Every finding on record at Fidelia Hospice, Inc

Upon patient record review, 2 of 14 (Patient #1, 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 Patient 1: The medication list indicates triamcinolone 0.1% topical bid PRN redness or itching of skin; however, there is no indication of a location for application of the topical cream. (corrected onsite) Patient 2: The medication list contains a duplicate order for the patient's acetaminophen 325mg. (corrected onsite)

Upon patient record review, 1 of 14 (Patient #4) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual's attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient's progress toward desired outcomes • Reassessment of the patient's response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient 4: The RN last saw the patient on 03.23.2023; there is no evidence that a comprehensive assessment has been performed since this date. Of note, the LVN has seen the patient 2 x weekly as scheduled, and the patient's needs have been discussed during IDT meetings.

Upon patient record review, 1 of 14 (Patient #3) 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: The order related to the patient's catheter indicates SN to change Foley catheter monthly and PRN dislodged, flush catheter q visit, change once a month or PRN. This order is incomplete as it does not specify the size of the catheter or balloon, and does not specify who is flush the catheter. (corrected onsite)

Upon client record review, 3 of 14 (Patient #1, 3, 5) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: SN visits were ordered for 1 x weekly; however, during the week of 04.02.2023, the LVN saw the patient twice, on 04.03.2023 and 04.08.2023. There was no additional/supplemental order for the additional SN visit, and documentation for both visits indicated routine patient needs. Patient 3: SN visits were ordered for 2 x weekly; however, during the week of 03.26.2023, the LVN saw the patient only once, on 03.27.2023. There was no documentation of a missed visit, nor any communication from the patient or family requesting a change in the visit schedule. Patient 5: SN visits were increased to 2 x weekly on 04.04.2023; however, during the week of 04.16.2023, the LVN saw the patient only once, on 04.20.2023. There was no documentation of a missed visit, nor any communication from the patient or family requesting a change in the visit schedule.

Upon patient record review 1 of 14 (Patient #7) 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 7: Aide visits were ordered for 3 x weekly; however, during the week of 04.09.2023, the Aide saw the patient only twice, on 04.11.2023 and 04.13.2023. There was no documentation of a missed visit, nor any communication from the patient or family requesting a change in the visit schedule.