Patient 3: Upon home visit finding, pt is taking Melatonin gummies and Cranberry gummies and has for a "long time" according to caregiver these meds are not on the POC. Corrected on site. Patient 4: The POC contains Morphine Sulfate 20mg/ml, dose 1, 0.25ml-1ml every 4 hours prn pain. There is no evidence of an order for the range and the dose is incorrect. Corrected on site. Patient 5: The nurse documents on 3-18-23 and 3-22-23 "pt currently taking nystatin for a fungal infection to toes." There is no evidence of Nystatin on the POC. Corrected on site. Patient 9: The POC contains daily fiber oral powder 1 tsp daily, there is no evidence of a diluent. Corrected on site. Patient 12: The POC contains Atorvastatin 409 tabs daily, Myrbetriq 50 tabs daily, Naproxen 60 tabs daily, Furosemide 40 tabs daily, hydroxyzine 25 tabs daily. All incorrect doses. Patient 13: The POC contains Morphine Sulfate 20mg/ml 0.25-1ml every 4 hours prn. There is no evidence of an order for the range. The POC contains a Foley order with directives to irrigate foley with NS, though no amount of NS was ordered to be used. Patient 14: The POC contains Morphine Sulfate 20mg/ml 0.25-1ml every 4 hours prn. There is no evidence of an order for the range. The POC contains Hyoscyamine 1-2 tabs every 4 hours prn, with no directive for the range.

Upon client record review, 2 of 14 (Patient #9,#10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 9: The medical record contains a PRN visit by the nurse on 5-2-23. There is no evidence of an order for the PRN visit. Corrected on site. Patient 10: The POC contains orders for nursing 1x a week. There is evidence the nurse made an extra visit on 3-31-23 and 4-29-23 with no evidence of a PRN order. Corrected on site.

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. Patients 1,2,3: The agency has a nursing bag policy IC.60 that states "Close bag before performing care". The nurses left their bags open at each visit while performing care.

Upon patient client record review, 5 of 14 (Patient #9, 10, 11, 12, 13) 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 9: The Medical record contains an MD order for Senna, this medication was not added to the POC. Corrected on site. Patient 10: The nurse documents on 3-30-23 "IBP" There is no evidence this is an approved abbreviation. The medical record contains an MD order for Tizanidine 4mg, there is no evidence of this medication being on the POC. Corrected on site. Patient 11: The medical record contains MD orders for prednisone, keflex, lorazepam, simethicone. These medications were not added to the POC. Patient 12: The medical record contains MD orders for atorvastatin, myrbetriq, naproxen, furosemide, hydroxyzine. These medications were not added to the POC. Patient 13: There is evidence of an order for a foley catheter on 1-17-23 there is no evidence the foley order was added to the POC.

Upon client record review, 1 of 14 (Patient #12) did not have evidence that the discharge summary includes all required information. Patient 12: The discharge summary does not include 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.