Every finding on record at Graceful Hospice Care Inc.

Upon patient record review, 1 of 14 (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. 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 #2, Upon home visit, patient verbalizes she takes Tylenol 650mg as needed for pain. No evidence of Tylenol documented on medication profile.

Upon patient record review, 10 of 14 (Patient #1,2,3,4,5,6,7,8,9,10) 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 #1,2,3,4,5,6,7,8,9,10, Each patient is documented as full code. No evidence of full code status address in care plan. Patient #2,3,4,5,6,7,8,10, No evidence of funeral home addressed on initial assessment. No evidence of funeral arrangements addressed in care plan.

Upon patient record review, 2 of 14 (Patient #1,2) 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. Patient #1, Upon home visit patient was using an electric wheelchair. No evidence of electric wheelchair documented under DME on the Plan of Care. Patient #2, Upon home visit patient has a wheeled walker. No evidence of wheeled walker documented under DME on the Plan of Care.

Upon client record review, 6 of 14 (Patient #5,6,7,8,9,10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #5,6,7,8,9,10, MSW initial visits completed as telephone visit. No evidence of order to complete telephone visit.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #2, LVN was using gloves, removed and applied a new pair of gloves. No evidence of hand sanitizing before using the new gloves.

Upon patient client record review, 2 of 14 (Patient #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 Patient #7,9, No evidence of election date documented on the Election of Hospice Medicare and patient authorization form.

Upon patient client record review, 1 of 14 (Patient #13) did not have evidence that each patient record contains Advance Directives. Patient #13, No evidence of copies of Living Will or POA for Healthcare in chart. Consent form documents patient has a Living Will and a POA for Healthcare.

Upon observation, there was no evidence the hospice documented the cost savings achieved through the use of volunteers. It was noted that the agency has had volunteer hours completed but no evidence of a cost-savings report.