Every finding on record at Hospice Preferred Choice, Inc.

Upon patient record review, 1 of 14 (Patient #4) did not contain a current/comprehensive Medication Profile: Patient #4: The record reflected that the patient was utilizing Oxygen 2 lpm continuous, per nasal cannula. Oxygen was not included on the Medication Profile.

Upon patient record review, 1 of 14 (Patient #4) did not contain evidence that the Hospice had 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 RN SOC assessment reflected that the patient had a cardiac pacemaker. This pacemaker was not included on the SOC 90-day POC, nor on the most recent IDG Meeting of 11/27/24.

Upon patient record review, 2 of 14 (Patients #4 and 6) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments: Patient #4: The record reflected that the patient was utilizing Oxygen 2 lpm continuous, per nasal cannula. This Oxygen was not included on the 11/27/24 IDG POC. Patient #6: The IDG meeting dated 11/21/24, included a Physician order for: "1) Has right hand/wrist contracture and wears a splint. Care to be done 2x per week as follows: Remove splint, wash hand and dry, apply anti-fungal powder". This treatment order does not include 'who' Hospice or ALF staff to provide such care; and 2) "Has bright red fluid-filled blister on left upper thigh. Wash with soap and water/celine cleanser, apply skin protection barrier, then an island dressing." This treatment order does not include 'who' Hospice or ALF staff to provide such wound care, nor a Physician-ordered frequency for such wound care.

Upon patient record review, 1 of 14 (Patient #5) did not contain evidence that the IDG had ensured that care and services were provided in accordance with the Plan of Care: Patient #5: A verbal order was obtained on 08/20/24 for, "Volunteer Coordinator evaluated; nor further visits are required." However, Volunteer visits were made on August 21, 22, and 28, 2024.

Upon observation, the annual report documented the use of Volunteers, providing day-to-day administrative and/or direct patient care services, in an amount that at a minimum did not equal 5 percent of the total patient care hours of all paid Hospice employees and contract personnel. Calendar-year 2023 resulted in 0.02%.

Upon patient record review, 1 of 14 (Patient #6) did not contain evidence that all entries were clear/complete: Patient #6: The IDG meeting dated 11/21/24, included a Physician order for: "1) Has right hand/wrist contracture and wears a splint. Care to be done 2x per week as follows: Remove splint, wash hand and dry, apply anti-fungal powder". The 11/25/24 SN visit documented, "Patient was pre-medicated, and tolerated hand-cleansing well"; without any documented details of such hand treatment that was provided. The 11/27/24 SN visit narrative documented, "Has hand splint in place. No cleaning needed to be done at this time." However, later in the same narrative paragraph, the nurse further documented, "Patient pre-medicated prior to hand care (without the details of such hand care), and patient tolerated cleansing well." This is unclear documentation.