Every finding on record at Direct Provider of Hospice, Inc.

Upon patient record review 3 of 14 (Patient #2,4,6) 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 2: There was no evidence of a spiritual comprehensive assessment of the patient and family, patient refused SC. There is no evidence that an RN or Social Worker completed this part of the assessment. Patient 4 There was no evidence of a spiritual comprehensive assessment of the patient and family, patient refused SC. There is no evidence that an RN or Social Worker completed this part of the assessment. Patient 6 There was no evidence of a spiritual comprehensive assessment of the patient and family, patient refused SC. There is no evidence that an RN or Social Worker completed this part of the assessment.

Upon patient record review, 3 of 14 (Patient #1,3,5) 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: Current medication record includes an order for Voltaren 1% topical gel, order does not include a site of application. Patient 3: Current medication record includes an order for Nystatin Topical powder, order does not include a site of application. Patient 5: Current medication record includes an order for Voltaren 1% topical gel, order does not include a site of application. Current medication record includes an order for Nystatin Topical powder, order does not include a site of application.

Upon patient record review, 2 of 14 (Patient #3,4) 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 POC dated 1/7/26 has a medication order for Aspirin 81mg daily without a risk for bleeding care plan that includes appropriate goals and interventions. Patient 4: The POC dated 1/7/26 has a medication order for Xarelto 10 mg daily. There is no evidence of a risk for bleeding care plan that includes appropriate goals and interventions.

Upon patient record review, 3 of 14 (Patient #1,3,5) 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: Current POC dated 1/7/26 includes an order for Voltaren 1% topical gel, order does not include a site of application. Patient 3: Current POC dated 1/7/26 includes an order for Nystatin Topical powder, order does not include a site of application. Patient 5: Current POC dated 1/7/26 includes an order for Voltaren 1% topical gel, order does not include a site of application. Current medication record also includes an order for Nystatin Topical powder order does not include a site of application.

Upon client record review, 1 of 14 (Patient #4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 4: Initial POC dated 10/15/25 includes visit frequencies to include SC 1 time per month and 3 prn. There is no evidence of SC visits for the month(s) of October, November, and December.

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: The current aide POC dated 11/19/25 does not include frequency for turn and reposition, change patient linens.

Upon patient record review 3 of 14 (Patient #4, 5, 9) 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 patient was admitted on 5/19/22, the initial psychosocial assessment was completed on 5/28/22. Patient #5 The patient was admitted on 2/12/22, the initial psychosocial assessment was completed on 2/18/22. Patient #9 The patient was admitted on 7/19/22, the initial psychosocial assessment was completed on 8/3/22, the assessment for spiritual care was completed on 7/31/22.

Upon patient record review 1 of 14 (Patient #11) 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 #11 The patient was admitted on 5/11/21, the psychosocial assessment was not completed within 5 days or throughout the patients services.

Upon patient record review, 8 of 14 (Patient #1, 2, 3, 4, 5, 6, 7, 8) 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 #1-8 The patient has orders upon admit for Oxygen 2-5 L via NC as needed for shortness of breath that are not included on the medication profile.

Upon patient record review, 5 of 14 (Patient #1, 2, 4, 7, 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 #1 The orders for SW visits are written as: 1 month only and as needed for psychosocial needs and support, there is no quantity for the PRN visits. Patient #2 The orders for SW visits are written as: 1 month only and as needed for psychosocial needs and support, there is no quantity for the PRN visits. Patient #4 The frequency orders for SN are entered as 2 x week & PRN, the order does not indicate a quantity of PRN visits. The aide visit orders are entered as 2 x week & PRN. Patient #7 The frequency orders for social worker is entered "as needed for psychosocial needs and support." The spiritual care orders are entered "as needed for spiritual counseling needs and support." Patient #9 The frequency orders for social work and spiritual care are entered as initial + PRN for psychosocial assessment, resources and emotional support; SC: Initial + PRN for spiritual support, prayers and counseling.

Upon patient record review, 1 of 14 (Patient #4) 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 #4 The patient has wound care orders initiated on 7/4/22, "cleanse wound with NS, pat dry, apply foam dressing and change as needed." The order does not specify a frequency or requirements for "as needed."

Upon patient record review, 6 of 14 (Patient #1, 2, 3, 5, 7, 10) 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 patient was treated for UTI with Bactrim DS 1 pill PO BID x 10 days starting on 12/2/22, there is no problem statement in the plan of care and no interventions or goals for the treatment. Patient #2 The initial comprehensive assessment identifies that the patient is diabetic and uses Humulin-R SQ, there is no problem statement, interventions or goals that identify the monitoring of the glucose levels in relation to the dietary needs and changes throughout the continuum of care. Patient #3 There is evidence in the patient record of wound care orders for a sacral wound identified on 7/4/22, there is no problem statement with goals or interventions for skin/wound care. Patient #5 There is evidence in the patient record of signs and symptoms of approaching death documented on 4/4/22 and 4/8/22 with documented anxiety and shortness of breath, there is no problem statement with interventions or goals added to the plan of care. Patient #7 There is evidence in the patient record of signs and symptoms of approaching death documented on 9/30/22 with anxiety and shortness of breath, there is no problem statement with interventions or goals added to the plan of care. Patient 10 There is evidence of shortness of breath, anxiety and pain, there is no problem statement with interventions or goals added to the plan of care.

Upon patient record review, 8 of 14 (Patient #1, 2, 3, 4, 5, 6, 7, 8) 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 hospice aide care plan indicates tasks for bathing, shampoo, linen change and ambulation assist as "per request." Patient #2 The hospice aide care plan indicates tasks for shampoo and nail care as "per request." Patient #3 The hospice aide care plan indicates tasks for bathing, shampoo and linen change as "per patient request." Patient #4 The hospice aide care plan indicates tasks for shower, shampoo, mobility assistance and linen change to be performed PRN. Patient #6 The hospice aide care plan indicates tasks for shower, shampoo, shave, ambulation assistance and linen change to be performed PRN. Patient #5 The hospice aide care plan indicates tasks for shower, shampoo, ambulation assistance and linen change to be performed PRN. Patient #7 The hospice aide care plan indicates tasks for bathing and shampoo to be performed "per request." Patient #8 The hospice aide care plan indicates tasks for bathing to be performed PRN.