Every finding on record at E Hospice Group of Arizona No. 1 LLC

Upon patient record review, 6 of 14 (Patients #2,#3,#5,#6,#7,#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 2: The medication profile contained lidocaine topical patches with no area defined for administration. Corrected on site. Patient 3: The medication profile contained medihoney for wound care as a current medication for a wound that was inactivated 3/26/24. During home visit medication reconciliation with the RN, the patient had Tylenol PM, omeprazole, vitamin D, multivitamins, dulcolax, and preservision in the home that was not included on the medication profile. The medication profile also included lorazepam and morphine as current medications, however the patient did not have them in the home. Corrected on site. Patient 5: The medication profile contained duplicative listings for clopidogrel dated 2/22/24 and 4/2/24. Corrected on site. During the home visit, the facility medication profile did not include acetaminophen, antacid anti-gas, guaifenesin, levothryoxine, Milk of Magnesia, and morphine that was present on the hospice medication profile. Corrected on site. Patient 6: The medication profile contained duplicative listings for oxycodone 10mg every four hours as needed. Corrected on site. Patient 7: The medical record contained nursing documentation upon admission identifying patient use of oxygen. There was no evidence of oxygen included on the medication profile. Corrected on site. Patient 10: During the home visit, the facility medication profile and treatment orders did not include calmoseptine topical cream for administration that was included on the hospice medication profile. Corrected on site.

Upon patient record review, 3 of 14 (Patients #1,#2,#6) 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 medical record contained nursing documentation upon admission identifying patient had a history of a fall with fracture and was a high risk for falls. There was no evidence of problem, goals, and interventions related to fall safety included in the plan of care. Corrected on site. Patient 2: The medical record contained nursing documentation upon admission identifying patient had dyspnea and edema related to cardiac dysfunction. There were problems identified in the plan of care for altered cardiopulmonary function and respiratory dysfunction, however, there was no evidence of goals and interventions related to those issues. Corrected on site. Patient 6: The medical record contained an uploaded DNR order for the patient upon admission. The plan of care stated the patient did not have any advance directives and did not identify the patient as a DNR code status. Corrected on site.

Upon patient record review, 2 of 14 (Patients #3,#6) 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 3: The medical record contained orders for social work and spiritual care frequencies of 2 PRN. There was no evidence of an anticipated scheduled need for care and the patient declined those services. Corrected on site. Patient 6: The medical record contained an order for spiritual care frequencies of 2 PRN. There was no evidence of an anticipated scheduled need for care and the patient declined those service. Corrected on site.

Upon patient record review, 2 of 14 (Patients #2,#7) 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 2: The medical record contained an order for lidocaine topical patches with no area defined for administration. Corrected on site. Patient 7: The medical record contained nursing documentation upon admission identifying patient use of oxygen. There was no evidence of an order for oxygen rate, frequency, and delivery method. Corrected on site.

Upon patient record review, 1 of 14 (Patient #2) 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 2: The medical record contained nursing documentation 7/25/24 identifying patient is a higher risk of falls due to oxygen refusal. There was no evidence of problems, goals, and interventions updated related to fall safety. Corrected on site.

Upon patient record review, 2 of 14 (Patients #11,#12) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patients 11, 12: The bereavement care plans contained tasks for follow up calls within 2 months, 6 months, and PRN. Follow up calls were occurring monthly and not reflected as anticipated need and frequency in the care plans.

Upon patient record review, 3 of 14 (Patients #1,#2,#10) 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 medical record contained nursing documentation upon admission identifying patient is a full assist with transfers and utilized a wheelchair. There was no evidence of instructions for max assist with transfers and use of a wheelchair included on the aide care plan. Corrected on site. Patient 2: The medical record contained nursing documentation 7/25/24 identifying patient was at a higher risk for falls due to oxygen refusal and required assistance for transfers since admission. There was no evidence of instructions for assist with transfers, fall risk, and oxygen use included on the aide care plan. Corrected on site. Patient 10: The aide care plan contained a task to shower as needed. There was no evidence of instructions that the patient is cognitively able to make own decisions on the aide care plan. The medical record also contained nursing documentation upon admission identifying patient is unable to transfer without assistance and requires use of wheelchair. There was no evidence of transfer instructions and use of a wheelchair included on the aide care plan. Corrected on site.

Upon patient record review 1 of 14 (Patient #6) 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 6: The medical record contained an order for aide visit frequency twice weekly. There was no evidence of a second visit completed the week of 7/21/24.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. The agency had a volunteer utilization rate of 1.23% for 2023.