Every finding on record at Elevation Hospice of Colorado LLC

Upon patient record review, 2 of 23 (Patients #11, #16) 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 Patient 11: Facility is missing amlodipine 5mg, hydrocodone 5/325 ever 4 hours as needed for pain, and dextromethorphan/guaifenesin 3 times a day. Patient 16: Facility medication administration profile is missing the aspirin order.

Upon patient record review, 2 of 23 (Patients #8, #11) 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: Wound to coccyx has measurements on admit date of 4/28/25, then again on 5/15/25 and wounds to right arm with measurements on 5/19/25, none since. Per company policy, wound care measurements are to be weekly. Patient 11: Patient developed new wound on 4/9/25 to the coccyx. No measurements have been charted since identification. Per company policy, wound care measurements are to be weekly.

Upon patient record review, 1 of 23 (Patient #4) 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 4: In recert visit, the nurse charts that the patient "wheels himself into the bathroom". There is no wheelchair orders-corrected on site

Upon patient record review, 1 of 23 (Patient #14) 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 14: Upon admission, patient required supplemental oxygen, plan of care correctly identified use and safety, patient does not require oxygen use and orders written to discontinue use on 2/4/25, the plan of care was not updated to reflect the change in patient status-corrected on site.

Upon client record review, 1 of 23 (Patient #15) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 15: The massage therapist order is 4 times a month, only 3 documented visits for month of May.-corrected on site.

Upon observation, there was no evidence the hospice investigates all adverse events, incidents, accidents, variances or unusual occurrences that involve patient care and develops a plan of correction to prevent the same or similar event from occurring again. Patient 17 has a nurse visit due to a documented fall on 4/22/25, no incident report was found concerning fall. Upon investigation, agency agreed and added a late entry for incident.

Upon patient record review, 3 of 23 (Patients #8, #13, #16) 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 8: There are no instructions in the aide care plan for management of the wound care dressing to the coccyx. Patient 13: There are no instructions in the aide care plan for management of the wound care dressing to coccyx. Patient 16: There are no instructions in the aide care plan for management of the wound care dressing to the left second toe.

Upon patient record review, 1 of 13 (Patient #13) 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 #13: On 2/5/2022, the RN documented the patient had suppositories and Milk of Magnesia in the home. Neither medication was listed on the med profile or had been part of the medication review.

Upon patient record review, 6 of 13 (Patients #2, #3, #6, #7, #9 and #11) did not have evidence in the patient record that the comprehensive assessment included a bereavement component which included 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 #2, #3, #6, #7, #11: There was no Initial Bereavement Assessment as of the Survey date of 5/24/2022. Patient #9: Had a start of care date of 1/26/2021. The Initial Bereavement Assessment was not completed until 3/25/2022.

Upon client record review, 4 of 13 (Patients #1, #2, #12 and #13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1: On 3/4/2022, the RN documented patient on "4.5 liter of Oxygen. Informed wife to increase to 6..." There was no Physician order to increase the oxygen. Patient #2: Physician orders listed Social Work frequency at 2 x month. There was no documentation to indicate the second Social Work visit had been conducted for the month of April. Patient #12: On 4/20/2022, the Initial Plan of Care included orders of ..."Hospice Nurse to maintain indwelling catheter...". On 4/25/2022, the patient had an "unwitnessed fall and pulled out the catheter." On 4/26/2022, the RN documented the attempt of "insert a new catheter without any luck..." There was no order obtained to discontinue the foley catheter. Patient #13: On 2/5/2022, the RN documented ..."This RN inquired about bowel meds. Primary caregiver reported they had a suppository and Milk of Magnesia in the home. Advised to give at this time..." Neither medication was listed on the Plan of Care.

Upon patient record review 1 of 13 (Patient #8) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient #8, a note dated 3/8/2022 revealed the Social Worker documented that the primary caregiver ..."would like for a volunteer to see her to play games..." There was no referral made to start Volunteer services as requested by the primary caregiver.

Upon patient record review, 8 of 13 (Patients #1, #2, #3, #4, #5, #7, #8, #13) 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: The record indicated the patient was on Oxygen and had multiple falls. There was no documentation to indicate Oxygen and Fall precautions were added to the Aide Care Plan. Patient #2: The record indicated the patient was at risk for falls and on 3/4/2022, the RN documented ..."she seems to be more hard of hearing and I was required to shout to communicate..." There was no documentation to indicate hearing and fall precautions were part of the Aide Care Plan. Patient #3: The record indicated the patient had multiple falls prior to admission. There was no documentation to indicate fall precautions were part of the Aide Care Plan. Patient #4: The record indicated the patient was at risk for falling and on 4/25/2022 the Chaplain documented ..."Chaplain called daughter to ask about the patient's hearing apparatus. Daughter says she has it at home but plans on bringing another one for us at the facility..." There was no documentation to indicate fall and hearing precautions were part of the Aide Care Plan. Patient #5: The Initial Plan of Care listed a secondary diagnosis as "History of Falling". There was no documentation to indicate fall precautions were part of the Aide Care Plan. Patient #7: The record indicated the patient was a fall risk and was currently using oxygen. There was no documentation to indicate fall precautions or oxygen precautions were part of the Aide Care Plan. Patient #8: The record indicated the patient was on oxygen. There was no documentation to indicate that oxygen precautions were part of the Aide Care Plan. Patient #13: A Physician order dated 2/14/2022 stated, ..."hold all oral pills. Patient having trouble swallowing..." There was no documentation to indicate the Aide Care Plan had been updated with aspiration precautions.

Upon patient record review 7 of 13 (Patients #1, #2, #3, #4, #5, #6, #9) 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 #1: The Aide Care Plan dated 11/13/2021, directed the Aide to shampoo the patient on Monday, Wednesday and Friday. There was no documentation to indicate the Aide provided that task during the visits conducted on 2/16/2022, 3/2/2022 and 3/4/2022. Patient #2: The Aide Care Plan dated 2/21/2022, directed the Aide to: provide nail care every Monday, provide a shower and shampoo every Wednesday and to weigh the patient every other Monday. (a) The Aide documented the provision of nail care on Friday, 3/18/2022 and Friday, 3/25/2022. (b) On Wednesday, 3/16/2022, the Aide documented that a shower and shampoo was "not required this visit." and the Aide documented the provision of a shower and shampoo on Monday, 3/28/2022. (c) There was no documentation to indicate the Aide weighed the patient during the month of March. Patient #3: The Aide Care Plan dated 1/18/2022, directed the Aide to provide a shower and shampoo on Monday, Wednesday and Friday and assist with feeding Monday - Friday. (a) On Tuesday, 1/25/2022 and Thursday, 1/27/2022 the Aide documented the provision of a shower and shampoo. (b) On Monday, 1/31/2022 under "assist with feeding", the Aide documented "not required." Patient #4: The Aide Care Plan dated 4/15/2022, directed the Aide to provide foot and nail care every Wednesday and a shower and shampoo every Saturday. (a) On Monday, 4/25/2022 and Monday, 5/16/2022 the Aide documented the provision of nail care. On Tuesday, 4/26/2022 the Aide documented the provision of nail care. (b) On Saturday, 4/23/2022, 4/30/2022 and 5/14/2022, the Aide documented that a shampoo and shower were "not required at this visit." Patient #5: The Aide Care Plan dated 4/12/2022, directed the Aide to shower and shampoo the patient on Monday and Thursday. On Monday 4/18/2022, 5/2/2022 and 5/9/2022, the Aide documented that "shower and shampoo not required this visit". Patient #6: The Aide Care Plan dated 3/7/2022, directed the Aide to shower and shampoo the patient on Wednesday. On Wednesday 3/16/2022, 3/23/2022 and 4/6/2022, the Aide documented that "shower and shampoo not required this visit". Patient #9: The Aide Care Plan dated 1/27/2022, directed the Aide to provide foot and nail care every Saturday. On Monday, 2/7/2022 and Thursday, 2/3/2022, the Aide documented the provision of foot and nail care.