Every finding on record at Family Hospice, Ltd.

Upon patient record review, 1 of 11 records (Patient #11) 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 #11: The medication profile indicated Enema (Sodium Phosphate 19GM-7GM/118ml) per rectum as needed. There was not evidence of a complete frequency.

Upon patient record review, 2 of 11 records (Patient #2,#11) 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 #2: The patient was admitted on 8/12/22. The record indicated that the bereavement assessment was not completed until 8/18/22. Patient #11: The patient was admitted on 7/18/22. The record indicated that the initial bereavement assessment was completed on 8/18/22.

Upon patient record review, 1 of 11 records (Patient #11) did not have evidence the plan of care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #11: The record indicated an order for an Enema (Sodium Phosphate 19GM-7GM/118ml) per rectum as needed. There was not evidence of a complete frequency.

Upon patient record review, 1 of 11 records (Patient #11) 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 #11: The IDG documentation for the date of 8/10/22 indicated that the patient had decreased po intake. He was eating only 1 meal/day and it consisted of small bites. The IDG dated 8/24/22 indicated that the patient had not taken in po in 10 days and was minimally responsive. There was not evidence that imminence of death was added to the plan of care or that the plan of care was updated to reflect these changes. The patient died on 8/24/22.

Upon client record review, 3 of 11 records (Patient #2,#4,#6) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2: The visit frequency for the spiritual care counselor was 2m3, 1m1 and 2 prn. A missed visit note dated 12/26/22 indicated only that the visit was missed without identifying the reason or if anyone was notified. Patient #4: The visit frequency for the spiritual care counselor was for an evaluation then 2 every 2m2, 2m1 and 2 prn. The record indicated that the spiritual care counselor conducted the evaluation on 10/28/22 and provided subsequent visits on 11/21/22, 12/6/22, and 12/20/22. Patient #6: The visit frequency for the spiritual care counselor was for an evaluation then 2 every 2m2, 2m2 and 2 prn. The record indicated that the spiritual care counselor conducted the evaluation on 10/28/22 and provided subsequent visits on 11/9/22, 11/21/22, 12/2/22, and 12/21/22.

Upon patient record review, 1 of 11 records (Patient #11) did not have evidence in the patient record that hospice aide assignments and duties are: • Specific written patient care instructions, including alerts and precautions for a hospice aide that 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. Patient #11: The record indicated that the patient was on Eliquis 5mg po BID. There was not evidence that bleeding precautions were a part of the aide plan of care.

Upon patient record review 1 of 11 records (Patient #3) 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 Patient #3: The aide plan of care indicated to provide nail care weekly. The aide visit frequency was 3w1,5w8. From 12/5/22 through current, the record indicated that nail care was provided at each visit. In addition, for the dates of 11/24/22 and 12/27/22, the aide documented that the visits were missed due to Holiday, office closed. There was not evidence that the patient/family/representative was involved in the decision to change the care plan frequency.

Upon contract review, 1 of 6 contracts (MC) did not have evidence of a contract to fulfill the role of alternate medical director. The contract did not have evidence that indicated an alternate Medical Director/Designee. It also did not include a provision of the ability of this physician to fulfil the duties of the Medical Director in times of temporary absences. The contract indicated 'Independent Contractor, Hospice Physician,'

Upon client record review, 1 of 11 records (Patient #1) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient #1: The record indicated wound care orders dated 12/6/22 and 12/13/22 which included that the skilled nurse or the facility nurse may do the wound care. The wound care orders did not specifically identify which provider was to provide the wound care. Corrected on site.