Every finding on record at Hospice of Laughlin, LLC

Upon patient record review 2 of 14 (Patient #8, 9) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient #8, Patient declined SC service, agency has declination of service assessment at admission, decline the following services: chaplain service, to complete section 2. No evidence section 2 was completed by RN for spiritual assessment at start of care. Patient #9, RN initial assessment documents patient accepts both MSW and SC services. No evidence of orders for MSW or SC evaluation within first 5 days. MSW obtained order for evaluation to be completed on 2/4/25 then documented a missed visit on 2/4/25. Patient was admitted on 1/24/25.

Upon patient record review, 1 of 14 (Patient #1) 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: Upon review of medication in the home Myrbetriq tab 25 mg, take 1 tablet every day was ordered by the NP on 8/15/25. No evidence the medication was listed on the medication profile. COS

Upon patient record review, 4 of 14 (Patient #2,3,5,6) 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 #2,3,5, MSW documented no funeral arrangements have been made. No evidence initial care plan identifying interventions and goals. Patient #6, Documentation states patient is a full code and has no funeral home arrangements. No evidence initial care plan identifying interventions and goals.

Upon patient record review, 1 of 14 (Patient #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 #4, RN admission note documents patient was receiving home health care for wound care. RN notified MD of wound and wound care orders received from MD to continue with Alginate silver gauze. No evidence of wound care orders documented on plan of care.

Upon client record review, 2 of 14 (Patient #1,4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1, Plan of care states to check pulse oxygenation level every visit. No evidence of a pulse oxygenation level checked during nurse visit on 7/29/25. Patient #4, Communication note on 7/27/25, patient son called stating patient's BS 327 and the only insulin patient has is Lispro which is long acting. On call RN documented ways for patient to decrease his blood sugar. RN did not identify that Lispro is the short acting insulin. Patient was to receive 8 units of Lispro for BS of 327. No evidence that RN instructed patient to take correct dose of insulin. Admission visit on 7/26/25, admitting RN documented patient had insulins available. No evidence plan of care was followed. Order for pulse oxygenation level every visit. No evidence of pulse oxygenation level completed on 7/29/25, 7/31/25, 8/5/25, 8/7/25 nursing notes.

Upon patient record review 2 of 14 (Patient #1, 8) 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 #1, MSW documented on 4/22/25 initial assessment note, patient is frustrated as she can not longer see her PCP and patient wants physical therapy. MSW documented she will notify Administrator. No evidence of discussion in the next IDG meeting. No evidence of physical therapy initiated. Patient #8, MSW initial assessment documents in narrative note that patient requests visits twice weekly for socialization, LMSW unable to accommodate due to high caseload. Patient is scheduled for weekly visits and is agreeable to that. No evidence volunteer services were offered to support patients emotional need for socialization.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #1, RN entered bag to obtain hand sanitizer to clean hands prior to washing hands. RN removed b/p cuff and used item then returned to clean area. RN removed thermometer from clean area, used item then returned to clean area. No evidence infection control was followed. Patient #2, RN entered bag to obtain hand sanitizer to clean hands prior to washing hands. No evidence infection control was followed.

Upon patient record review 2 of 14 (Patient #1,3) 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 #1, Aide frequency was 2x/week starting 4/11/25. IDG note on on 7/27/25 document Aide frequency 1x/week. Patient was seen 3x/week the week of 8/4/25 and 8/11/25. COS Patient #3, Aide frequency 2x/week effective 7/26/25. No evidence of two aide visits completed on 7/26/25 since it is a Saturday. COS

Upon client record review, 5 of 14 (Patient #6,7,8,9,10) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patient #6,7,8,9,10, No evidence of hospice discharge summary sent to PCP, summary documents patient was advised to follow up with his PCP.

Upon client record review, 4 of 14 (Patient #6,7,8,9) did not have evidence that the discharge summary includes all required information. Patient #6, No evidence of patient stay, including treatments, symptoms and pain management documented on discharge summary. Discharge summary documents diagnosis, orientation, full code, signed revocation form, notified Medical Director, staff, pharmacy and DME provider. Patient was advised for follow up with his PCP. Patient 7,8,9, No evidence of patient stay, including treatments, symptoms and pain management documented on discharge summary.

Upon personnel record review, 1 of 1 applicable (Personnel #4) did not have evidence of a medical exemption in accordance with CMS guidelines. Personnel #4: Review of the Medical Director's Personnel record, revealed the exemption was signed and dated by himself. There was missing evidence that the Covid Medical Exemption had been signed and dated by a licensed practitioner, who was not the individual requesting the exemption.