Every finding on record at Graceful Hospice & Palliative Care LLC

Upon patient record review 4 of 14 (Patient #6,#9,#10,#11) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient #6: There was not evidence of a spiritual assessment. Patient #9: There was not evidence of a spiritual assessment. Patient #10: There was not evidence of a spiritual assessment. Patient #11: There was not evidence of a spiritual assessment.

Upon patient record review, 2 of 14 (Patient #1,2) 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 #1: Spironolactone was on the medication profile but not in the patients home. In addition, Oxygen was on the medication profile as 2-4 L via NC continuous. The patient/caregiver states she uses it prn. (Corrected on site) Patient #2: Tylenol 8 hour tablet for pain was on the medication profile but not in the patients home. (Corrected on site). The POC dated 8/15/24 indicated in the narrative that the patient is taking acetaminophen/codeine for generalized pain. The medication profile indicated it was discontinued on 7/12/24.

Upon patient record review, 2 of 14 (Patient #3,#5) 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 #3: The medication profile contained Morphine sulfate, Lidocaine patch, Tramadol, Acetaminophen, and Hydrocodone-acetaminophen all prn for pain. There was not evidence indicating the parameters In addition, the medication profile contained Docusate Sodium, Bisacodyl prn, and Polyethylene glycol prn for constipation. There was not evidence indicating the dosage parameters of how often each could be given. (Corrected on site) Patient #5: The medication profile contains Tylenol, Lidocaine patch, and hydrocodone-acetaminophen all prn for pain. There was not evidence indicating dosage parameters and how often each could be given. (Corrected on site)

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. Documentation reveals volunteer usage for 2023 was not tracked.