Every finding on record at Green Paradise Hospice Care, Inc.

Upon patient record review, 1 of 14 (Patient #10) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable state law. Patient #10, Patient signed their own consents. Initial RN comprehensive on 9/6/23 documented fall due to sun downing, confusion, weakness. MSW documented on initial assessment on 9/7/23, confused.

Upon patient record review, 1 of 14 (Patient #10) did not have evidence that the hospice obtained the patient's or representative's signature confirming that they received a copy of the Patient's Rights and Responsibilities. Patient #10, Patient signed their own consents. Initial RN comprehensive on 9/6/23 documented fall due to sun downing, confusion, weakness. MSW documented on initial assessment on 9/7/23, confused.

Upon patient record review, 1 of 14 (Patient #10) did not have evidence that if a state court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with state law may exercise the patient's rights to the extent allowed by state law. Patient #10, Patient signed their own consents. Initial RN comprehensive on 9/6/23 documented fall due to sun downing, confusion, weakness. MSW documented on initial assessment on 9/7/23, confused.

Upon patient record review, 1 of 14 (Patient #10) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #10, Patient signed their own consents. Initial RN comprehensive on 9/6/23 documented fall due to sun downing, confusion, weakness. MSW documented on initial assessment on 9/7/23, confused.

Upon patient record review, 1 of 14 (Patient #10) did not have evidence of the appropriate documentation for release of confidential information. Patient #10, Patient signed their own consents. Initial RN comprehensive on 9/6/23 documented fall due to sun downing, confusion, weakness. MSW documented on initial assessment on 9/7/23, confused.

Upon patient record review, 1 of 14 (Patient #10) did not have evidence that the patient received information about the services covered under the hospice benefit. Patient #10, Patient signed their own consents. Initial RN comprehensive on 9/6/23, documented fall due to sun downing, confusion, weakness. MSW documented on initial assessment on 9/7/23, confused.

Upon patient record review, 1 of 14 (Patient #10) did not have evidence that the patient received information about the scope of services that the hospice will provide and specific limitations on those services. Patient #10, Patient signed their own consents. Initial RN comprehensive on 9/6/23 documented fall due to sun downing, confusion, weakness. MSW documented on initial assessment on 9/7/23, confused.

Upon patient record review, 1 of 14 (Patient #3) 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 #3, Patient seen as home visit. DME listed is oxygen and oxygen supplies. Patient had shower chair in home which was not documented on POC.

Upon client record review, 3 of 14 (Patient #5,9,11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #5, LVN frequency 1x/week. Visits made twice a week on 9/18/23, 9/20/23, 9/25/23, 9/27/23. Patient #9, LVN frequency 3x/week. Patient was admitted on Sat 9/23/23. LVN first visit was 9/25/23. Patient #11, LVN frequency 1x/week. Visits made twice a week on 7/17/23, 7/21/23,7/31/23, 8/4/23, 8/7/23, 8/9/23.

Upon patient record review 3 of 14 (Patient #1,5,10) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #1, Visit on 11/8/23, aide documented aspiration which was not on the care plan. 11/27/23 aide documented toileting which was not direction on the care plan. Patient #5, Frequency 2x/week on 9/12/23. Visits made on 9/15/23, 9/18/23, 9/2-/23, 9/25/23, 9/27/23, 10/2/23, 10/5/23. Only 1 visit the first week was made. Patient #10, Frequency 2x/week on 9/6/23. First visit made on second week. Visits on 9/11/23, 9/14/23, 9/18/23, 9/21/23. Also, visit on 9/25/23, Aide checked adult diapers/briefs which was not directed on care plan. Aide documented diet as tolerated, which was not directed on care plan.

Upon patient client record review, 1 of 14 (Patient #10) 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 #10, Patient signed their own consents. Initial RN comprehensive on 9/6/23 documented fall due to sun downing, confusion, weakness. MSW documented on initial assessment on 9/7/23, confused.

Upon patient client record review, 1 of 14 (Patient #1) 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 #1, IDG note from 12/1/23, no evidence of MD signature.

Upon client record review, 1 of 14 (Patient #10) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed. Patient #10, Patient signed their own consents. Initial RN comprehensive on 9/6/23 documented fall due to sun downing, confusion, weakness. MSW documented on initial assessment on 9/7/23, confused.