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

Upon patient record review, 2 of 14 (Patients #3, #5) 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 #3: The initial bereavement assessment not completed within 5 days of start of care. Agency completed during this survey on 6/24/25. Patient #5: The initial bereavement assessment did not include bereaved name and/or contact information. Corrected on site. Update to bereaved contact information completed.

Upon patient record review, 4 of 14 (Patients #1,2,3,5) 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 #1: This patient had a hospital bed, wheelchair and shower chair. These were not included on the Plan of Care. Corrected on site, POC updated. Patient #2: This patient had a wheelchair and bedside table. These were not included on the Plan of Care. Corrected on site, POC updated. Patient #3: This patient had a wheelchair, walker, hospital bed and APP mattress. These were not included on the Plan of Care. Corrected on site, POC updated. Patient #5: The record reflected that this patient had oxygen per medication list. There was no O2 Concentrator on the Plan of Care. Corrected on site, POC updated.

Upon personnel record review, 1 of 14 (Personnel #8) 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.) Personnel #8: This task listed below was validated as "verbalized" not "observed" per skills competency form. ·Normal range of motion and positioning

Upon patient record review, 2 of 14 (Patients #12. #13) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #12 and #13: The election statement did not include start of care date. The area on the form for this date was left blank.

Upon patient record review, 2 of 14 (Patients #11, #12) did not have evidence that the discharge summary includes all required information. Patient #11: The discharge summary did not include evidence that patient's current plan of care was included on this document. The discharge summary read that the patient discharged for revocation from hospice only. Patient #12: The discharge summary did not include evidence that patient's current plan of care was included on this document.

Upon patient record review, 4 of 11 (Patient #2, 3, 4, 9) 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 #2- The medication profile included diclofenac sodium 3% topical gel. The location for application was not specified. Patient #3- The medication profile included diclofenac sodium 1% topical gel apply to affected area twice daily. The location for application was not specified. Patient #4- The medication profile included Voltaren gel 1% 2 x daily. The location for application was not specified. Patient #9- The medication profile included mupirocin 2% topical cream, apply to affected area 2 x daily. The location for application was not specified.

Upon patient record review, 1 of 7 (Patient #1) 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 #1- The medical record contained information that the patient was on a blood thinner and at risk for bleeding. The bleeding risk was not included on the plan of care.

Upon patient record review, 4 of 11 (Patient #2, 3, 4, 9) 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- The plan of care included diclofenac sodium 3% topical gel. The location for application was not specified. Patient #3- The plan of care included diclofenac sodium 1% topical gel apply to affected area twice daily. The location for application was not specified. Patient #4- The plan of care included Voltaren gel 1% 2 x daily. The location for application was not specified. Patient #9- The plan of care included mupirocin 2% topical cream, apply to affected area 2 x daily. The location for application was not specified.

Upon patient record review, 3 of 11 (Patient #6, 7, 11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #6- The plan of care included orders for SN 1 x week. There was evidence of 2 visits the week of 6/12/22 (on 6/14 and 6/17). Patient #7- The plan of care included orders for SN 1 x week. There was evidence of 2 visits the week of 6/12/22 (on 6/14 and 6/18). Patient #11- The plan of care included orders for wound care to 3 wounds (Stage III to Right inner buttocks, Stage III to sacrum and Stage IV to left hip) as follows: cleanse with derma cleanser, pat dry with gauze sponge, apply tetracyte, therahoney and cuticerin to wound bed followed by durafiber. Cover with allevyn life foam 3 x week. Secure with primafix plus as needed. The SN visits dated 3/14/22 and 3/17/22 documented patient has multiple wounds, SN cleansed with n/c, pat dry, apply medication and cover with dressing. The specific ordered wound care was not documented as completed.

Upon patient record review, 1 of 7 applicable (Patient #1) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #1- The patient was on a blood thinner and at risk for bleeding. The bleeding risk was not included on the aide care plan.

Upon patient record review 1 of 7 applicable (Patient #8) did not have evidence documentation in the patient record that a hospice aide provides services that were ordered by the interdisciplinary group and included in the plan of care Patient #8- The plan of care included order for HHA 2 x week effective 6/7/22. There was no evidence in the medical record of HHA visits having been performed.