Every finding on record at Elbrus Hospice Inc

Upon observation, there was no evidence that during the initial assessment visit in advance of furnishing care, the hospice provided the patient and/or family with verbal (meaning spoken) and written notice of the Patient's Rights and Responsibilities in a language and manner that the patient understands. Patient#1,#2,#3: There is no evidence patient was given written form of patient rights and responsibilities. Agency corrected by providing to the patients appropriately.

Upon patient record review, 1 of 14 (Patient #3) 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#3: During home visit it was confirmed that patient no longer takes Januvia 100mg. However, this medication is still active on medication profile. The agency placed an order to discontinue this medication in order to correct on site.

Upon patient record review, 3 of 14 (Patient #1,#3,#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 indicates the following precautions were ordered by physician on 12/2/24: fall, skin, bleeding, and aspiration. There is no evidence of aspiration or skin precaution interventions or goals on plan of care. The agency corrected the plan of care on site. Patient#3: The record indicates the following precautions were ordered by physician on 6/2/25: fall, skin, bleeding, and aspiration. There is no evidence of skin precaution interventions or goals on plan of care. The agency corrected the plan of care on site. Patient#9: The record indicates the following precautions were ordered by physician on 5/1/25: fall, skin, bleeding, and aspiration. There is no evidence of Aspiration or bleeding precaution interventions or goals on plan of care. The agency corrected the plan of care on site.

Upon patient record review, 2 of 14 (Patient #2,#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#2: There is no evidence of an order to change patient diet to puree as noted by RN on 6/10/125. The agency put in an order for the diet in order to correct. Patient#6: There is no evidence of amount or instructions for Glucerna to meet dietary needs of patient. The agency placed a new order to correct on site.

Upon patient record review, 2 of 14 (Patient #2,#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#2: On admit patient was ordered Regular diet NAS. On 6/10/25 the RN documents patient eating puree foods. There is no evidence of a change to plan of care. The agency updated the plan of care to include problems, goals, and interventions to reflect the change in dietary needs for the patient. Patient#6: SN documentation indicates patient patient has suboptimal nutritional intake and poor intake on multiple SN visits over from march to current . Glucerna was also added to patient diet on 5/7/25. No evidence of updated problems, goals, interventions related to nutritional needs.