Every finding on record at Hospice of Cleveland County, Inc.

Upon patient record review, 5 of 29 (Patients #2,10,12,19,24) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death.

Upon patient record review, 1 of 29 (Patient #2) 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: During medication reconciliation at visit the following findings: 1. Hospice med profile indicated Nitrostat 0.4 mg 1 tab every 5 minutes NTE 3 tabs / ALF medication profile did not include this medication 2. ALF included Hydrocortisone 2.5% (rt arm), hyoscyamine 0.125 mg every 6 hours PRN, Morphine 5mg every 6 hours PRN. / Hospice medication profile did not include these medications.

Upon patient record review, 1 of 29 (Patient #2) 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: Patient has a malnutrition diagnosis and family provides an Ensure supplement. The hospice was unaware of the supplement being given. There were no orders for Ensure in the hospice record.

Upon patient record review, 5 of 29 (Patients #2,11,15,21,22) 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 2: This patient had an APP Mattress. This were not included on the Plan of Care. Patient #11:The record reflected that this patient had an IV Pole. This was not included on the Plan of Care. Patient 15: The record reflected that this patient had oxygen and a walker. These were not included on the Plan of Care. Patients #21 and 22: The record reflected that this patient had an APP mattress and a nebulizer machine. These were not included on the Plan of Care.

Upon patient client record review, 1 of 29 (Patient #11) 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 #11: The Initial Nursing Comprehensive contained the answer "No" for patient receiving nutritional supplement. The next line indicated on the comprehensive patient receives 5-6 boluses per day. The Initial Plan of Care indicated this patient receives Nutren 0.07Kcal/mL. The Nursing Initial Comprehensive was not consistent.

Condition of Participation: Hospices that Provide Inpatient Care Directly.

Upon observation, there was no evidence the hospice inpatient facility tests their power systems in accordance with NFPA 99 and NFPA 110 including the maintenance and testing of alternate power sources and transfer inspection and testing and maintenance and testing of circuitry. On 04/09/26 during the tour of the TESTA building, it was observed that the emergency stop button for the generator was located inside the outdoor metal enclosure rather than in an external, readily accessible location. Staff confirmed that there was no remote stop station positioned outside the generator enclosure, which is not in compliance with NFPA 110 (2010 Edition), Section 5.6.5.6 requirements that all emergency generator sets have a remote manual stop station located outside the housing of the prime mover, where it is readily accessible and appropriately identified.

Upon observation, there was no evidence the fire alarm systems of a facility are provided consistent with the 2012 editions of the LSC of the National Fire Protection Association and NFPA 99. The provisions of the adopted edition of the Life Safety Code do not apply in a State if CMS finds that a fire and safety code imposed by State law adequately protects patients in hospices. Existing Construction On 04/07/26 during a tour of the Wendover building, the following deficiencies were observed: 1. Inside the main entrance door, on the left side while facing the door opening, a wheelchair was positioned directly in front of a fire alarm pull station, obstructing access to the device and was not in compliance with NFPA 101 Life Safety Code, Section 19.3.4.1, which requires fire alarm systems to be installed and maintained in accordance with NFPA 72 National Fire Alarm and Signaling Code. NFPA 72 requires initiating devices to be accessible and unobstructed. 2. In patient rooms 5 and 15, bathroom emergency call system pull cords were observed to terminate greater than 6 inches above the finished floor, reducing accessibility for patients requiring assistance, and was not in compliances with NFPA 101 Life Safety Code, Section 19.3.4 which requires patient safety features, including nurse call systems, to be maintained and ensure accessibility and proper operation. 3. The Fire Alarm Control Panel (FACP) cabinet contained exposed wiring and not in compliance with NFPA 72 National Fire Alarm and Signaling Code Sections 10.5.1 and 10.5.5 which require equipment to be installed in a neat and workmanlike manner and protected from physical damage. Additionally, NFPA 99 Health Care Facilities Code Section 6.3.2.2.8 requires electrical components of essential systems to be installed safely, and NFPA 101 Life Safety Code Section 9.6.1.3 requires fire alarm systems to be installed, tested, and maintained in accordance with NFPA 72

Upon observation, there was no evidence the hospice provided follow-up for all temperature variations out of range with mercury-in-glass thermometer that included documented follow-up within a described time frame as defined in policies and procedures. Nourishment Refrigerator: • 12/25/25 - 12/29 = 42°; no documented follow-up • 1/13 & 1/14/26 = 42°; no follow-up Family Kitchen Refrigerator: • 2/27/26 = 32°; no follow-up • 3/17 & 3/18/26 = 32°; no follow-up

Upon observation, there was no evidence the hospice investigates all adverse events, incidents, accidents, variances or unusual occurrences that involve patient care and develops a plan of correction to prevent the same or similar event from occurring again. Patient#3: The record indicates on 6/14/25 patient passed away. The SN was not allowed to attend the death per family request. Agency documented family called ambulance and paramedic pronounced patient in the home. Family called the funeral home. Agency policy states "incident report should be prepared for all occurrences that are not consistent with the ordinary and customary operations".

Upon patient record review, 2 of 5 (Patient #3, #4) 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: The medication profile lists Morphine, Lorazepam, Haloperidol, Hyoscyamine, Prochlorperazine, and Acetaminophen frequency directions as "take as directed". There are no clear instructions on how frequent the medications should be taken. Patient #4: The medication profile lists Morphine, Lorazepam, Haloperidol, Hyoscyamine, Bisacodyl, and Acetaminophen frequency directions as "take as directed". There are no clear instructions on how frequent the medications should be taken.

Upon patient record review, 1 of 5 (Patient #5) 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 #5: The plan of care did not contain evidence of problems/interventions/goals for ascites however, admission and NP visit notes state "the patient has ascites".

Upon patient record review, 2 of 5 (Patient #3, 4) 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 #3: The plan of care lists Morphine, Lorazepam, Haloperidol, Hyoscyamine, Prochlorperazine, and Acetaminophen directions "take as directed". There order does not specify the frequency of the medications. Patient #4: The plan of care lists Morphine, Lorazepam, Haloperidol, Hyoscyamine, Bisacodyl, and Acetaminophen directions "take as directed". The order does not specify the frequency of the medications.

Upon patient client record review, 1 of 5 (Patient #2) 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 #2: The visit note dated 6/3/23 by the RN indicates the patient has a "wound to the buttocks stage 2". The patient does not have a wound to the buttocks.

Upon patient record review, 11 of 24 (Patient #1, #2, #3, #6, #7, #8, #10, #13, #16, #17, #19) 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: The medication profile listed on 04/04/2023 a fentanyl 5mcg transdermal patch change every 72 hours however, there was no evidence of specific directions for placement. COS Patient #2: The medication profile listed on 03/16/2023 clortrimazole-betamethasone and Silvadene topicals along with diclofenac topical (03/27/2023) without evidence of areas for application. COS Patient #3: The medication profile listed on 05/20/2022 oxygen 2-4 liters PRN for hypoxia however, there was no evidence of a route. In addition, on 01/04/2023 Zithromax 1 tablet for 5 days ordered however, was still active on medication profile. Patient #6: The medication profile listed Voltaren topical 2 times per day PRN for knee pain however, did not have evidence of specific knee. COS Patient #7: The medication profile listed on 02/27/2023 nystatin topical PRN 2 times per day for rash however, did not contain evidence of specific area for application. In addition, listed on 02/27/2023 oxygen 2 liters PRN shortness of breath however, there was no evidence of a route. COS Patient #8: The medication profile listed on 02/10/2023 nitro 0.4mg SL 1 tab PRN chest pain however, there was no evidence of specific directions for use. On 02/22/2023 listed nystatin cream and powder PRN however, there was no evidence of specific area for application. Oxygen 2 liters PRN for shortness of breath/dyspnea however, there was no evidence of a route. COS Patient #10: The medication profile listed on 04/10/2023 hydrocodone-acetaminophen 5/325 2 tablets every 6 hours PRN and on 03/03/2023 Tylenol 500mg 1 tablet every 6 hours PRN however, there was no evidence of a maximum allowable dose. COS Patient #13: The medication profile listed oxygen 4 liters continuous however, there was no evidence of a route. COS Patient #16: The medication profile listed oxygen 4 liters continuous however, there was no evidence of a route. In addition, listed nystatin powder however, there was no evidence of specific area for application. COS Patient #17: The medication profile listed oxygen 2 liters PRN dyspnea however, there was no evidence of a route. In addition, listed nystatin ointment and magic butt paste however, there was no evidence of specific area for application. COS Patient #19: The medication profile listed on 03/30/2023 a fentanyl patch 100 mcg however, there was no evidence of specific directions for placement. COS

Upon patient record review, 3 of 24 (Patient #1, #17, #18) 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 #1: The patient admitted 03/10/2023 however, there was no evidence that a bereavement assessment was completed. Patient #17: The patient admitted 03/31/2023 however, there was no evidence that a bereavement assessment was completed. Patient #18: The patient admitted 02/03/2023 however, there was no evidence that a bereavement assessment was completed.

Condition of Participation: Interdisciplinary Group, Care Planning, and Coordination of Services. L536

Upon patient record review, 2 of 24 (Patient #3, #11) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #3: The nurse notes on 02/08/2023 patient had developed a skin tear with treatment order however, there was no evidence of an assessment performed by nurse. Patient #11: The nurse noted on 03/30/2023 visit patient has "wound to L heel which is being treated by facility however, there was no evidence of assessment of the wound or orders. COS.

Upon patient record review, 10 of 24 (Patient #1, #2, #4, #7, #8, #9, #10, #11, #12, #19) 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 #2, #10, #11, #19: The advance directives on plan of care for each patient state "in progress" for 2-5 months for each patient. #2 was COS Patient #1: The initial social worker assessment noted funeral planning incomplete however, there was no problems/interventions/goals related to assisting patient. COS Patient #4: The plan of care did not contain evidence of problems/interventions/goals for wound care however, admission noted patient had two stage 4 wounds. Patient #7: The patient admitted with senile degeneration of the brain however, there was no evidence of problems/interventions/goals for neurologic on plan of care. COS Patient #8: The plan of care contained wound care problems/interventions/goals for JP drain that was documented to be removed 02/22/2023 and wound closed. COS Patient #9: The patient admitted with Alzheimer's however, there was no evidence of problems/interventions/goals for neurologic on plan of care. COS Patient #10: The plan of care did not contain evidence of problems/interventions/goals for wound care however, admission noted patient had multiple wounds. In addition, the initial social worker visit indicated family requested assistance with funeral planning however, there was no problems/interventions/goals related to assisting patient. COS Patient #12: The patient admitted with lung cancer however, there was no evidence of problems/interventions/goals for respiratory on plan of care. COS

Upon patient record review, 16 of 24 (Patient #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11, #12, #16, #17, #18, #19) 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. Patients #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11, #12, #16, #17, #18, #19: The PRN visit frequencies for the nurse visits were 10-11 and for social workers 5.

Upon patient record review, 11 of 24 (Patient #1 #2, #3, #6, #7, #8, #10, #13, #16, #17, #19) 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 on 04/04/2023 a fentanyl 5mcg transdermal patch change every 72 hours did not have evidence of specific directions for placement. COS Patient #2: The order on 03/16/2023 clortrimazole-betamethasone and silvadene topicals along with diclofenac topical (03/27/2023) did not contain evidence of areas for application. COS Patient #3: The order on 05/20/2022 oxygen 2-4 liters PRN for hypoxia did not contain evidence of a route. COS Patient #6: The order for Voltaren topical 2 times per day PRN for knee pain did not have evidence of specific knee. COS Patient #7: The order on 02/27/2023 nystatin topical PRN 2 times per day for rash did not contain evidence of specific area for application. In addition, the order on 02/27/2023 oxygen 2 liters PRN shortness of breath did not contain evidence of a route. COS Patient #8: The order on 02/10/2023 nitro 0.4mg SL 1 tab PRN chest pain did not contain evidence of specific directions for use. On 02/22/2023 the order for nystatin cream and powder PRN did not contain evidence of specific area for application. The order for oxygen 2 liters PRN for shortness of breath/dyspnea did not contain evidence of a route. COS Patient #10: The orders on 04/10/2023 hydrocodone-acetaminophen 5/325 2 tablets every 6 hours PRN and on 03/03/2023 Tylenol 500mg 1 tablet every 6 hours PRN did not contain evidence of a maximum allowable dose. COS Patient #13: The order for oxygen 4 liters continuous did not contain evidence of a route. COS Patient #16: The order for oxygen 4 liters continuous did not contain evidence of a route. In addition, the order for nystatin powder did not contain evidence of specific area for application. COS Patient #17: The order for oxygen 2 liters PRN dyspnea did not contain evidence of a route. In addition, the orders for nystatin ointment and magic butt paste did not contain evidence of specific area for application. COS Patient #19: The order on 03/30/2023 a fentanyl patch 100 mcg did not contain evidence of specific directions for placement. COS

Upon patient record review, 10 of 24 (Patient #1, #2, #4, #5, #8, #11, #12, #13, #17, #19) 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: The social worker's initial assessment noted patient was using a walker however, there was no evidence of this on plan of care. COS Patient #2: The IDG note on 03/11/2023 noted patient was using a hoyer lift and hospital bed and nurse note on 04/16/2023 a trapeze bar however, there was no evidence of these on plan of care. COS Patient #4: The chaplain's initial assessment noted patient was using a hospital bed however, there was no evidence of this on plan of care. COS Patient #5: The nurse's initial assessment noted patient was using a hospital bed, over bed table, hoyer lift, and wheelchair however, there was no evidence of these on plan of care. COS Patient #8: The nurse's initial assessment noted patient was using a hospital bed with rail and nurse's note on 04/13/2023 noted oxygen however, there was no evidence of these on plan of care. COS Patient #11: The nurse's note on 03/30 and 04/11/2023 noted a wheelchair and hospital bed however, there was no evidence of these on plan of care. COS Patient #12: There was an order for aerosolized medication on 03/31/2023 however, the nebulizer was not included on plan of care. COS Patient #13: The nurse's initial assessment noted patient was using a hospital bed however, there was no evidence of this on plan of care. COS Patient #17: The social worker's note on 04/14/2023 noted oxygen was deliver day prior however, there was no evidence of this on plan of care. COS Patient #19: The medication list noted patient using aerosolized medication however, there was no evidence of nebulizer on plan of care. COS

Upon patient record review, 7 of 24 (Patient #3, #13, #15, #16, #17, #18, #19) 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 #3: The nurse notes on 02/08/2023 patient had developed a skin tear with treatment order and on 03/08 treatment for unna boot however, there was no evidence of problems/interventions/goals update to plan of care. Patient #13: The plan of care did not have evidence of problems/interventions/goals for GIP level of care. In addition, social worker note on 04/17 noted patient may need to return to nursing facility the next day however, the plan of care was not updated to reflect discharge preparation. Nurse practitioner documented on 04/17/2023 note that patient had a stage II wound however, there was no evidence of problems/interventions/goals or orders for treatment of this wound. COS Patient #15: The orders reflected level of care changed to routine on 04/12/2023 however, the plan of care reflected problems/interventions/goals continued for GIP. COS Patient #16: The IDG note on 04/19/2023 noted patient had wounds on bilateral elbows and R shin however, the plan of care was not updated with problems/interventions/goals. In addition, the plan of care was not updated when patient entered respite to reflect needs for LOC change. COS Patient #17: The plan of care was not updated when patient entered respite to reflect needs for LOC change. COS Patient #18: The nurse documented wound on 03/27/2023 however, the plan of care did not have evidence of problems/interventions/goals. COS Patient #19: The plan of care reflected imminence problems/interventions/goals since start of care 11/02/2022. COS

Upon client record review, 8 of 24 (Patient #1, #2, #3, #7, #8, #10, #12, #18) 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 nurse note on 03/31/2023 and LVN note on 04/07/2023 documented each checked for impaction and removed however, there was not evidence of an order. COS Patient #2: The nurse note on 04/13/2023 indicated filling of the medi-planner however, there was no evidence of order or on plan of care. In addition, patient had multiple wounds however, wound measurements and identification of wounds was inconsistent per agency response that wounds are measured weekly. RN note 3/7/23 noted heel wound only, note on 3/9/23 noted performed wound care per orders to buttocks and sacral wounds, 3/17/23 noted left buttock wound, 3/21/23 noted right and left buttock wounds, 3/28/23 noted left buttock and right heel. Inconsistent measurements and wound care documentation not consistent with wound care orders. Patient #3: The visit frequency for nursing on 04/09/2023 was 2W1, 1W7, 10 PRN however, the week of 04/09 there was only evidence of one visit on 04/12. In addition, the social worker visit frequency on 02/05/2023 was 2w1 however, the week of 02/05 there was no evidence a a visit. In addition, on 03/09/2023 nurse noted "performed wound care per orders to buttocks and sacral" however, there was no evidence of details for care provided. Patient #7: The visit frequency for social work was 1 every2W6 and 2 PRN on 04/09/2023 however, there was no evidence of visit the week of 04/09 and the next visit on 04/18. Patient #8: The nurse visit on 02/13/2023 noted changing of dressing to wound for JP drain however, there was no evidence of orders. In addition, the social worker visit frequency on 02/26/2023 was 1W2, 1 every 2W8, 5 PRN however the week of 03/05 there was no evidence of a visit. The nurse visit frequency on 03/26/2023 was 2W6, 1W1, 10 PRN however, the week of 04/09 there was evidence of one visit performed. Patient #10: The patient had multiple wounds however, wound measurements and identification of wounds was inconsistent per agency response that wounds are measured weekly. 4/10/23 nursing note wound 1 stage 3 coccyx and wound 2 DTI left heel. 4/17/23 nursing note wound 2 and 3 healed right outer ankle and wound 3 DTI left heel. Inconsistent documentation to clarify which wound was assessed and care provided to. Patient #12: The visit frequency for nursing on 03/29/2023 was 2W13, 1W1, 10 PRN however, the week of 04/02 there was no evidence of visits and one missed visit note. COS Patient #18: The nursing visit frequency 04/02/2023 was 1W2, 1 every 3W3, 2 PRN however, the week of 04/02 there were 3 routine visits and the week of 04/07 there was 7 visits.

Upon patient record review 5 of 24 (Patient #7, #8, #9, #11, #16) 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 #7: The aide visit frequency ordered 02/26/2023 was 2W12, 1W1 however, the week of 04/02 and 04/09/2023 there was only evidence of one visit. Patient #8: The aide visit frequency ordered 02/12/2023 was 2W12, 1W1 however, the week of 03/05 there was not evidence of a visit. Patient #9: The aide visit frequency ordered 04/13/2023 was 2W13 however, the week of 04/03 there was not evidence of a visit. Patient #11: The aide visit frequency ordered 02/15/2023 was 1W1, 2W12 however, the week of 04/09 there was not evidence of a visit. Patient #16: The aide visit frequency ordered 04/02/2023 was 16W1, 6W1, 2W9 however, the week of 04/02 and 04/09 there was evidence of 14 visits for each of these weeks.

Upon patient client record review, 1 of 24 (Patient #9) did not have evidence that each patient record contains Advance Directives. Patient #9: Upon admission it is documented patient has advance directive of MOST/POST however, there was no evidence of this in file.

Upon patient client record review, 1 of 24 (Patient #1) 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 nurse note on 4/11/2023 stated "Kim called and NP stated patient not GIP appropriate. Patient to go in morning to start GIP" COS

Upon observation, there was no evidence construction, maintenance, and safety equipment at the facility is provided consistent with the 2012 editions of the LSC of the National Fire Protection Association and NFPA 99. The provisions of the adopted edition of the Life Safety Code do not apply in a State if CMS finds that a fire and safety code imposed by State law adequately protects patients in hospices. (Reference inpatient kitchen) Existing Construction Upon tour of Testa facility, it was observed that in the family kitchen/dining area there was a residential stove available to families for cooking however, there was no evidence of fire extinguisher within visual site and does not meet standard that portable fire extinguishers in accordance with NFPA 96 are located in all kitchen areas. COS

Upon client record review, 1 of 24 (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: The visit frequency for social work on 02/15/2023 was 1W1, 1 every 2W2, 1 every 3W3, 1 every 2W2, 1 every 3W3, 5 PRN and on 03/26/2023 1W2, 1 every 2W2, 1 every 3W3, 5PRN however, there was no evidence of visit the weeks of 02/26 and 04/09 as ordered. In addition, the nurse on 03/30/2023 visit patient has "wound to L heel which is being treated by facility however, there were no problems/interventions/goals for wound noted on plan of care. COS.