Every finding on record at Holisticare Hospice of New Jersey LLC

Upon patient record review 2 of 19 (Patient #2,7) 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. Pt #2 - Admitted 11/7/23. Psychosocial not completed until 11/20/23. Pt #7 -Admitted 10/10/23. note on 10/13/23 and 10/16/23 - pt has declined chaplain visit on 10/13 and services on 10/16/23. No evidence of spiritual assessment as part of comprehensive assessment within 5 days of admission.

Upon patient record review, 2 of 19 (Patient #5, 6) 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 Pt #5 , 6 - No evidence that oxygen was included in the medication profile (Corrected on site)

Upon patient record review, 2 of 19 (Patient #5,6) 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. Pt #5 - On physician orders, the tab for patients DME states pt has oxygen concentrator with tubing at bedside. There are no other orders for the oxygen use. Under treatments, the care plan also says instruct on use of oxygen, as needed to manage signs and symptoms of dysphagia. No evidence patient ever needed the oxygen and no orders for it to be in home. Pt #6 - No evidence of oxygen order frequency on pt record. Order says O2 - 3 l/min nasal cannula (Corrected on site)

Upon patient record review, 1 of 19 (Patient #14) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Pt #14 - SW documented in pt record day prior to patient death "Kay - (wife) stated she would like some assistance with finding support groups and individual therapists within the area that she can go to discuss her grief. SW assisted in finding therapists in the area under Medicare and also got the list of support groups in the Neptune area and provided it to the spouse." No evidence in record that SW talked to pts daughter about bereavement support and follow up for 13 m. after the pts death

Upon patient record review 2 of 19 (Patient #2,6) 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 Pt #2 - HHA orders starting 11/7/23 say CHHA 1xwk then 11/12/23 2xwk for 13 weeks. No evidence of visits after 11/21. No order in record to discontinue aide services. Pt #6 - 12/12/23 - orders for aide started and plan of care developed. 12/12/23 aide 2xwk for 1 week then 12/17/23 orders state aide 4xwk Documented visits 12/13, 12/14. 12/18 - family requested no aide today, and 12/19/23. No order to discontinue aide services or documents of visits made.

Upon patient record review 3 of 19 (Patient #7, 10, 19) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Pt #7 - Supervisory aide visits: 11/13/23 and then 12/13/23. No evidence of Sup. Aide visit every 14 days during this time. Pt #10 - The record indicated aide supervisory visit was conducted on 11/17/23 and 12/8/23. Pt #19- The record indicated aide supervisory aide visits documented were 11/30/23, 12/19/23 - more than 14 days

Upon client record review, 1 of 19 (Patient #4) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Pt #4 - No evidence that wound care orders identify who is responsible for performing the care (nursing facility or hospice).

Upon patient record review, 2 of 19 (Patient #15, 16) did not have evidence that the hospice provided the following information: • The most recent hospice plan of care specific to each patient • Hospice election form and any Advance Directives specific to each patient • Physician certification and recertification of the terminal illness specific to each patient • Names and contact information for hospice personnel involved in hospice care of each patient • Instructions on how to access the hospice's 24-hour on-call system • Hospice medication information specific to each patient • Hospice physician and attending physician (if any) orders specific to each patient Pt's 15, 16 - no evidence that the election statement and certification or recertifications were on facility chart. (Corrected on site)