Every finding on record at Diamond Care Group Inc.

Upon patient record review, 1 of 14 records reviewed (Patient #1) did not have evidence that the hospice obtained the patient's or representative's signature confirming that they received a copy of the Patient's Rights and Responsibilities. Patients #1: The record did not show evidence the patient had received a copy of the patients rights and responsibilities. COS.

Upon patient record review 1 of 14 records reviewed (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: The record indicated the start of care was 07/22/24. There was no evidence of the psychosocial comprehensive assessment being completed until 07/28/24.

Upon patient record review 1 of 14 records reviewed (Patient #13) 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 13: The record indicated the start of care was on 01/03/24. There was no evidence of the psychosocial assessment being completed at the time of the survey.

Upon patient record review, 2 of 14 records reviewed (Patient #4,#6) 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 #4: Upon home visit medication reconciliation audit, the patient was taking AREDS 2 one tablet daily this was not listed on the MAR. COS. Patient #6: The record indicated on the MAR the patient was taking Hydrocodone/Acetaminophen 5mg/325mg one tab po BID and Acetaminophen ES 500mg 2 tabs po Q6hours prn pain. There was no max amount of Acetaminophen in a 24 hour period. COS.

Upon patient record review, 1 of 14 records reviewed (Patient #4) 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 #4: The record indicated the start of care was 07/22/24. There was no evidence of the Bereavement Assessment being completed until 07/28/24.

Upon patient record review, 1 of 14 records reviewed (Patient #12) 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 #12: The record indicated during the RN visit on 04/08/24 the patient complained of aching pain 8/10 on his neck and spine and on his left knee and ankle. He requested his pain frequency be adjusted. The record indicated an order for Oxycodone/Acetaminophen 10/325 one tab po QID on 04/08/24. There was no evidence of a nurse follow up to determine the effectiveness of this pain medication. The next visit was on 4/13/24 at the time of the pronouncement.

Upon patient record review, 4 of 14 records reviewed (Patient #1, #3, #7, #9)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 #1: The record indicated the patient was on Eliquis 5mg po BID and Plavix 75mg po QDAY. There was no evidence of a written plan of care addressing bleeding precautions. COS. In addition: The patient had diabetes. There was no individualized written plan of care to include a measurable goal to measure his blood sugar readings and what levels to report to the hospice nurse and or physician. COS. Patient #3: The record indicated a PT Evaluation was ordered on 7/10/24. There was no evidence of an individualized care plan reflecting the patient/family goals and interventions based on the need for Physical Therapy. COS. Patient #7: The record indicated the patient was on insulin Lantus Solo-Star 100U/ml pre filled prn solution for injection 25 U SQ at bedtime. There was no evidence of an individualized written plan to manage the blood sugar levels and what levels to report to the hospice nurse and or physician. COS. Patient #9: The record indicated the patient was prescribed Clindamycin Hydrochloride 300mg po Q6hours x 7 days for an infected toe. There was no evidence of an individualized written plan of care noting the patient's progress towards outcome and goals. COS.

Upon patient record review, 1 of 14 records reviewed (Patient #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. Patient #6: The record indicated the patient was prescribed Hydrocodone/Acetaminophen 5mg/325mg one tab po BID and Acetaminophen ES 500mg 2 tabs po Q6hours prn pain. The physicians order did not include the max amount of Acetaminophen in a 24 hour period. COS.

Upon patient record review, 2 of 14 records reviewed (Patient #5, #6) 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 #5: The record indicated the patient had a care plan for high risk for falls and had an actual fall and a stat skull X-Ray on 5/9/24. There was no evidence the care plan was updated to note the patient's progress towards outcome and goals. COS. Patient #6: The record indicted the patient had a care plan for high risk for infection and was prescribed Cipro 500mg po BID X 7 days and Bactrim DS X 7 days for a wound infection on 06/13/24. There was no evidence of the patients progress towards outcome/goals from the plan of care. COS.

Upon client record review, 2 of 14 records reviewed (Patient #3, #4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #3: The record indicated the chaplain made a visit on 8/9/24 and there was no order for this visit. Patient #4: The record indicated the RN was ordered to complete a visit every 14 days. The RN visit was due on 08/05/24 and there was no evidence of an RN visit until 08/07/24.

Upon observation, there was no evidence the hospice provides infection control education regarding basic and high-risk infection control procedures as appropriate to the care/services provided that is consistent with OSHA and CDC recommendations. During the home visit for patient #3 with the nurse, the nurse used the Sani Wipes to clean her assessment tools with her bare hands. It was marked on the container not to be used on skin and on the material safety data sheet.

Upon patient record review, 2 of 14 records reviewed (Patient #1, #4) 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: The record indicated a Mechanical Lift was ordered on 07/17/24. There was no evidence the hospice aide care plan was updated to include the use of the mechanical lift. COS. Patient #4: The record indicated the patient was on Eliquis 5mg po BID. There was no evidence of bleeding precautions on the hospice aide care plan. COS.

Upon patient record review 1 of 14 records reviewed (Patient #3) 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 #3: The record indicated a hospice aide made a visit on 07/12/24. There was no evidence of an order for this visit.

Upon patient record review, 2 of 14 records reviewed (Patient #1, #9) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient's clinical information and provide written documentation that it is anticipated that the patient's life expectancy is 6 months or less. Patient #1: The record indicated the patient was in their 5th Benefit Period from 5/20/24 - 07/18/24. There was no evidence the Physician signed the recertification of terminal illness in a timely manner. The date he signed was on 05/31/24, there was no evidence of a verbal order documented by a registered nurse on this recertification. Patient #9: The record indicated the patient was in their 2nd Benefit Period from 08/22/24 to 11/19/24. There was no evidence the Physician signed the recertification of terminal illness in a timely manner. The date he signed was on 08/30/24, there was no evidence of a verbal order documented by a registered nurse on this recertification.

Upon patient client record review, 14 of 14 records reviewed (Patient #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11, #12, #13, #14) 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 #1-14: The record indicated each had a notice of election signed. There was no evidence the election statement contained the individual or representative acknowledged the identified attending physician was his or her choice.

Upon patient client record review, 7 of 14 records reviewed (Patient #1, #2, #3, #7, #8, #9, #10) 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 #1: The record indicated IDG occurred on 9/6/24. There was no evidence of the MD Signature and or RN Signature. COS. Patient #2: The record indicated IDG occurred on 9/6/24. There was no evidence of the MD Signature and or RN Signature. COS. Patient #3: The record indicated IDG occurred on 8/9/24. There was no evidence of the MD Signature. COS. Patient #7: The record indicated IDG occurred on 07/12/24. There was no evidence of the MD Signature and or RN Signature. COS. Patient #8: The record indicated IDG occurred on 06/14/24. There was no evidence of the MD Signature and or RN Signature. COS. Patient #9: The record indicated IDG occurred on 07/26/24. There was no evidence of the MD Signature. COS. Patient #10: The record indicated IDG occurred on 09/06/24. There was no evidence of the MD Signature and or RN Signature. COS. In addition, The record indicated the patients SOC date is 07/02/24 to this agency however, transferred from another agency in 2nd benefit period. The record indicated they would be in the 2nd benefit period however, listed dates as 07/02/24 to 09/15/24, this would be incorrect as the patient benefit period dates would not be affected for transferring.