Every finding on record at Hospice and Palliative Care of Arizona, LLC

Upon patient record review, 5 of 5 (Patient #1,#2,#3,#4,#5) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patients 1,2,3,4,5: The medical record does not contain evidence in the comprehensive assessment that the imminence of death was considered.

Upon patient record review, 3 of 5 (Patient #1,#4,#5) 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: Patient 1: The medication profile contains Miralax with directive of "give 17gm by mouth mixed with water or juice". No evidence of the amount of liquid needed to mix the medication. Corrected on site Patient 4: The medication profile contains Albuterol with directive of "administer 1 vial INH via SVN every 4-6 hours as needed". Nursing unable to state what SVN stands for. Corrected on site. Patient 5: The medication profile contains Ketoconazole cream 2% with directive of "apply to affected area topically once daily" No evidence of a location. Corrected on site.

Upon patient record review, 3 of 5 (Patient #1,#4,#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 medications and treatments. Patient 1: The plan of care contains Miralax with directive of "give 17gm by mouth mixed with water or juice". No evidence of the amount of liquid needed to mix the medication. Corrected on site. Patient 4: The plan of care contains Albuterol with directive of "administer 1 vial INH via SVN every 4-6 hours as needed for shortness of breath". Nursing unable to state what SVN stands for. Corrected on site. Patient 5: The plan of care contains Ketoconazole cream 2% with directive of "apply to affected area topically once daily" No evidence of a location. Corrected on site.

Upon patient record review, 1 of 5 (Patient #4) 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 4 Nursing visits on 12-9-21, 1-14-22 and 3-9-22 document the patient with oxygen and respiratory distress. There is evidence that the patient continues to have respiratory distress, oxygen use, congestion, and decreased lung sounds and there is no evidence of an update to the plan of care for these identified problems.

Upon client record review, 5 of 5 (Patient #1,#2,#3,#4,#5) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: The plan of care contains an order for SN to visit one time per week. The SN visits were made on 2-16-22 and 2-18-22. Patient 2: The plan of care contains an order for SN to visit 1 time per week. The SN visits were made on 3-28-22 and 3-30-22. Patient 3: The plan of care contains an order for SN visit 1 time per week. The SN visits were made on 11-21-21 and 11-27-21. The medical record contains a physician order dated 11-24-21 patient refused MSW services and the plan of care continues to contain an order for MSW 1 time per month to present date. The MSW did not visit other than the initial assessment. Corrected on site. Patient 4: The plan of care contains an order for SN visit 1 time per week. The SN visits were made on 12-14-21 and 12-16-21. The medical record contains a physician order dated 12-19-21 patient refused MSW services and the plan of care continues to contain an order for MSW 1 time per month to present date. The MSW did not visit other than the initial assessment. Corrected on site. Patient 5: The plan of care contains an order for SN visit 1 time per week. The SN visits were made on 3-24-22 and 3-26-22.

Upon patient record review, 5 of 5 (Patient #1,#2,#3,#4,#5) did not have evidence in the patient record that hospice aide assignments and duties are: Patients 1: The aide plan of care contains directive from RN to perform: nail care prn, shave prn, change linens prn, light housekeeping prn, make bed prn, assist with ambulation prn, assist with transfers prn. Corrected on site. Patient 2: The aide plan of care contains directive from RN to perform: nail care prn, shave prn, change linens prn, light housekeeping prn, make bed prn, assist with ambulation prn, assist with transfers prn. Corrected on site. Patient 3: The aide plan of care contains directive from RN to perform: shave prn, change linens prn, light housekeeping prn, make bed prn, assist with ambulation prn, assist with transfers prn. Corrected on site. Patient 4: The aide plan of care contains directive from RN to perform: nail care prn, change linens prn, make bed prn, assist with ambulation prn, assist with transfers prn. Corrected on site. Patient 5: The aide plan of care contains directive from RN to perform: nail care prn, shave prn, assist with ambulation prn, assist with transfers prn. Corrected on site.

Upon patient record review 1 of 5 (Patient #3) did not have evidence documentation in the patient record that a hospice aide provides services that are: Patient 3: The plan of care contains an order for aide to visit 1 time per week. There is evidence of the aide visiting 2 times per week the week of 11-21-21 through 11-27-21. Visits completed 11-24-21 and 11-26-21 by the aide.

Upon patient client record review, 1 of 5 (Patient #1) did not have evidence that each patient record contains: this references that the documentation is part of the patient record. Patient 1: The aide performed visits 1 time a week since SOC 2-16-22, there was no evidence of documentation of the aide visit in the clinical record. Writer noted supervisory visits performed by RN and asked if the aide had in fact visited, she had visited on 2-17-22, 2-24-22, 3-3-22, 3-10-22, 3-17-22, 3-24-22, 3-31-22 and had not completed the documentation. The agency policy 2-009.1 states all documentation to be submitted with in 48 hours of visit. The DPCS called the aide and had her submit her documentation during survey. Corrected on site.

Upon patient client record review, 2 of 5 (Patient #1 and #2) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient 1: The medical record contains an EOB that does not have evidence of the Medicare Hospice benefit being elected as patient did not check the box. Patient 2: The medical record contains a notification of items, goods and services covered by hospice. The patient does not indicate on the form in space provided whether or not they want to receive a copy of the form.

Upon patient client record review, 3 of 5 (Patient #1,#2,#3) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 1: The medical record contains an admitting order by medical director "Please admit patient to AZ Superior Hospice under routine level of care." Corrected on site. Patient 2: The medical record contains an admitting order by medical director "Please admit patient to AZ Superior Hospice under routine level of care." Corrected on site. Patient 3: The medical record contains an admitting order by medical director "Please admit patient to AZ Superior Hospice under routine level of care." Corrected on site.