Every finding on record at Globalcare Health Services LLC

Upon patient record review, 1 of 14 (Patient #3) did not have evidence of the appropriate documentation for release of confidential information. Patient#3: Personnel were sending wound pictures of patients via cell phone.

Upon patient record review, 2 of 14 (Patient #3,4) 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 Pt#3 Upon chart review, noted the nursing comprehensive stated patient is using O2 at 3LPM. Under the directions on the medication profile, oxygen was listed at 3LPM, under the dosage column it was listed as 2L. There was no evidence of instructions on which liter flow was correct. Pt#4, The medication profile listed direction to give Tylenol for a fever. There was no evidence of parameters.

Upon patient record review, 1 of 14 (Patient #9) 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. Pt #9 No evidence that the bereavement risk assessment was completed within 5 days of the election of hospice. Pt was admitted on 7/24/24 and the risk assessment was completed on 1/31/25

Upon patient record review, 7 of 14 (Patient #1,2,3,4,6,7,8) 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. Pt#1, The nursing comprehensive showed evidence of altered mobility, high risk for falls, high risk for bleeding r/t the use of Eloquis, spiritual concerns, and high risk for aspiration. Frequency ordered for spiritual care was one visit per month. No evidence of problems, interventions or goals were added to the POC. Corrected onsite. Pt #2, The initial POC showed evidence of a spiritual care comprehensive assessment, POC frequency was one time per month, and their were no evidence of problems, interventions or goals added to the POC. Corrected on site. Pt #3, The nursing comprehensive showed evidence of high risk of constipation and being treated with Senna, high risk for bleeding r/t the use of Xarelto. The record showed evidence of a spiritual care comprehensive assessment with a frequency of one time per month. No evidence of problems, interventions or goals were added to the POC. Corrected on site. Pt#4, The nursing comprehensive documented the patient was at high risk for infection r/t aspiration and incontinence, patient using oxygen, and high risk for bleeding r/t the use of Plavix. No evidence of problems, interventions or goals were added to the POC. Corrected onsite. Pt#6, The medication list showed patient was receiving a Duoneb treatment daily. No evidence of problems, interventions or goals were added to the POC. Pt#7, The nursing comprehensive assessment had documented the patient was receiving a mechanical soft diet and was requiring medications to be crushed. There was no evidence of problems, interventions or goals r/t aspiration precautions added to the POC. Pt#8, The nursing comprehensive documented patient was assessed to be high risk for falls as well as high risk for poor skin integrity. There was no evidence of problems, interventions or goals added to the POC.

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. Pt #3 The medical record contains an order dated 2/19/25 that states the oxygen at 3L/min. The dosage on that same order states the oxygen is at 2L/min via NC. No evidence of clear instructions of the liter flow

Upon patient record review, 4 of 14 (Patient #1,2,3,6) 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 equipment and supply needs. Upon record review Pt#1, The nursing comprehensive showed evidence of patient utilizing incontinent, oxygen and suction supplies. Those supplies were not listed on the POC. Pt#2: The record indicated the patient is incontinent and utilizing briefs. Those supplies were not listed on the POC. Pt#3: The medical record showed evidence of wound orders, oxygen use and incontinence. Those supplies were not listed on POC. Pt#6: The medical record showed evidence of a suction machine noted in nursing comprehensive. The suction machine was not listed on POC. These were all corrected onsite

Upon patient record review, 2 of 14 (Patient #1,2) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Pt #1, POC indicates RN frequency as one time per week. The medical record showed RN visits on 3/17/25, 3/20, 4/2, and 4/9. The record indicated the LPN visited patient on 3/27. Pt #2, POC documented RN frequency as one time per week. The medical record showed RN visits on 3/13/25, 3/21, and 4/9. There was no evidence of an RN visit for week of 3/31/25

Upon patient record review 2 of 14 (Patient #1, 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 Pt#1, Initial POC ordered aide frequency to be 1 visit in week one. Documentation showed an aide visit was performed on 3/14/25 and 3/15/25. Pt#7, The aide POC showed a frequency of 5 visits per week; the week of 3/31/25, the medical record showed patient received aide visits on 3/31, 4/1, 4/2, 4/3, 4/4, and 4/5

Upon patient record review 1 of 14 (Patient #1) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Pt#1, There was no evidence that a registered nurse made a supervisory visit between the dates of 3/17/25 and 4/2/25

Upon patient record review, 5 of 14 (Patient #1,4,5,7,9) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Pt#1, Upon medical record review. the patient had an addendum to the Election of Benefits form signed by the DPOA however did not include Vitamin D3 as a non covered medication. Pt#4,5,7,9, The Election of Benefit form was signed by the patients POA, however there was no evidence of the reason listed as to why the beneficiary was unable to sign.