Every finding on record at Elevate Hospice and Palliative Care LLC

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 1: On the medication profile there is an order for MiraLAX 17g, there is no diluent listed for this medication. Corrected on site. Patient 3: On the medication profile there is an order for acetaminophen 500mg 1 tablet 3 times daily as needed and an order for hydrocodone/acetaminophen 5-325mg 1 tablet 3 times daily, there is not a daily limit for these medications. Corrected on site. Patient 10: On the medication profile there is Tylenol 500mg 1 tab 2 times daily and acetaminophen 500mg 1 tab every 6 hours as needed, there is not a daily limit for this medication. Corrected on site.

Upon patient record review, 1 of 14 (Patient #10) 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 10: On the plan of care there is an order for aspirin 81mg daily, there is not a risk for bleeding with goals and interventions on the plan of care. Corrected on site.

Upon patient record review, 2 of 14 (Patient #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 3: On the plan of care there is an order for acetaminophen 500mg 1 tablet 3 times daily as needed and an order for hydrocodone/acetaminophen 5-325mg 1 tablet 3 times daily, there is not a daily limit for these medications. Corrected on site. Patient 10: On the medication profile there is Tylenol 500mg 1 tab 2 times daily and acetaminophen 500mg 1 tab every 6 hours as needed, there is not a daily limit for this medication. Corrected on site.

Upon personnel record review, 1 of 11 (Personnel #5) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel 5: On the competency assessment performed by the aide, there is no evidence that there were techniques for shampoo in sink, tub and bed.

Upon patient client record review, 3 of 14 (Patient #2,3,10) 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 2: On the RN assessment dated 11-11-25, The RN documented, "Abdomen SNT with active bowel movements". SNT is not an approved abbreviation. On 10/12/25 there is documentation from the RN, "RN updated RNCM". RNCM is not an approved abbreviation. Patient 3: There is documentation in the RN comprehensive assessment, "Educated on EOL", EOL is not an approved abbreviation. Patient 10: There is documentation in the RN comprehensive assessment, "Knows she is in a GH." GH is not an approved abbreviation.

Upon observation, there was no evidence of contracts/agreements with other facilities/agencies/hospices to receive patients in the event the hospice cannot provide care to their patients during an emergency.

Upon patient record review 4 of 11 (Patient #3, #5, #9, #10) 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 3: SOC 5/12/2022 psychosocial assessment occurred 6/10/2022. Patient 5: SOC 12/14/2021 spiritual assessment occurred 12/20/2021. Patient 9: SOC 3/17/2022 psychosocial assessment occurred on 3/30/2022. Patient 10: SOC 3/1/2022 psychosocial assessment occurred on 3/8/2022.

Upon patient record review 1 of 11 (Patient #11) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient 11: There was no evidence of a psychosocial assessment.

Upon patient record review, 1 of 11 (Patient #2) 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 dated 6/9/2022 included Aspercream Lidocaine 4% topical patch, apply to affected area for 12 hours and remove for 12 hours. There was no evidence of an area to apply. Corrected on site.

Upon patient record review, 1 of 11 (Patient #5) 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 5: SOC date 12/14/2021, Bereavement assessment occurred 12/20/2021.

Upon patient record review, 2 of 11 (Patient #1, #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: Terminal diagnosis at SOC Alzheimer's, seizure disorder as comorbidity, takes seizure medication. There was no evidence of a Neuro problem/interventions for seizures. Corrected on site. Patient 6: Terminal diagnosis of Senile degeneration of brain, Secondary CVA 2019 and 2021. There was no evidence of a Neuro problem/interventions for CVA. Corrected on site.

Upon patient record review, 2 of 11 (Patient #5, #10) 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 5: SOC SN order included SN visits 1x week and 4 PRN per week. Corrected on site. Patient 10: SOC SN order included SN visits for 1x week and 5 PRN per week.

Upon patient record review, 1 of 11 (Patient #2) 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: An order dated 6/9/2022 included Aspercream Lidocaine 4% topical patch, apply to affected area for 12 hours and remove for 12 hours. There was no evidence of an area to apply the patch. Corrected on site.

Upon client record review, 3 of 11 (Patient #5, 8, 9) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 5: MSW made initial visit via telehealth, there was no evidence of an order for a telehealth visit. Patient 8: SOC MSW order dated 8/31/2022 included MSW 1x Month. No evidence of visit made in month of October, no order for dc, no missed visits. Patient 9: SOC MSW order dated 3/17/2022 included MSW 1x month. No evidence of visits in April or May, no missed visits or dc order in evidence.

Upon patient record review, 2 of 10 applicable (Patients #1, #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: Terminal diagnosis at SOC Alzheimer's, seizure disorder as comorbidity, takes seizure medication. There was no evidence on the aide POC/assignment sheet for seizure precautions. Corrected on site. Patient 10: Patient has order for O2, there was no evidence on the aide POC/Assignment sheet for Oxygen precautions.

Upon personnel record review, 6 of 7 applicable (Personnel #2, #5, #6, #7, #8, #13) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel 2, 5, 6, 7, 8, 13: There was no evidence of a skills competency assessment.

Upon client record review, 1 of 1 applicable (Patient #11) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patient 11: There was no evidence of a discharge summary.

Upon observation, there was no evidence a copy is provided of the hospice written policies and procedures on the management and disposal of controlled drugs to the patient or patient representative and family. The agency has an informed consent that includes: Controlled medication disposal was discussed and policy provided, which the family/rep signs. What is actually provided is a document: Fact sheet Arizona Department of environmental Quality; Proper disposal of medications. This document does not mention controlled meds and is not their policy. They do have a policy through Corridor 4-054 Home use and disposal of controlled meds.

Upon observation, there was no evidence the hospice discussed the policies and procedures for managing the safe use and disposal of controlled drugs with the patient or representative and the family in a language and manner that they understand to ensure that these parties are educated regarding the safe use and disposal of controlled drugs. The agency has an informed consent that includes : Controlled medication disposal was discussed and policy provided, which the family/rep signs. What is actually provided is a document: Fact sheet Arizona Department of environmental Quality; Proper disposal of medication. This document does not mention controlled meds and is not their policy. They do have a policy through Corridor 4-054 Home use and disposal of controlled meds.

Upon client record review, 11 of 11 (Patients #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed. Patients 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11: The agency has an informed consent that includes : Controlled medication disposal was discussed and policy provided, which the family/rep signs. What is actually provided is a document: Fact sheet Arizona Department of environmental Quality; Proper disposal of medication. This document does not mention controlled meds and is not their policy. They do have a policy through Corridor 4-054 Home use and disposal of controlled meds. There was no evidence of accurate documentation in the patient's record that the written policies and procedures for managing controlled drugs was provided and discussed.