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

Upon patient record review, 5 of 14 (Patient #1,#2,#3,#7,#9) 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: Medication profile contains duplicate entries for Cyclobenzaprine, as added on 5/23/25 and 7/31/25. Ondansetron duplicated with entries on 7/2/25 and 1/31/26. Patient currently taking Meclizine 25mg BID, however, there is no evidence of this medication on the med profile. Patient 2: Medication profile contains Atorvastatin 40mg QD; however, patient currently taking Atorvastatin 80mg per medication bottle in the home. Patient 3: Silvadene entered on medication profile on 11/15/24 with instructions to treat leg burn and to discontinue once healed. Wound has been resolved but medication remains active on the profile. Facility medication record contains the following medications: Bisacodyl suppository insert 1 Q12H PRN, Calmoseptine ointment apply topically to peri area PRN, Collagenase ointment to sacral area 1x/daily, MOM 30mL PO Q6H PRN, MiraLAX Q12H PRN, Naloxone nasal liquid 4mg/0.1mL PRN, Scopolamine transdermal patch 1x/Q3days, Tums 500mg 2 tabs Q2H PRN with no evidence of these medications on the hospice medication profile. The hospice medication profile contains the following medications: Benadryl 25mg Q6H PRN, Clotrimazole 1% topical apply to nail fungus as directed, Guaifed 100mg/5mL admin as directed PRN, Lasix 40mg QD, Senna 8.6mg 1 tab BID with no evidence of these medications on the facility medication record. Patient 7: On 2/7/26 RN documented patient has redness in abdominal skin fold and caregiver using antifungal powder to treat, however, there is no evidence of medication on the profile. Patient 9: Medication profile contains Juven oral powder packet; however, there were no instructions for dilutant when preparing this medication.

Upon patient record review, 1 of 14 (Patient #8) 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 8: RN provided a visit to patient on 2/17/26 and documented medications missing from delivery 3 days ago. Patient cannot remember how many pain pills he can take or has taken in a day. Nurse spoke with niece, whom patient lives with, to make a decision about who would provide care for him. Patient advised he was depressed but did not have a plan to harm himself. RN reordered medications but no evidence of follow up or collaboration with IDG for follow up. RN scheduled to visit patient the following week on 2/24/26. On 2/24/26 RN documented patient verbalized pain in left foot 5/10. RN documented that she did not set up the Medi planner, as patient does not like to use it. Instead, RN wrote down pain med administration instructions for patient, as he can't remember how to take medication. Patient verbalized depression and stated "life isn't worth living". Per the record the patient does not adhere to his antidepressants medication schedule. No evidence of follow up visit next day by RN or collaboration with IDG for follow up. SW has been scheduled to visit patient on 2/27/26.

Upon patient record review, 1 of 14 (Patient #1) 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: Patient taking aspirin with no evidence of care plan with problems/goals/interventions for risk for bleeding.

Upon patient record review, 1 of 14 (Patient #7) 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 7: IDG meeting on 2/20/26 SW documented plan to visit patient 2x/month; however, there was no evidence of SW frequency on recert POC order.

Upon patient record review, 5 of 14 (Patient #1,#2,#3,#7,#9) 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: Medical record contains duplicate orders for Cyclobenzaprine written on 5/23/25 and 7/31/25. Also, duplicate orders for Ondansetron written on 7/2/25 and 1/31/26. Patient currently taking Meclizine 25mg BID, however, there is no order for this medication. Patient 2: Medical record contains order for Atorvastatin 40mg QD; however, patient currently taking Atorvastatin 80mg per medication bottle in the home. Patient 3: Facility order written on 2/10/26 to paint right 5th metatarsal head with betadine and leave open to air twice daily with no evidence of this order in the hospice medical record. Facility also has orders for wound care written on 2/18/26 to apply border foam to protect elbows and sacrum wound care with instructions to cleanse wound with Dakin's solution, apply soaked Dakin's gauze and cover with border dressing daily; however, no evidence of either of these orders in the medical record. Facility medication record contains orders for the following medications: Bisacodyl suppository insert 1 Q12H PRN, Calmoseptine ointment apply topically to peri area PRN, Collagenase ointment to sacral area 1x/daily, MOM 30mL PO Q6H PRN, MiraLax Q12H PRN, Naloxone nasal liquid 4mg/0.1mL PRN, Scopolamine transdermal patch 1x/Q3days, Tums 500mg 2 tabs Q2H PRN with no evidence of orders for these medications in the hospice medical record. The hospice medical record contains orders for the following medications: Benadryl 25mg Q6H PRN, Clotrimazole 1% topical apply to nail fungus as directed, Guaifed 100mg/5mL admin as directed PRN, Lasix 40mg QD, Senna 8.6mg 1 tab BID with no evidence of these medications on the facility medication record. Patient 7: On 2/7/26 RN documented patient has redness in abdominal skin fold and caregiver using antifungal powder to treat, however, there is no evidence of an order for this medication in the medical record. Patient 9: Medical record contains an order for Juven oral powder packet with no instructions for dilutant when preparing this medication.

Upon patient record review, 1 of 14 (Patient #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 equipment and supply needs. Patient 5: Documentation identified patient use of bed rails, shower chair and Hoyer Lift. There was no evidence of orders for the DME included in the plan of care order or orders throughout the benefit period.

Upon patient record review, 4 of 14 (Patient #1,#3,#5,#6) 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: Patient taking anticoagulant with no instructions for risk for bleeding on aide care plan. Patient 3: Documentation identified patient as using a Hoyer lift for transfers. Aide care plan instructions were 2-person assist for patient transfers instead of use of Hoyer. Patient 5: Instructions on aide care plan for patient transfer to bedside commode; however, RN documentation on 2/5/26 identifies patient as incontinent and no longer uses bedside commode. Patient now uses Hoyer lift for transfers with no instructions on the aide care plan for Hoyer use. Patient 6: Aide care plan on 2/3/26 with frequency for tasks is "as needed" and "patient request" with no evidence of direct frequency instructions.

Upon patient client record review, 1 of 14 (Patient #6) did not have evidence that each patient record contains Advance Directives. Patient 6: No evidence of documented fully executed DNR in the chart.

Upon patient client record review, 1 of 14 (Patient #9) 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: Per patient demographics in the chart, patient lived in personal home; however, patient has resided in SNF since hospice admission.

Upon client record review, 1 of 14 (Patient #9) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient 9: Admission POC contains an order for wound care, however, the order did not indicate facility and hospice responsibility for the wound care.

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 Patient #4: The staff member was observed placing the tablet, notepad, and gloves on the table with no barrier. Also, observed the staff member using hand sanitizer then placing the bottle in the bag with clean items then took it out and used again and placed the bottle back in with clean items. Patient #9: The staff member was observed placing her nursing bag on the sofa with no barrier then placed the barrier on the table and sat the bag on the barrier. Then sat cleaning wipes on top of the patients tissue box, removed gloves and went into her nursing bag several times to retrieve equipment without washing or sanitizing her hands between entering the bag and providing patient care.