Every finding on record at Devotion Hospice, LLC

Upon patient record review, 4 of 14 (Patient #1,10,11,12) 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:Miconazole was listed on the medication profile with instructions for applying, "a thin layer to affected area", but there was no evidence the specific area was identified (route). Additionally, Diclofenac was on the medication profile with instructions to "apply to muscles", but there was no evidence of the specific area (route). Patient #10: Doxycycline was ordered on 3/4/26 with an end date of 7 days, but was still active on the medication profile. Patient #11: Cipro was ordered on 3/27/26 with an end date of 7 days, but the medication was still active on the medication profile. Patient #12: Cipro for 5 days was ordered on 3/23/26 but remained active on the medication profile with no evidence of a stop date.

Upon patient record review, 2 of 14 (Patient #13, #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 #13: ASA was on the patient's med profile, but there was no evidence bleeding precautions were part of the plan of care. Patient #14: Enoxaparin was on the patient's med profile, but there was no evidence bleeding precautions were on the plan of care.

Upon patient record review, 4 of 14 (Patient #6,#7,#8,#9) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #6: The plan of care dated 08/09/25 indicated the Chaplain was ordered 1 PRN, but there was no reason documented. Patient #7: Plans of care dated 3/10/26 and 3/25/26 showed PRN visits were part of the RN frequency, but there was no evidence of a reason for PRN. Patient #8: The plan of care dated 10/28/25 showed the frequencies for both SW and Chaplain were 1 PRN, but there was no evidence of a reason for PRN. Patient #9: The plan of care dated 03/05/26 showed the Chaplain and SW frequencies were ordered as 1 PRN, but there was no evidence of a reason for PRN.

Upon patient record review, 1 of 14 (Patient #1) 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: On 08/16/25 the SN documented the patient was using 5 L of O2 per NC, and Ativan every 2 hours. However, the medication profile showed the patient was using 2-4 L of O2 and Ativan was ordered q 4 hours and there was no evidence of new orders.

Upon client record review, 2 of 14 (Patient #8, #13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #8: On 04/22/26, an order was written for SN visits 3x week for wound care, but on the week of 4/26/26 - 5/2/26 there were 2 visits on 4/28 and 5/1/26 without evidence of a 3rd or a missed visit order. Patient #13: SW was accepted per RN at admission on 09/22/25. An order written for SW routine visits, but there was no evidence of a SW visit and no evidence of documentation indicating the patient declined SW services.

Upon patient record review, 1 of 14 (Patient #1) 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 #1: ASA was on the medication profile, but there was no evidence of bleeding precautions on the aide care plan dated 07/27/25.

Upon patient record review 1 of 14 (Patient #2) 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 #2: The aide care plan dated 08/18/25 indicated the patient was to receive a shower every visit. However, on 08/20/25, 08/21/25 and 08/22/25, the aide gave the patient a bed bath and documented the patient was unable to get in the shower.

Upon patient record review, 6 of 6 (Patient 1,2,3,4,5,6) did not have evidence that the patient chooses a health care provider, including an attending physician. Patients 1-6: On the election of benefits the patients selected: "I decline to choose attending physician" with further verbiage, "hospice medical director to be appointed". There is no evidence of the contracted hospice medical director being appointed as the attending. Other hospice physicians gave admission verbal orders, completed the CTI narratives, signed the CTI's, and signed Plans of Care. These physicians are not specified/named in the patient record as attending. There is no evidence of clear delineation of attending physician. Each Pt Face Sheet delineates agency NP as the attending with other hospice MDs listed as "Medical Director"

Upon patient record review, 6 of 6 (Patients 1,2,3,4,5,6) 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. Patients 1-6: Upon record review, the Initial Hospice Plan of Care order in each chart states, "Catheterize for signs and symptoms of urinary retention or stage 3 or 4 decubitus. Change foley catheter as indicated." Verified with staff this is considered a PRN order versus a standing order and no further MD communication or clarification would be needed to institute this treatment order. No evidence of further clarification such as size, flush, or the"indications" that would warrant changing the catheter.

Upon patient record review, 1 of 6 (Patient #5) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient's life expectancy is 6 months or less if the illness runs its normal course. Pt. 5: Pt. SOC date is 4/29/23 with the CTI was signed by the physician 3 calendar days past admission (5/2/23). There is no evidence of a timely verbal order as it is signed by the nurse and dated, 5/16/23.

Upon patient client record review, 1 of 6 (Patients 1,2,3,4,5,6) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Pt. 5 - On the election statement the "through" blank is filled in with the end date of the benefit period. No evidence of the name of the Hospice of patient's choice. This was noted as an identified problem in the ongoing Q1 QAPI plan.