Every finding on record at Hospice Preferred Choice, Inc.

Upon patient record review, 5 of 19 (Patient #1,#2,#3,#4,#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#1: Upon home visit, guaifenesin and potassium are on the agency medication profile, the patient said he no longer takes either, Corrected on site. Patient #2: A physicians order indicated on 09/20/2024 that all medications are to be crushed. There was not evidence for the medications to be crushed on the medication profile. Corrected on site. Upon home visit, Bisacodyl and levsin are on the agency medication profile but not at the ALF medication profile. In addition, the physician order dated 09/20/2024 is for medications to be crushed. The ALF supervisor said they have not received the order as of 09/25/2024. Corrected on site. Patient #3: The medication profile indicated acetaminophen, hydrocodone/acetaminophen, and morphine for pain. There was not evidence of parameters. Corrected on site. Upon home visit, the patient is taking Atorvastatin, it is not on the agency medication profile. Corrected on site. Patient #4: The medication profile indicated acetaminophen, hydrocodone/acetaminophen, and morphine for pain. There was not evidence of parameters. Corrected on site. Upon home visit, acetaminophen, Bisacodyl, Haloperidol, and Hyoscyamine are on the agency medication profile but not in the home. In addition, the patient is taking Clopidogrel and it's not on the agency medication profile. Corrected on site. Patient #6: The medication profile indicated hydrocodone/acetaminophen and morphine for pain. There was not evidence of parameters. Corrected on site.

Upon patient record review, 5 of 19 (Patient #1,#8,#9,#10,#14) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patients #1,#8,#9,#10,#14: There was not evidence in the record that the comprehensive assessment included a bereavement assessment completed within 5 days.

Upon patient record review, 1 of 19 (Patient #2) 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 #2: The care plan was not updated with the patient declining and having difficulty swallowing documented in the medical record 09/20/2024. Corrected on site

Upon patient record review, 1 of 19 (Patient #2) did not have evidence that the IDG shares information on a on-going basis with non-hospice healthcare providers furnishing services unrelated to the terminal illness and related conditions. Patient #2: The record indicated a physicians order for crushing the patients medications and a change to a pureed diet on 09/20/2024. As of 09/25/2024, there was not evidence that the ALF was notified. Corrected on site.

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 agency volunteer hours were documented for 2023 at 0.28%.

Upon personnel record review, 1 of 14 (Personnel #10) did not have evidence the hospice employees and contract employees have received orientation on the hospice philosophy. Personnel record #10: The personnel record does not contain evidence of orientation to the hospice philosophy.

Upon personnel record review, 1 of 14 (Personnel #10) did not have evidence the hospice obtained a criminal background check on all contracted individuals who have direct patient care and access to patient records. Personnel record #10: The personnel record does not contain evidence of a criminal background check.