Every finding on record at Graceful Aging Hospice Care, Inc.

Upon patient record review, 1 of 14 (Patient #10) 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 Patient #10: During the home visit it was noted the Agency medication record contain Colace as needed and Polyethylene glycol as needed. The ALF did not have those medications listed on the patients medication record.

Upon SNF/NF contract review, 1 of 3 (Santa Paula Post Acute) did not have a delineation of the responsibilities of the hospice and the SNF/NF to provide bereavement services to SNF/NF personnel. (Corrected on site.)

Upon patient record review, 1 of 5 applicable (Patient #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. Patient 2: The patient's care plan related to pain indicates the patient uses Voltaren gel 1% to the lower back. Voltaren gel is not on the medication list. (corrected on site)

Upon patient record review, 1 of 5 (Patient #2) 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 a detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs. Patient 2: The initial psychosocial assessment, dated 10.23.2021, and initial spiritual care assessment, also dated 10.23.2021, both indicate that the patient refuses ongoing services of these supportive disciplines. However, the patient's plan of care was updated at the 10.25.2021 IDT meeting to reflect ongoing monthly PRN visits with both the MSW and the chaplain; no routine visits were assigned to either discipline. The plan of care should reflect no future visits, including PRN visits, from either the MSW or chaplain. (corrected on site)