Every finding on record at Ennoble Hospice Nj, LLC

Upon patient record review, 4 of 23 (Patient #5, 7, 8, 16) 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 #5: Admitted with Foley catheter. No related problems, goals, interventions. Updated during survey Patient #7: Admitted with Lewy Bodies, history of constipation, initial medication orders including stool softener, laxative, suppository and enemas as needed, but no related problems, goals, interventions. Updated IDG plan of care prior to end of survey. Patient #8: Initial med order. Dulcolax 10 mg daily as needed for constipation. No related problems, goals, interventions. Patient #16 with history of hospitalization for fecal impaction. Has no related problems, goals, interventions. Patient medications include Fentanyl. Bowel regiment includes Dulcolax suppository daily as needed. Updated care plan before end of survey.

Upon patient record review, 2 of 23 (Patient #1, 2) 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 #1: 11/18/23 POC SC frequency 3 PRN; PRN visits for spiritual and emotional care needs. Start date 11/18/23. End date 1/16/24. Chaplain 1-2 m 2 m; one or two visits every eight weeks for Chaplain to provided spiritual and emotional support. Start Date: 12/1/23. End Date 1/16/24. Corrected before end of survey Patient #2: 11/1/23 POC SC frequency 3 PRN; PRN visits for spiritual and emotional care needs. Start date 11/1/23. End date 12/30/24. Chaplain 1-2 m 2 m; one or two visits every eight weeks for Chaplain to provided spiritual and emotional corrected before end of survey

Upon client record review, 2 of 23 (Patient #13, 17) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #13: Admitted 10/10/23. 12/11/23 SN note - documents wound care provide to right heel. There is no MD order for wound care identified in EMR. Orders updated 12/14/23 prior to end of survey. Patient #17. Patient admitted 10/10/23. Foley present at time of admission from hospital. Initial order to change monthly. No documented evidence changed in November notes. Documented as changed 12/7/23.

Upon patient record review, 2 of 23 (Patient #21, 23) did not have evidence the hospice offers bereavement counseling that includes: • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient #21: Patient passed away 8/16/23. Bereavement phone call 8/21/23. No answer. No other attempts documented. Patient #23: Patient passed away 12/22/22. Initial assessment visit by SC was 1/4/23. Documented plan to follow up phone call 2/4/23 (phone or letter). No further documentation of phone calls until 9/21/23 phone call.

Upon patient record review 4 of 23 (Patient #1, 4, 5, 18) 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: HA Assignment sheet 3/23/23 has HA frequency of 7 days week. Tasks for shampoo and linen assigned weekly. HA documented as done daily 11/19 (Sun) thru 11/26/23 (Sat) Patient #4: HA Assignment for weight 1x/month. "Done" every day week of 11/20-11/23/23. Patient #5: HA Assignment for weight 1x/month. "Done" 11/30, 12/1, 12/2/23. Patient #18 HHA shampoo 3x wk. Documented as "Done" 11/26, 11/27, 11/28, 11/30, 12/1, 12/2/23.

Upon patient client record review, 2 of 23 (Patient #19, 20) did not have evidence that each patient record contains Advance Directives. Patient #19, 20: Clinical record did not include information regarding presence of Advance Directives and/or end of life decisions.