Every finding on record at Hospice of Grace and Palliative Care Inc

Upon patient record review, 3 of 14 (Patient #1,2,9) 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#1, 2, 9 - Miralax had no diluent listed on the medication profile. - corrected onsite

Upon patient record review, 5 of 14 (Patient #3,4,5,8,10) 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 #3 - Pt is a full code with no problems, goals or interventions. - corrected onsite Patient #4 - The nursing comprehensive dated 08/25/25 noted patient health history included seizures. There was no problems, goals or interventions. - corrected onsite Patient #5 - The nursing comprehensive dated 08/13/25, noted patient to be at high risk of aspiration. The patient was noted to have an order for a pureed diet and an order to thicken all liquids. There was no evidence of problems, goals, or interventions. - corrected onsite Patient #8 - The nursing comprehensive on 08/20/25, noted that patient suffered from dysphagia and was utilizing a thickening product for all fluids. There was no problems, goals or interventions related to dysphagia on the patient's plan of care. In addition, the patient was taking Eliquis and did not have bleeding precaution on the plan of care. - corrected onsite Patient #10 - The nursing comprehensive dated 08/25/25, noted the patient required a mechanical soft diet with thickened liquids. There was no evidence of problems, goals or interventions related to the risk of aspiration. - corrected onsite

Upon patient record review, 3 of 14 (Patient #1,2,9) 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 #1, 2, 9 - Miralax had no diluent on the POC orders. - corrected onsite

Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient #1 - The IDG note for the date of 08/18/25, is missing the signature of the RN and the MD. The IDG note from 08/29/25 is also missing the signatures of the RN and the MSW.

Upon patient record review 1 of 14 (Patient #2) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient #2 - The social worker comprehensive assessment noted at the visit, there was much conflict noted between family members present about the care of their mother. The social worker also noted that the patient's spouse stated she had an order of protection against her brother who had showed up at the patient's home. The note also stated that the wife called the police to report this violation of that order during the comprehensive assessment. The assessment also stated that as the Social Worker was walking out of the patient's home, the police department showed up. There was no evidence of follow up by this Social Worker to this incident on this day or the following days. The next Social Worker visit was on 08/28/25.

Upon patient record review 1 of 14 (Patient #4) 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 #4 - The initial plan of care had evidence of an order outlining the patient was to receive aide visits two times per week. The aide plan of care dated 08/05/25, also contained a frequency order for aide visits as two times per week. The week of August 17th, there was only one aide visit completed on 08/22/25. There was no evidence of any missed or refused visit documentation for the other required visit.

Upon patient record review, 2 of 5 (Patients #1 and 3) 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: A Surveyor conducted home visit, revealed that the patient ambulated with the assistance of a cane and walker. The walker was not included in the Plan of Care. Patient #3: A Surveyor conducted home visit, revealed that the patient ambulated with the assistance of a cane and walker. The cane was not included in the Plan of Care.

Upon personnel record review, 5 of 13 (Personnel #1, #7, #8, #9 and #12) did not have evidence the hospice employees and contract employees have received orientation on the hospice philosophy.