Every finding on record at Hospice Preferred Choice, Inc.

Upon patient record review, 5 of 19 (Patient #1,2,6,8,13) 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 #1: The medication record indicates an order on 12/2/24 Albuterol 2.5 mg 4X wk. On 12/3/24 an order was written to clarify Albuterol 2.5 mg 4Xday. The order for 4X week was not discontinued. (corrected on site.) Patient #2: The medication record indicates on 1/22/25 Oxygen 1-5L PRN, route "inhalation", titrate to keep > 90%. The order does not indicate a route and the titration instructions do not indicate 90% of what.(corrected on site.) Patient #6: The medication record indicates an order for Oxygen 2 L at night. The instructions state "CPAP at night". There is no order for CPAP with settings on the medication record. (corrected on site.) Patient #8: The nurses note on 12/27/24 states "facility nurse reports Oxygen 1L PRN for SOB. Oxygen is not on the medication record. (corrected on site.) Patient #13: Upon home observation the facility medication record listed Xarelto. Xarelto was not on the hospice medication record. (corrected on site.)

Upon patient record review, 1 of 19 (Patient #1) 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 #1: The patient was receiving wound care to the L breast. The wound was not assessed the week of 1/16/25. According to Amedisys wound care policy, wounds are to be assessed weekly.

Upon patient record review, 4 of 19 (Patient #1,2,6,8) 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 medication record indicates an order on 12/2/24 Albuterol 2.5 mg 4X wk. On 12/3/24 and order was written for to clarify Albuterol 2.5 mg 4Xday. The order for 4X week was not discontinued. (corrected on site.) Patient #2: The medication record indicates on 1/22/25 Oxygen 1-5L PRN, route "inhalation", titrate to keep >90%. The order does not indicate a route and the titration instructions do not indicate 90% of what. (corrected on site.) Patient #6: The medication record indicates an order for Oxygen 2 L at night. The instructions state "CPAP at night". There is no order for CPAP with settings. (corrected on site.) Patient #8: The nurses note on 12/27/24 states "facility nurse reports Oxygen 1L PRN for SOB. There is no order for oxygen. (corrected on site.)

Upon patient record review 9 of 19 (Patient #1,2,3,5,7,8,11,12,14) 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: There is evidence the Volunteer Assessment on 11/29/24 the patient requested a volunteer. Noted volunteer was unavailable in December 2024 and January 2025. Patient #2: There is evidence the Volunteer Assessment on 12/26/24 the patient requested a volunteer. Noted volunteer was unavailable in January 2025. Patient #3: There is evidence the Volunteer Assessment on 11/29/24 the patient requested a volunteer. Note volunteer was unavailable in December 2024 and January 2025. Patient #5: There is evidence the Volunteer Assessment on 11/20/24 the patient requested a volunteer. Noted volunteer was unavailable in December 2024 and January 2025. Patient #7: There is evidence the Volunteer Assessment on 11/21/24 the patient requested a volunteer. No volunteer was available. There is no documentation that a volunteer was provided. Patient #8: There is evidence the Volunteer Assessment on 12/3/24 the patient requested a volunteer. Noted volunteer was unavailable in December 2024 and January 2025. Patient #11: There is evidence the Volunteer Assessment on 11/20/24 the patient requested a volunteer. Noted volunteer was unavailable in December 2024 and January 2025. Patient #12: There is evidence the Volunteer Assessment on 11/20/24 the patient requested a volunteer. Noted volunteer was unavailable in December 2024 and January 2025. Patient #14: There is evidence the Volunteer Assessment on 11/26/24 the patient requested a volunteer. Noted volunteer was unavailable in December 2024 and January 2025.

Upon patient record review 2 of 19 (Patient #1,4) 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 #1: The aide plan of care indicated nail care every Tuesday. The week of 2/2/25 and 2/10/25, the aide did not visit on a Tuesday. Patient #4: The aide plan of care indicated tub bath and shampoo care every Tuesday. The week of 2/2/25 and 1/19/25, the aide did not visit on a Tuesday.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. The documentation indicated that the volunteer percentage for 2024 was 0.84%.

Upon patient record review, 1 of 19 (Patient #9) 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 #9: The medical record indicates a supervisory visit by the RN on 12/4/24 to evaluate the aide. The patient does not have an aide.

Upon patient record review, 4 of 19 (Patient #1,2,6,7) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #1: There is an order on 12/3/24 for Oxygen 2L/min. The nurses notes on 2/10/25 and 2/17/25 indicate the Oxygen was at 3L/min. Patient #2: There is an order on 12/23/24 for Oxygen 1L/min. The nurses notes on 12/26, 12/30 and 1/2/25 indicate the Oxygen was at 2L/min. Patient #6: There is an order for the Volunteer to visit weekly. The volunteer did not visit in the month of January. Patient #7: There is an order on 11/4/24 for Oxygen 3L/min. The nurses note on 2/17/25 indicate the Oxygen was at 2L/min.