Every finding on record at Harmonia Hospice and Palliative Care, Inc.

Upon patient record review 4 of 15 (Patients #1, 3, 5, 10) 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 #1: There was no evidence of an initial spiritual care assessment completed in the record. There was no follow up assessment completed by RN. Patient #3: There was no evidence of an initial spiritual care assessment completed in the record. There was no follow up assessment completed by RN. Patient #5: There was no evidence of an initial spiritual care assessment completed in the record. There was no follow up assessment completed by RN. Patient #10: There was no evidence of an initial spiritual care assessment or an initial psychosocial assessment completed in the record. There was no follow up assessment completed by RN.

Upon patient record review, 3 of 15 (Patients #1, 4, 7) 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: The patient has oxygen in the home. There is no evidence of oxygen on the medication profile. Patient #4: The patient has oxygen in the home. There is no evidence of oxygen on the medication profile. Patient #7: The patient has oxygen in the home. There is no evidence of oxygen on the medication profile.

Upon patient record review, 1 of 15 (Patient #1) 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 #1: There was no evidence in the record of an initial bereavement assessment being completed within 5 days of admission.

Upon patient record review, 2 of 15 (Patients #1, 9) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #1: Patient complained of level 8 pain with a self identified threshold of level of 2 per the patient plan of care during nursing visit on 04/11/25. No follow up phone call or visit for 7 days. On 05/03/25, patient complained of level 3 pain as well as had new findings of edema and wheezing. No follow up phone call or visit to patient for 6 days. On 05/13/25, patient complained of level 5 out of 10 pain. Norco taken by patient, however, no phone call or follow up visit for 4 days. The patient developed new skin breakdown on lateral right foot on 05/10/25. There was not a complete wound assessment performed on the wound including measurements, any exudate, any tunnelling to date. Patient #9: The patient was admitted on 04/01/25 with what was described in nurse narrative as "stage IV arterial ulcer" on right foot. There was no evidence in the record of measurements taken as well as a full wound assessment at any time from admission to hospice through discharge on 04/26/25.