Every finding on record at Hospice Partnership Operating Company, L.L.C.

Upon patient record review, 6 of 14 (Patient #4, #6, #7, #8, #12, #13) 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 #4:The medication profile included an entry dated 9/25/2023; Oxygen 2-10 L via n/c for dyspnea PRN, there was no specific parameters of how to dispense or titrate. Corrected on site. Patient #6: The medication profile included the following pain meds: 6/15/2023 MS prn pain or SOB, 9/7/2023 Hydrocodone PRN pain, and 9/7/2023 Tylenol ES prn pain or fever. There were no parameters on what to dispense and when. Corrected on site. Patient #7: The medication profile included 9/25/2023 Oxygen 2-5L continuous via n/c for symptom management. There was no evidence of specific parameters of how to dispense. Corrected on site. Patient #8: The medication profile dated 8/17/2023 included Meropenem 1G IV q 8 hrs for UTI, add NS flush with 3mls Q shift and after every Meropenem infusion to keep line patent. There was no order or specification as to who was to do this, Hospice nurse vs SNF staff. Corrected on site. Patient #12: The medication profile dated 1/27/2023 included Insulin Glargine u-100 SQ per instructions use as directed. There was no evidence of a sliding scale for the insulin dosage. Patient #13: The medication profile dated 6/20/2022 (pt came on service 9/22/2023, carried over from SNF orders) included Oxygen 2-10 L continuous for SOB, call Hospice if need to go over 5L.There were no orders for specific parameters or titration of the O2.

Upon patient record review, 8 of 14 (Patient #4, #5, #7, #8, #10, #11, #12, #13) 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 #4: Patient experienced seizure on 9/23/2023, no problem statement with goals/interventions for Neuro/seizures. Corrected on site. Patient #5: Patient has IDDM, and has wound, on POC no evidence of problems/goals/interventions for Endocrine and skin integrity. Corrected on site. Patient #7:Braden score on SN SOC assessment was "10", high risk. On POC no evidence of problems/goals/interventions for skin integrity. Corrected on site. Patient #8: Pat has IDDM, on POC no evidence of problems/goals/interventions for Endocrine. Corrected on site. Patient #10: Braden score on SN SOC assessment was "12", high risk. POC had no evidence of problems/goals/interventions for skin integrity. Patient #11: Patient has IDDM, POC had no evidence of problems/goals/interventions for Endocrine. MSW identified on SOC assessment "no funeral plans in place", no evidence of problem/goals/interventions for funeral planning. Patient #12: Patient has has IDDM, POC had no evidence of problems/goals/interventions for Endocrine. Patient #13: Patient has a wound to right foot, POC had no evidence of problem/goals/interventions for skin integrity.

Upon patient record review, 4 of 14 (Patient #5, #7, #12, #13) 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 #5: Orders for the following pain meds: 6/15/2023 MS prn pain or SOB, 9/7/2023 Hydrocodone PRN pain, and 9/7/2023 Tylenol ES prn pain or fever. There were no parameters on what to dispense and when. Corrected on site. Patient #7: Orders dated 9/25/2023 included O2 2-5L continuous via n/c for symptom management. There was no evidence of specific parameters of how to dispense. Corrected on site. Patient #12: Order dated 1/27/2023 included Insulin Glargine u-100 SQ per instructions use as directed. There was no evidence of a sliding scale for the insulin dosage. Patient #13: Order dated 6/20/2022 (pt came on service 9/22/2023, carried over from SNF orders) included O2 2-10 L continuous for SOB, call Hospice if need to go over 5L.There were no orders for specific parameters or titration of the O2.

Upon client record review, 1 of 14 (Patient #4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #4: Order dated 9/5/2023 for MSW 3xweek. Week of 9/3/2023 and 9/10/2023 there were two MSW visits with no missed visits documented.

Upon patient record review, 9 of 14 (Patient #2,#3,#4, #7, #8, #10, #11, #12, #13) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable. Patient #2, #3, #7, #10: Patient on O2, no O2 precautions on Aide POC/assignment. Corrected on site. Patient #4: Patient experienced seizure on 9/23/2023, no evidence of seizure precautions on Aide POC/Assignment. Corrected on site. Patient #8: Patient on O2, no O2 precautions, high risk of falls with no fall precautions on on Aide POC/assignment, Corrected on site. Patient #11, #12, #13: Patient has O2 orders, no evidence of Oxygen precautions on Aide POC/Assignment.

Upon patient record review 3 of 14 (Patient #1, #3, #5) 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 order for 2x week, week of 9/10/2023 no visits or missed visits. Patient #3: Order 7/23/2023 Aide 3xweek x 12. Weeks of 8/13, 9/3, and 9/10/2023 had 2 visits each with no documented missed visits. Patient #5: Order 8/20/2023 for Aide 3x week x8, week of 9/2/2023 had one visit 9/8 and a missed visit 9/4.

Upon client record review, 1 of 14 (Patient #14) 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 #14: There was no evidence of a discharge summary

Upon observation, there was no evidence a copy is provided of the hospice written policies and procedures on the management and disposal of controlled drugs to the patient or patient representative and family. The patient handbook did not contain the policy for Medication Management policy MM-001 TX. Corrected on site, with copies sent to patients and now included in the handbook.

Upon client record review, 7 of 14 (Patient #1, 2, 3, 4, 11, 12, 13) did not have evidence that the patient/family receive instruction in the safe use of durable medical equipment and supplies. The hospice may use persons under contract to ensure patient/family are educated. The patient and family can demonstrate the appropriate use of durable medical equipment to the satisfaction of the hospice staff. Patients 1, 2, 3, 4, 11, 12, 13 did not have evidence they were educated on the use of the DME.

Upon client record review, 1 of 14 (Patient #8) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient #8: Order date 8/17/2023 included Meropenem 1 g IV q 8 hrs for UTI, add NS flush with 3mls Q shift and after every Meropenem infusion to keep line patent. There was no order or specification as to who was to do this, Hospice nurse vs SNF staff. Corrected on site.

Upon patient record review, 1 of 14 (Patient #5) did not have evidence that the hospice provided the following information to the SNF: • The most recent hospice plan of care specific to each patient Patient #5: Last Plan of care provided was dated 8/30/2023, missing one from 9/13/2023. No documentation this was provided to the SNF.