Every finding on record at Eternal Grace Hospice Inc

Upon patient record review, 7 of 14 (Patients # 4, 5, 6, 8, 9, 12, 14) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patients # 4, 5, 6, 8, 9, 12, 14: The patients' medical record did not contain evidence of imminence of death during the comprehensive assessment.

Upon patient record review, 1 of 14 (Patients # 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: During medication reconciliation of medications the patient's medication list contained orders for Protonix 20 mg delayed-release, 1 tab oral twice a day for GERD. Patient did not have this medication available for use.

Upon patient record review, 14 of 14 (Patients # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14) 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. Patients # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13: Patient's medical record contained order for bereavement counselor as needed and did not contain frequency or scope for services, social worker x1 PRN, and Nurse x3 PRN and did not contain a scope for services to be provided. Patient # 14: Patient's medical record contained orders for MSW x3 PRN, SC x3 PRN, and Nurse 2-3 times per week and as needed and did not contain a scope for services to be provided.

Upon observation and home visits, 1 of 3 (Patient #1) here was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient # 1: Upon entering the patient's home the RN placed her bag directly on the table without a bag barrier underneath.

Upon patient record review, 6 of 14 (Patients # 1, 2, 3, 7, 10, 14) 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 Patients # 1, 3, 10: The most current aide plan of care did not contain frequencies for the tasks of record bowel movement and change linens. Patient # 2: The most current aide plan of care did not contain frequencies for the tasks of record bowel movement , change linens, turn and reposition, feeding assistance, encourage fluids as tolerated, and assist with oral medications per RN instructions. Patient # 7: The most current aide plan of care did not contain frequencies for the tasks of record bowel movement, turn and reposition, and change linens. Patients # 14: The most current aide plan of care did not contain frequencies for the task of change linens.

Upon patient record review, 1 of 14 (Patient # 2) did not have evidence that each patient record contains Advance Directives. Patient # 2: On the consent/election of benefit form, the nurse had checked both a) patient does not have an advance directive, and b) patient has an advance directive. Both boxes where checked making it unclear as to whether the patient had an advance directive or not.