Every finding on record at Harmony Life Hospice, Inc.

Upon patient record review 2 of 14 (Patient #5, #8) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #5: Patient admitted on 10/18. SC comprehensive assessment completed on day 6 - 10/23/23. Patient #8: Patient admitted on 10/11. SC comprehensive assessment completed on day 6 - 10/16/23.

Upon patient record review 1 of 14 (Patient #13) 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 #13: No evidence of a comprehensive spiritual care assessment being completed.

Upon patient record review, 7 of 14 (Patient #1, #4, #5, #7, #8, #11, #12) 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: Plan of care included orders for Miralax powder for solution 17g 1 packet oral daily as needed for constipation. No diluent instructions listed. Patient #4: Medication profile lists Oxygen 2-5 lpm inhalation as needed for shortness of breath. No route ie nc/mask indicated. Plan of care included orders for Fleet disposable enema rectal as directed. No instruction for administration given. Patient #5: Plan of care included orders for Albuteral Sulfate 0.083% inhalation 4 times a day as needed for SOB. No route/instructions to be given via nebulizer. Oxygen 3-5 lpm as needed for SOB. No route NC/Mask indicated Patient #7: Plan of care included orders for Miralax powder for solution 17g 1 packet oral daily as needed for constipation. No diluent instructions listed. Melatonin one tablet by mouth once daily for insomnia, time of day not indicated/hour of sleep. Patient #8: Medication profile lists Oxygen 2-5 lpm inhalation as needed for shortness of breath. No route ie nc/mask indicated. Patient #11: Medication profile lists Oxygen 2 lpm inhalation continuous. No route ie nc/mask indicated. Patient #12: Medication profile lists Oxygen 2lpm inhalation as needed for SOB. No route ie nc/mask indicated.

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: Patient admitted as a full code. No evidence of any goals or interventions to address code status

Upon patient record review, 7 of 14 (Patient #1, #4, #5, #7, #8, #11, #12) 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 #1: The order for Miralax powder for solution 17g 1 packet oral daily as needed for constipation did not contain evidence of diluent instructions listed. Patient #4: The order for Oxygen 2-5 lpm inhalation as needed for shortness of breath without evidence of route ie nc/mask indicated. Orders for Fleet disposable enema rectal as directed with no evidence of instruction for administration given. Patient #5: Ordes for Albuteral Sulfate 0.083% inhalation 4 times a day as needed for SOB without evidence of route/instructions to be given via nebulizer and oxygen 3-5 lpm as needed for SOB and no evidence of route NC/Mask indicated Patient #7: Orders for Miralax powder for solution 17g 1 packet oral daily as needed for constipation did not contain evidence of diluent instructions listed. Melatonin one tablet by mouth once daily for insomnia, time of day not indicated/hour of sleep. Patient #8: Order for oxygen 2-5 lpm inhalation as needed for shortness of breath without evidence of route ie nc/mask indicated. Patient #11: Order for oxygen 2 lpm inhalation continuous without evidence of route ie nc/mask indicated. Patient #12: Order for oxygen 2lpm inhalation as needed for SOB without evidence of route ie nc/mask indicated.

Upon patient record review, 5 of 14 (Patient #4, 5, 6, 11, 12) 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 #4: On the plan of care, Oxygen is listed in the medication list. However, no evidence of any oxygen tanks, concentrator or oxygen supplies listed on the plan of care under DME or Supplies. Patient #5: On the plan of care, Oxygen is listed in the medication list. However, no evidence of any oxygen tanks, concentrator or oxygen supplies listed on the plan of care under DME or Supplies. POC lists patient uses cane and walker. Items not listed under DME. DME section left blank. Patient #6: DME and Supplies section of POC left blank. Records indicate patient uses a walker Patient #11: On the plan of care, Oxygen is listed in the medication list. However, no evidence of any oxygen tanks, concentrator or oxygen supplies listed on the plan of care under DME or Supplies. Patient #12: On the plan of care, Oxygen is listed in the medication list. However, no evidence of any oxygen tanks, concentrator or oxygen supplies listed on the plan of care under DME or Supplies. Record indicates patient uses cane and walker Items not listed under DME. DME and supplies left blank.

Upon client record review, 1 of 14 (Patient #7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #7: Plan of care ordered LVN 1xwk effective 5/27. LVN saw pt 2xwk the wk of 5/29, 6/5, 6/12, 6/19, 6/26, 7/3, 7/10, 7/17, 7/24, 7/31, 8/7, 8/14, 8/21, 8/28, 9/4, 9/11, 9/18, 9/25, 9/27, 10/2, 10/9, 10/16, 10/23, 10/30. No evidence of an order to increase the frequency. MSW ordered monthly on the initial POC. No evidence of an MSW visit in July, September or October.

Upon patient record review 1 of 14 (Patient #2) 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 #2: Aide ordered 2xwk beginning 9/18 on initial plan of care. Only one visit the week of 9/18 was documented on 9/22