Every finding on record at Gratified Hospice Care, Inc

Upon patient record review,1 of 14 (Patient 2) did not have evidence that the patient has received effective pain management and symptom control from the hospice for conditions related to the terminal illness. Patient 2: On 2/15/25 the RN comprehensive assessment the RN documented the patient has "2+ pitting edema , cool extremities", there is no evidence in the patient record for symptom control medication for 2+ pitting edema or refusal of symptom management medications from the patient.

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: On 4/20/25 medication profiel contains medications, "Hydroxychloroquine Sulfate 200mg tablet, 30 tablets, take one tablet once a day for Malaria and Jardiance 25mg tablet, take one tablet once a day for Diabetes", during a home visit with the patient the both medications were not found in the home. The caregiver and patient stated he was not taking these medications. Patient 2: The current medication profile contains medication "Docusate Sodium 100mg capsule 100mg, take one tab once a day" , during a home visit with the patient the medication was not found in the home and patient stated they are no longer taking this medication.

Upon patient record review, 1 of 14 (Patient #7) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient 7: On 2/27/25 the MSW documented the bereavement comprehensive assessment "Bereavement risk assessment was completed for the primary caregiver of pt" the documentation does not identify the names of the caregiver for bereavement risk.

Upon client record review, 1 of 14 (Patient #4) did not have evidence that the hospice follows the individualized plan of care developed in in collaboration with the attending physician (if any), the patient or representative, and the primary caregiver in accordance with the patient's needs if any of them so desire. Patient 4: In the comprehensive assessment the RN documented "Family elects Dr. L to follow patient care" on the admission consent the Hospice MD was elected as patients choice for health care provider. There is no evidence that the patient's choice for health care provider collaborated for the development of the plan of care.

Upon patient record review, 1 of 14 (Patient #6) 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 6: On 3/17/25 the RN comprehensive assessment contains information of patient using a "walker and cane" There is no risk for falls on the plan of care.

Upon patient record review, 1 of 14 (Patient #4) did not have evidence that the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions which including interventions to manage pain and symptoms. Patient 4: On 4/24/25 the RN documented, "Pt awake, alert and oriented to person and place, exhibiting signs of restlessness and confusion". There is no evidence of interventions or documentation to call physician addressing symptom management for restlessness and confusion.

Upon client record review, 1 of 14 (Patient #4) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient 4: In the comprehensive assessment the RN documented "Family elects Dr. L to follow patient care" on the admission consent the Hospice MD was elected as patients choice for health care provider. There is no evidence that the patient's choice for health care provider collaborated for review and revision of the plan of care at least every 15 days.

Upon patient record review 2 of 14 (Patient 9,10) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient 9: On 2/21/25 in the comprehensive assessment, the RN documented "HHA three times weekly". There is no evidence in the POC for the aide to see the patient three times a week or visits made to patient from the aide. Patient 10: On 2/16/25 in the comprehensive assessment, the RN documented "HHA three times weekly". There is no evidence in the POC for the aide to see the patient three times a week or visits made to patient from the aide.

Upon personnel record review, 1 of 12 (Personnel # 5) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel 5: The aide competency did not contain evidence of the aide performing a tub and shower bath or shampooing in sink and bed

Upon patient client record review, 1 of 14 (Patient #4) 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 4: In the comprehensive assessment the RN documented "Family elects Dr. L to follow patient care" on the admission consent the Hospice MD was elected as patients choice for health care provider. There is no evidence that the patient's choice for health care provider was documented on the election of benefit form.

Upon patient client record review, 5 of 14 (Patient #2,4,8,9,10) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 2: On 2/17/25 the MSW documented on the bereavement comprehensive assessment, "Bereavement assessment completed following the death of the 68 year old male who has been receiving services under Gratified Hospice Care. Initial grief responses assessed". There is no evidence that the patient is deceased at the time of the bereavement assessment. Patient 4: On 3/27/25 the RN comprehensive assessment, the RN documented "patient has been treated for multiple respiratory in sections". It is unclear what "respiratory in sections" is. Patient 8: On the CTI dated 2/23/25 in the RN assessment narrative it is documented "patient has been treated for multiple respiratory in sections " It is unclear what "respiratory in sections" is. Patient 9: On the CTI dated 2/21/25 in the RN assessment narrative it is documented "patient has been treated for multiple respiratory in sections " It is unclear what "respiratory in sections" is. Patient 10: On the CTI dated 2/16/25 in the RN assessment narrative it is documented "patient has been treated for multiple respiratory in sections " It is unclear what "respiratory in sections" is.

Upon observation, there was no evidence the hospice provides orientation to personnel of a SNF/NF or ICF/IID regarding the policies and procedures of the provision of care/service including all required content.

Upon patient record review, 1 of 5 (Patient #4) 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 #4 The patient chart reflected Oxygen usage. The Medication list did not have Oxygen on this list.

Upon patient client record review, 2 of 5 (Patient #3 and #4) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #3 The Initial Nursing Assessment at SOC states the patient uses ibuprofen 400 mg for breakthrough pain. The Medication list and MD Supplemental order taken by admitting nurse both indicated ibuprofen 800 mg for breakthrough pain. The dosage for ibuprofen on nursing note was not congruent with MD supplemental order or medication list. Patient #4 The CTI benefit period duration had 91 day duration for 1st benefit period, not 90 days. The agency benefit period reads 12/15/21 to 3/15/22 (91 days). The 1st benefit should read 12/15/21 to 3/14/22 (90 days).