Every finding on record at Health Horizons, Inc.

Upon patient record review, 5 of 11 (Patient #3, 4, 6, 7, 11) 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 #3 - Patient is on oxygen 2LPM via NC. Oxygen is not on the medication profile. Patient #4 - Patient is on oxygen 2LPM via NC. Oxygen is not on the medication profile. Patient #6 - Medication profile contained Zyrtec 5mg 2 x day PRN - no modifier for PRN. Patient #7 - Patient is on oxygen 2-4LPM via NC. Oxygen is not on the medication profile. Patient #11 - Patient is on oxygen 2-4LPM via NC. Oxygen is not on the medication profile.

Upon patient record review, 2 of 11 (Patient #3, 9) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #3 - POC 04/11/2022 Chaplain visits ordered 1-3 PRN only. Patient #9 - POC 11/02/2021 Chaplain visits ordered 1-3 PRN only.

Upon patient record review, 6 of 11 (Patient #2, 3, 4, 6, 7, 11) 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 #2 - New wound care ordered on 05/20/2022 did not include frequency of wound care. Patient #3 - POC dated 04/11/2022 does not include oxygen but patient is on oxygen at 2 LPM via NC. Patient #4 - POC dated 05/20/2022 does not include oxygen but patient is on oxygen at 2 LPM via NC. Patient #6 - POC dated 02/04/2022 has Zyrtec 5mg 2 x day PRN - no modifier for PRN. Patient #7 - POC dated 04/30/2022 does not include oxygen but patient is on oxygen at 2-4 LPM via NC. Patient #11 - POC dated 04/11/2022 does not include oxygen but patient is on oxygen at 2-4 LPM via NC.

Upon patient record review, 1 of 11 (Patient #7) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #7 - There was not evidence that the POC was updated with goals, interventions and progress towards outcomes regarding the SQ button placed on 05/02/2022.

Upon client record review, 1 of 11 (Patient #3) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #3 - POC dated 04/11/2022 contains order to assess vital signs every visit and PRN visits. No vital signs documented on 05/01/2022 or 05/07/2022 PRN SN visit.

Upon patient record review 1 of 7 applicable patients (Patient #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 Patients #10 - Aide care plan to shave legs every visit - task not addressed on 04/04/2022, 04/05/2022, 04/14/2022 or 04/15/2022. File nails every visit - aide documented on 04/14/2022 and 04/15/2022 that that nails were filed prior day. Task shampoo hair every visit - aide documented 04/14/2022 that shampoos are done on Fridays.

Upon SNF/NF contract review, 1 of 1 applicable contracts (SNF) did not have a delineation of the responsibilities of the hospice and the SNF/NF to provide bereavement services to SNF/NF personnel. Corrected onsite.

Upon client record review, 1 of 5 applicable (Patient #11) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #11 visit note on 03/25/2022 states to d/c foley catheter - no order for insertion or removal of foley catheter.