Every finding on record at Grace Hospice of Nevada LLC

Upon patient record review, 8 of 16 (Patients #4,#8,#9,#10,#13,#14,#16) 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. Patient 4: The medication profile contained aspirin and losartan with no defined route. Patient 10: The medication profile contained oxygen with no defined flow rate, and triamcinolone cream did not have route or affected area defined for administration. Patient 8,9,13,14,16: The medical record contained nursing documentation identifying patient use of oxygen. There was no evidence of oxygen included on the medication profile.

Upon patient record review, 1 of 16 (Patient #11) 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 11: The medical record contained social work and spiritual care frequency orders for once monthly as needed. There was no evidence of a scheduled frequency to anticipate patient needs.

Upon patient record review, 3 of 16 (Patients #10,#14,#15) 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 10: The medical record contained an order for triamcinolone with no defined route and affected area for administration. Patient 14: The medical record contained nursing documentation identifying patient use of oxygen. There was no evidence of an order for oxygen. Patient 15: The medical record contained nursing documentation identifying patient use of a trilogy. There was no evidence of an order for trilogy parameters.

Upon client record review, 1 of 16 (Patient #16) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 16: The medical record contained an order for catheter to be change once a month. There was no evidence of the catheter being changed between 1/8/22 and 2/26/22.

Upon patient record review, 3 of 16 (Patients #5,#7,#16) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patients 5,7,16: There was no evidence of bereavement care plan defining the needs of the bereaved and services to be offered with frequency of delivery.

Upon patient client record review, 1 of 16 (Patient #5) did not have evidence that each patient record contains Physician certification and recertification of terminal illness. Patient 5: There was no evidence of a certification of terminal illness received from the community attending physician elected by the patient/representative.