Every finding on record at Hospice Partners of America Holding LLC

Upon patient record review, 3 of 14 (Patients #7,#9,#10) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 7,10: The medication profile contained oxygen with instructions allowing titration without a max dose identified. Patient 9: The medication profile contained two differing oxygen orders identifying as PRN 4/8/26 and continuous 5/3/36, both instructions allowing titration without a max dose identified.

Upon patient record review, 1 of 14 (Patient #2) 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 2: There was no evidence of weekly wound assessments and measurements as required per agency policy, between 4/7/26 and 4/23/26.

Upon patient record review, 2 of 14 (Patients #6,#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 6: The medical record contained nursing documentation upon admission identifying patient issues with dyspnea requiring oxygen. There was no evidence of problems, goals, and interventions related to respiratory dysfunction and oxygen use included in the plan of care. Patient 10: The medical record contained nursing documentation upon admission identifying patient issues with dysphagia. There was no evidence of problems, goals, and interventions related to dysphagia included in the plan of care.

Upon patient record review, 3 of 14 (Patients #7,#9,#10) 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 7: The medical record contained an order for oxygen with instructions allowing titration without a max dose identified. Patient 9: The medical record contained two differing oxygen orders identifying as PRN 4/8/26 and continuous 5/3/36, both orders containing instructions allowing titration without a max dose identified. Patient 10: The medical record also contained an order for oxygen with instructions allowing titration without a max dose identified.

Upon patient record review, 3 of 14 (Patients #5,#6,#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 equipment and supply needs. Patient 5: The medical record contained nursing documentation upon recertification assessment 4/1/26 identifying patient use of foam boots for wound prevention. There was no evidence of an order for the boots included in the plan of care. Patient 6: The medical record contained nursing documentation upon admission identifying patient use of a Hoyer lift and bedrails. There was no evidence of orders for the DME included in the plan of care. Patient 9: The medical record contained nursing documentation upon admission identifying patient use of a shower chair and overbed table. There was no evidence of orders for the DME included in the plan of care.

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 9: The medical record contained nursing documentation identifying a patient fall 3/21/26. There was no evidence of an investigation of the incident and a plan of correction for prevention of similar incidents.

Upon observation during 2 of 3 home visits, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient 6: During home visit with the RN, the RN did not disinfect vital sign equipment prior to returning to bag as required per agency policy. Patient 7: During home visit with the MSW, the MSW did not cleanse hard surface or use a barrier before placing her bag down on a chair as required per agency policy.

Upon patient client record review, 1 of 14 (Patient #9) 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 9: The election form identified the patient elected to receive the Notification of Hospice Non-Covered Items. There was no evidence the agency provided the addendum upon request.

Upon patient client record review, 2 of 14 (Patients #1,#8) 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 contained an order for oxygen supplies 5/3/26 that was entered in error. Nursing documentation 4/3/26 identified the patient requested oxygen to be picked up from home due to no need at this time. Patient 8: The medical record contained an order for an oxygen concentrator in error. Agency verified the patient does not have oxygen in home.

Upon patient record review, 1 of 14 (Patient #10) did not have evidence that if a drug order is verbal or given via an electronic transmission, it is given to a Registered Nurse, Nurse Practitioner, pharmacist, physician or other licensed individuals as designated by state regulations. The person receiving the order records and signs it immediately and has the prescribing person sign it in accordance with state and federal regulations. Patient 10: The medical record contained nursing documentation 4/1/26 identifying a verbal order was received for Cipro. There was no evidence of a physician order documented and signed in the medical record.

Upon inpatient contract review, 1 of 6 (WNR) did not have evidence that the inpatient provider has established patient care policies consistent with those of the hospice and agrees to abide by the palliative care protocols and plan of care established by the hospice for its patients.

Upon inpatient contract review, 1 of 6 (WNR) did not have evidence that the hospice patient's inpatient clinical record includes a record of all inpatient services furnished and events regarding care that occurred at the facility; that a copy of the discharge summary be provided to the hospice at the time of discharge; and that a copy of the inpatient clinical record is available to the hospice at the time of discharge.

Upon inpatient contract review, 1 of 6 (WNR) did not have evidence that the hospice retains responsibility for ensuring that the training of personnel who will be providing the patient's care in the inpatient facility has been provided and that a description of the training and the names of those giving the training are documented.

Upon patient record review, 1 of 14 (Patient #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 Patient #6: 4/25/23 Order written as follows: Flush Chemo Port with 5-10 ml of 0.9% ns prn. No prn rationale noted. This medication was not included on the medication profile.

Upon patient record review, 2 of 14 (Patient #4, 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. Patient #4: 5/16/23 Order written: Cleanse with NS/WC air dry, apply medihoney, cover with foam dressing and secure with elastic. This order does not denote which wound this is applicable to and patient has 3 wounds. No clear direction if to change ALL wounds to this care. No clarification order found. Communication note describes that order is only for one of 3 wounds. Patient #6: 4/25/23 Order written as follows: Flush Chemo Port with 5-10 ml of 0.9% ns prn. No prn rationale noted.

Upon client record review, 4 of 14 (Patient #1, 2, 6, 8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1: MSW order 4/18/23 MSW 3x mo, 2xmo, 4 prn MSW visit performed 4/18/23. No evidence of missed visits for the additional visits. No evidence of order to correct frequency. CH order 4/17/23 2xmo, 1 prn. CH performed visit 4/17/23, No evidence of missed visit for additional visit that month. No evidence of order to correct frequency. Patient #2: SN order written 4/7/23: 1xwk and 3 prn effect 4/7/23: visits 4/7, 4/8. There is an extra visit performed in week #1, No evidence that this visit was a PRN nor evidence of order to correct frequency. Patient #6 MSW order written 4/20/23: No evidence of visits in April. No evidence of missed visit or order to correct frequency. Patient #8: 5/15/23 order written for CH and SW to visit today. MSW performed visit on 5/16/23. No evidence of order to move visit to 5/16/23

Upon patient record review 1 of 14 (Patient #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 #3: Aide care plan written 4/4/23 assigns file nails 1xwk, Aide performed 4/25, 4/26, 4/28, 5/1, 5/4 which is more frequently than ordered.