Every finding on record at Eleos, LLC

Upon patient record review, 3 of 19 (Patient #5, #6 and #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 Pt 5: Evidence of duplicate drug therapy. Morphine Sulfate 1/2ml by mouth every 3 hours for pain/SOB was ordered 5/17/23 and 5/29/23. Pt 6: Pt requires a G-tube due to CVA. Three medications (Hydrocodone, Melatonin, and Protonix)were ordered by mouth rather than per G-tube as all other ordered medications. (Corrected on-site) Pt. 10: Cough medication (Dextromethorphan/Guaifenesin) initiated on 5/17/23 x 5 days with no evidence of DC. This medication remains active on the patient medication record. Nitroglycerin 0.4mg tablets were ordered with instructions of, "1 tab q 5 minutes until pain subsides" with no limitation or further instruction if pain is unresolved. Corrected on-site.

Upon patient record review, 2 of 19 (Patient #2 and #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. Pt 2: Per medication review pt. utilizing Morphine Sulfate and Haldol with no individualized care plan initiated for pain/sob, or behaviors/agitation/delirium. Corrected on-site. Pt. 6: G-tube required due to CVA. There is no evidence of care planning for this to include precautions, checking of residuals, patient or family education, and flushing to include amount and frequency. Corrected on-site.

Upon patient record review and direct observation during home visit, 1 of 19 (Patient #1) 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. Pt. 1: Granddaughter stated during home visits that the hospice nurse performs dressing changes during visits and she (granddaughter) performs dressing changes, "on the off days". There is no delineation in the wound order as to whom is to perform dressing changes or at what frequency. Corrected on-site.

Upon patient record review 1 of 19 (Patient #14) 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 Pt. 14:Hospice aide services were declined by pt upon admission (4/1/23). Hospice aide services requested by patient with first visit 4/19/23. There is no evidence of MD order to initiate hospice aide services or designate a visit frequency. MD contacted with new order obtained.