Every finding on record at Fountain Hospice Inc.

Upon patient record review, 13 of 14 (Patient #1, 2, 3, 4, 5, 6, 7, 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. Patient #1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14: All original POC orders included frequency of SN Visits weekly and 3 prn visits per week for symptom management and any changes in condition. The prn frequency is too broad and frequency adjustments would be indicated to be proactive in symptom management.

Upon patient record review, 3 of 14 (Patient #5, 6, 11) 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 #5: 4/19/24 POC Item #10 of Orders: Blanchable redness on Left Heel .. apply foam border dressing and change every 3 days and as needed. May lift dressing as needed for wound assessment and press back down. Place heel protectors on patient. Caregiver may do treatment on non nursing days. There is no qualification for the as needed dressing changes. Patient #6: Board and Care resident admitted 5/7/24 with Foley catheter and 5/7/24 order to change Foley catheter once per month. There is no reference to size. Patient #11: Board and Care resident admitted 4/3/24 with Foley catheter and order to change catheter bag weekly and prn. Change indwelling urinary catheter monthly and prn. Cath 16 fr 10 cc balloon. PCG to empty bag daily and prn throughout the day. SN to assess Foley site during each visit may irrigate with 60 cc normal saline as needed for possible blockage. SN to change Foley catheter once per month. No reason for PRN for catheter change.

Upon patient record review, 1 of 14 (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: Foley catheter was removed per 4/25/24 IDG RN report however, POC problems/Goals/Interventions not updated to reflect removal/discontinuance of catheter.

Upon client record review, 3 of 14 (Patient #5, 6, 11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #5: 9/4/24 LVN Visit Note: Patient with non blanching redness to coccyx and blanchable redness on left heel was noted. SN applied calmoseptine and covered with foam bandage. Instructed PCG to reposition patient every 2 hours and reapply calmoseptine with every bowel movement. There is no order for calmoseptine to heel. Patient #6: 6/6/24 LVN note. "Urinary catheter .... Foley catheter 18 fr ...Catheter attached for gravity drainage" There was no documented order to change the catheter or size and nurse note unclear on balloon size. Patient #11: Foley catheter was removed per 4/25/24 IDG RN report. Date of catheter removal not clearly documented by RN and there was no order documented for catheter removal/discontinuance.

Upon patient record review, 2 of 14 (Patient #3, 10) 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 #3: Patient's medication profile includes Eliquis since start of care. Bleeding precautions are not included in aide assignment. Patient #10: Patient is on multiple diabetic medications (2 insulins and Ozempic). There is no reference to hypoglycemia precautions for aide assignment.

Upon patient client record review, 13 of 14 (Patient #1, 2, 3, 4, 5, 6, 7, 9, 10, 11,12, 13, 14) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patients # 1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14: Conflicting orders: Order for SC reads SC Coordinator two per week to assist with personal care and to promote comfort per RN assignment. Assess for needs initial eval within 5 days of admission for spiritual needs/status. Once per month for spiritual needs. May do phone orders per family request. Patient #2: Initial bereavement assessment (assigned to MSW) not signed by clinician. Patient #6: CTI for 5/7 (3rd/admitting benefit period) includes in RN Summary: "Patient medications are reviewed and sent to hospice for reconciliation. Skin pressure ulcer stage 2 on the sacrum cleaned. Applied skin barrier. Patient has an order for antibiotic IVP but midline is not present on hospice admission. No angiocath available to start new IV report given to hospice." Upon interview Administrator and DPCS not able to explain. Confirm that patient had no IV antibiotic order during hospice admission. Patient #11: DC Plan document not signed by clinician.