Every finding on record at Hospice Preferred Choice, Inc.

Upon patient record review 1 of 14 (Patient #11) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #11: Patient SOC 3/27/2023. The spiritual assessment occurred on 4/3/2023, day 7.

Upon patient record review, 8 of 14 (Patient #2, #3, #4, #5, #6, #12, #13, #14) 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 #2: The medication profile dated 9/1/2023 that included Oxygen order clarification inhale 1-5 LPM via NC prn SOB. There was no evidence of how to dispense at what dose. Corrected on site. Patient #3: The medication profile dated 10/10/2022 that included Oxygen order clarification inhale 1-5 LPM via NC prn SOB. There was no evidence of how to dispense at what dose. Corrected on site. Patient #4: The medication profile dated 7/24/2023 for Diclofenac 1% topical on affected areas for pain. There was no evidence of an area to apply. Dated 7/22/2023 included Lidocaine patch 4% topical for pain affected areas QD for 14 days. There was no evidence of an area to apply and order is still active. Corrected on site. Patient #5: The medication profile dated 6/5/2023 that included Nitroglycerin 0.4 mg 1 tab SL Q5 minutes as needed for chest pain. There was no limit to dosing. Corrected on site. Patient #6: The medication profile dated 8/28/2023 that included Polyethylene Glycol 17GM by mouth daily. There was no evidence of a diluent. Corrected on site. Patient #12: The medication profile dated 1/27/2023 that included Oxygen 1-5 LPM via NC prn SOB or SPO@ <90%. There was no evidence of how to dispense at what dose. Patient #13: The medication profile dated 10/17/2022 that included Oxygen 1-5 LPM via NC prn SOB Resp. comfort. There was no evidence of how to dispense at what dose. Patient #14: The medication profile dated 7/8/2022 that included Oxygen 1-5 LPM via NC prn SOB Resp. comfort. There was no evidence of how to dispense at what dose.

Upon patient record review, 10 of 14 (Patient #2, #3, #4, #5, #7, #8, #9, #11, #12, #14) 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 #2: Patient had photo uploaded to record of pressure ulcer to rt. great toe. There was no evidence on the POC with problem/interventions/goals specific to this wound. Corrected on site. Patient #3: Patient is on O2, and has a diagnosis of DMll. There was no evidence on the POC with problems/interventions/goals for O2 therapy or Endocrine/Diet. Corrected on site. Patient #4: Patient is on O2, and has several DME items listed as ordered. There was no evidence on the POC for problems/interventions/goals for O2 therapy and DME use/safety. Corrected on site. Patient #5: Patient has diagnosis of DMll. There was no evidence on the POC with problems/interventions/goals for Endocrine/Diet. Corrected on site. Patient #7: Patient is on O2, had SOC diagnosis of CVA rt sided hemiplegia/TIAs, Vascular Dementia. There was no evidence on the POC for problems/interventions/goals for O2 therapy and Neuro related to diagnosis. Corrected on site. Patient #8: Patient is on O2, and has diagnosis of dysphagia. There was no evidence on the POC for problems/interventions/goals for O2 therapy or risk of aspiration. Corrected on site. Patient #9: Patient is on O2 and had SOC diagnosis of ASHD, Vascular dementia. There was no evidence on the POC for problems/interventions/goals for O2 therapy or Cardiac related to diagnosis. Corrected on site. Patient #11: Patient on O2 and had SOC diagnosis of CA Lung with brain mets, COPD, Embolism, CLL and CAD. Patient has multiple DME items. There was no evidence on the POC for problems/interventions/goals for O2 therapy, Cardio/Respiratory related to diagnosis, Risk of seizure related to Brain mets, or DME. Patient #12: Patient is on O2 and had SOC diagnosis of HTN Heart Failure, CKD, Parkinson's and Seizures. The SN identified fall risk on SOC assessment. There was no evidence on the POC for problems/interventions/goals for O2 therapy, Neuro related to diagnosis or fall risk. Patient #14: Patient is on O2. There was no evidence on the POC for problems/interventions/goals for O2 therapy.

Upon patient record review, 1 of 14 (Patient #3) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #3: There is an order written by Chaplain for visit frequencies dated 8/21/2023, includes "Patient is once a month and patient is twice in one week" . Corrected on site.

Upon patient record review, 8 of 12 (Patient #2, #3, #4, #5, #6, #12, #13, #14) 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 #2: There was an order dated 9/1/2023 that included Oxygen inhale 1-5 LPM via NC prn SOB. There was no evidence of how to dispense at what dose. Corrected on site. Patient #3: There was an order dated 10/10/2022 that included Oxygen inhale 1-5 LPM via NC prn SOB. There was no evidence of how to dispense at what dose. Corrected on site. Patient #4: There was an order dated 7/24/2023 for Diclofenac 1% topical on affected areas for pain. There was no evidence of an area to apply. An order dated 7/22/2023 included Lidocaine patch 4% topical for pain affected areas QD for 14 days. There was no evidence of an area to apply and order is still active. Corrected on site. Patient #5: There was an order dated 6/5/2023 that included Nitroglycerin 0.4 mg 1 tab SL Q5 minutes as needed for chest pain. There was no limit to dosing. Corrected on site. Patient #6: There was an order dated 8/28/2023 that included Polyethylene Glycol 17GM by mouth daily. There was no evidence of a diluent. Corrected on site. Patient #12: There was an order dated 1/27/2023 that included Oxygen 1-5 LPM via NC prn SOB or SPO@ <90%. There was no evidence of how to dispense at what dose. Patient #13: There was an order dated 10/17/2022 that included Oxygen 1-5 LPM via NC prn SOB Resp comfort. There was no evidence of how to dispense at what dose. Patient #14: There was an order dated 7/8/2022 that included Oxygen 1-5 LPM via NC prn SOB Resp comfort. There was no evidence of how to dispense at what dose.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient 2: The RN removed the stethoscope from the clean area of the nursing bag and draped it over his neck prior to using it for patient care.

Upon patient record review, 3 of 14 (Patient #2, #3, #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 #2, 3, 4: Patient is on O2, the Aide POC did not include evidence of Oxygen precautions. Corrected on site.

Upon patient record review 1 of 14 (Patient #4) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient #4: Evaluation of the Hospice aide occurred on 8/11/2023, the next occurred on 9/6/2023.

Upon client record review, 1 of 14 (Patient #11) 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 #11: On DC summary it states Pt admitted to non contracted facility on 6/30/2023, SN notes on last visit 6/29/2023 pt. going to VA for end of life care. There was no evidence the discharge summary was sent to the attending or facility rendering care and no evidence of a signed revocation.

Upon client record review, 1 of 14 (Patient #2) 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 2 There was an order dated 8/28/2023 to apply betadine to rt. great toe daily, it did not specify who was to do this, RN or Facility staff. Corrected on site.

Upon personnel record review, 3 of 14 (Personnel #11, #12, #13 ) 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 #11, #12, #13: Criminal background checks supplied through the Rehab agency that provided files for PT/SLP/ and OT contained a list of exclusions by number, without a key to explain what those numbered exclusions were. The rehab spokesperson stated they did not have the key or explanation for the results provided.