Every finding on record at Hospice Preferred Choice, Inc.

Upon patient record review, 1 of 19 (Patient #11) 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 11: The medication profile includes duplicate entries on 7/28/24 of Tylenol/Acetaminophen 325mg 2 tabs every 6 hours as needed for pain or fever.

Upon patient record review, 2 of 19 (Patient #4,#9) 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: The medical record includes nursing documentation that patient's medication regimen includes Xarelto. The plan of care includes problems of actual/potential for bleeding or hemorrhage with no evidence of active interventions. Patient 9: The medical record contains nursing documentation of interventions provided to reduce risk of aspiration due to enteral feeds. There is no evidence that the plan of care includes problems, goals and interventions to reduce the risk of aspiration.

Upon patient record review, 5 of 19 (Patient #1,#2,#9,#10,#11) 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 medical record includes SN documentation that Imodium was ordered for diarrhea on 8/23/24. There is no evidence of an order for Imodium on the plan of care. Patient 2: The plan of care includes an order for wound care on 5/14/24 to include cleanse wound of left posterior calf with wound cleanser, pat dry with gauze, apply hydrogel and cover with Opti foam. There is no evidence that the order includes who is to perform care and frequency that care is to be performed. Patient 9:The plan of care includes an order on 5/14/24 for Osmolyte 1.5 calories for enteral feeds continuously. The order does not include the rate of infusion for Osmolyte. Patient 10: The plan of care includes an order on 6/1/24 for oxygen to be delivered at 3 liters per minute via nasal cannula continuously. There is SN documentation on each visit from 6/13 to present that patient is on room air. Patient 11: There is nursing documentation on 8/22, 8/27, 8/31, 9/1 and 9/2 that patient is receiving oxygen at 3 liters per minute via nasal cannula. The plan of care includes an order for oxygen to be delivered at 2 liters per minute.

Upon patient record review, 2 of 19 (Patient #1,#9) 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 1:The medical record includes documentation on 8/29/24 that patient complaint of diarrhea and subsequent change to medication regimen to control symptom. There is no evidence of an update to the plan of care with problem, goals and interventions for management of symptom. Patient 9: The medical record includes documentation of antibiotic therapy in use for urinary tract infections on 6/3/24 and 8/2/24. There is no evidence of an update to the plan of care with problems, goals and interventions for an active infection.

Upon patient record review, 2 of 19 (Patient #1,#4) 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 1 and 4: The plan of care includes anticoagulation therapy. The aide plan of care does not include bleeding precautions. COS