Every finding on record at Eden Hospice Care Inc

Upon patient record review 1 of 14 (Patient #11) 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 11: The patient was admitted on 5/8/23, the psychosocial assessment was completed on 5/14/23, the spiritual care assessment was completed on 5/16/23.

Upon patient record review, 3 of 14 (Patient #1, 3, 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 01: The medication profile includes Acetaminophen 325mg take 2 pills every 6 hours for mild pain and an additional order for Norco 5/325 1 pill every 4 hours as needed for severe pain, the medication profile does not include instructions/cautions for exceeding the maximum amount of acetaminophen per day. (Corrected on site.) Patient 03: The medication profile for Miralax 17gm give 1 capful by mouth daily for constipation, does not include a diluent to mix for administration. (Corrected on site.) Patient 10: The medication profile for Diclofenac 1% Topical Gel apply to affected area daily as needed, does not include an application site or a frequency for use. The medication profile for Triamcinolone 0.5%use twice a day for itching, does not include an application site. (Corrected on site.)

Upon patient record review, 3 of 14 (Patient #3, 5, 11) 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 03: The patient was admitted on 6/30/23, there is no evidence in the patient record of an initial bereavement assessment within 5 days or to date. Patient 05: The patient was admitted on 5/1/23, the initial bereavement assessment was completed on 5/8/23. Patient 11: The patient was admitted on 5/8/23, the initial bereavement assessment was completed on 5/14/23.

Upon patient record review, 3 of 14 (Patient #1, 3, 10) 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 01: The medication order on 9/8/22 Acetaminophen 325mg take 2 pills every 6 hours for mild pain and an additional order on 9/2022 for Norco 5/325 1 pill every 4 hours as needed for severe pain, does not include instructions/cautions for exceeding the maximum amount of acetaminophen per day. (Corrected on site.) Patient 03: The medication order on 6/19/23 for Miralax 17gm give 1 capful by mouth daily for constipation, does not include a diluent to mix for administration. (Corrected on site.) Patient 10: The medication order for Diclofenac 1% Topical Gel apply to affected area daily as needed, does not include an application site or a frequency for use. The medication order for Triamcinolone 0.5%use twice a day for itching, does not include an application site. (Corrected on site.)

Upon patient record review, 3 of 14 (Patient #1, 4, 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 01: The initial assessment on 9/8/22 indicates that the patient uses a wheelchair for mobility, and a shower chair for bathing. This wheelchair is referenced again in the nursing visit on 7/13/23, the shower chair is included in the hospice aide task assignment. The wheelchair and shower chair are not included in the DME plan of care. (Corrected on site.) Patient 04: The patient's hospice aide task assignment indicates that the patient uses a shower chair for bathing, this is not included in the patients DME in the plan of care. (Corrected on site.) Patient 05: The patient uses a walker, wheelchair, and shower chair for ADL's, these are not included in the patients DME in the plan of care. (Corrected on site.)

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 01: The patient requires the use of a wheelchair for mobility, this is not identified/included in the hospice aide assignment. (Corrected on site.)

Upon patient record review 1 of 14 (Patient #11) 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 11: The patient is scheduled hospice aide visits 2 times per week. There is only 1 visit noted in the patient record for the week of 7/3/23. (Corrected on site, late entry documented.)

Upon patient client record review, 1 of 14 (Patient #10) 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 10: The election form contained a section for the patient/representative to declare election or declination for receipt of Notice of Hospice Non-Covered Items. The section was empty and not completed upon admission.