Every finding on record at Grace Race Palliative Hospice LLC

Upon patient record review, 2 of 14 (Patient #7,#13) 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 • Drug therapy currently associated with laboratory monitoring Patient #7: The initial assessment dated 09/24/23 indicated the patient was using "O2" at "2-4 LM", additionally, the MD CTI summary dated 09-24-23 indicated patient did "not like to keep O2 on." Oxygen was not listed on the medication profile. Patient #13: Per MD CTI dated 12-8-23, the MD stated the patient was "on continuous O2", additionally, the Oxygen concentrator was listed on the plan of care dated 12-8-23. However, oxygen was not listed on the medication profile.

Upon patient record review, 9 of 14 (Patient #1,#2,#5,#7,#8,#9,#10#12,#13) 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. Patient#1,#2:The initial assessments, dated 09-11-23 for patient #1 and 11-10-23 for patient #2, indicated patients had heart failure and were using O2. There was no evidence of care plans for cardiac or respiratory problems. Patient#5: The initial assessment dated 10-14-22 indicated the patient had a diagnosis of CVA, was taking medications for seizures, and speech was garbled with poor grips bilaterally. There was no evidence care plans neurological problems. Patient#7:The initial assessment,09-24-23, indicated heart failure with O2 use. There was no evidence of care plans for cardiac or respiratory problems. Patient#8: The initial assessment dated 09-08-23 indicated patient had COPD and was using O2. there was no evidence of care plans addressing respiratory problems. Patient#9:The initial assessment, 09-11-23, indicated the patient had Dementia, "occasional chest pain" and uses O2. There was no evidence of care plans which addressed pain, respiratory or neuro problems. Patient#10: The initial assessment and the CTI dated 09-08-23 indicated the patient had Colon Ca, with "slow transit constipation". There was no evidence of care plans that address GI problems. Patient#12#13:The initial assessments, both dated 12-8-23, indicated both patients had COPD with O2 use. There was no evidence of care plans for respiratory problems.

Upon patient record review, 1 of 14 (Patient #7) 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 #7: The RN wrote "O2 ordered stat" on the initial assessment dated 09-24-23. There was no order for the oxygen.

Upon client record review, 8 of 14 (Patient #1,#2,#6,#7,#8,#9,#10,#11) did not have evidence that the plan of care included IDG's documentation of the patient's or families level of understanding, involvement and agreement with the plan of care. Patient #1,#2,#6,#7,#8,#9,#10,#11: All assessments for patient/family agreement and involvement in plan of care were not addressed.

Upon patient client record review, 1 of 14 (Patient #8) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #8: The effective date of election of hospice services was documented by beneficiary as 09-11-23. The agency start of care date was documented as 09-08-23.

Upon client record review, 1 of 14 (Patient #2, #3) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary Patient #3: The patient revoked hospice services on 02-03-23. There was no evidence of a discharge summary in the patient records.

Upon patient record review, 10 of 14 (Patient #1,#2,#6,#7,#8,#9,#10,#11,#12,#13 ) did not have evidence in the patient record that the interdisciplinary group, as part of the review of the plan of care, determines the ability of the patient and/or family to safely self-administer drugs and biologicals to the patient in his or her home. If the patient and/or family are not capable of safely administering drugs and biologicals in the home, the hospice must address this issue in the patient's plan of care. Patients #1,2,6,7,8,9,10,11,12,13: There was no evidence of documentation in the plan of care or assessments that showed the patient/family capability of administering medications.