Every finding on record at Hospice Preferred Choice, Inc.

Upon patient record review, 3 of 19 (Patients #2, 5, and 7) did not contain a Plan of Care which included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments: Patient #2: The IDG POC dated 09/19/23 included, "Has rash to left inner ankle, treatment in place." There were no additional details regarding this wound care treatment. Patient #5: The IDG POC dated 09/26/23 included, "Patient is NPO and reliant on tube feedings (FiberSource 1 can TID to QID)". This is an incomplete order, as it is not delineated as to the method/vehicle of administration, who will administer, nor who is responsible for observing/caring for the PEG Tube site. The same POC included, "Patient unable to handle own secretions at times and chokes." There was a verbal order dated 09/14/23 for the DME of 'suction machine'. However, the updated IDG POC 09/26/23 did not delineate the details of such suctioning intervention, such as who was responsible for the use of such, when to be used, nor the method of suctioning (oral only, verses nasal/tracheal, sterile/non-sterile, etc....) Patient #7: The IDG POC dated 09/19/23 included, "Wound to coccyx. Treatment Medi-Honey." Hospice nurse to do 2x per week on Tuesday and Thursday. SNF nurse to do Saturdays and p.r.n., without an indication for such p.r.n. wound care.

Upon patient record review, 3 of 19 (Patients #1, 3, and 4) did not contain evidence that the Plan of Care includes all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs: Patient #1: During Surveyor attended home visit on 09/26/23 the following DME was noted: Bed, WC, Shower Chair, and over-toilet commode. These DME had not been included on the most current updated IDG POC 09/19/23. Patient #3: During Surveyor attended home visit on 09/27/23 the following DME was noted: Bed, Bedside Table, and bedrail pads. These DME had not been included on the most current updated IDG POC 08/22/23. Patient #4: During Surveyor attended home visit on 09/27/23 the following DME was noted: Bedside Table, and commode. These DME had not been included on the most current updated IDG POC 09/05/23.

Upon patient record review, 1 of 19 (Patient #7) did not contain evidence that the revised IDG Plan of Care included all information from the patient's updated comprehensive assessments. The IDG POC dated 09/19/23 included a wound to left lateral sacral/coccyx. Treatment of Medi-Honey. Elsewhere on same POC it referenced that this wound care involved a recent dressing change by the SNF nurses, with the use of a Hydrocolloid dressing. These are not complete wound care orders. The regional clinical manager located a verbal order dated 08/29/23 which did include all necessary wound care details. However, these necessary wound care details were not updated to the next IDG POC dated 09/19/23.

Upon patient record review, 2 of 19 (Patients #1 and 2) did not contain evidence that the Hospice had provided the following required information to the SNF: Patient #1: There was not documented evidence that the Hospice had provided the SNF with the following required documents: • Hospice Election form • Physician Certification and Re-certification(s) of the terminal illness • Names and contact information for Hospice personnel involved in the care of each patient Patient #2: There was not documented evidence that the Hospice had provided the SNF with the following required documents: • Hospice Election form • Physician Certification and Re-certification(s) of the terminal illness • Names and contact information for Hospice personnel involved in the care of each patient • The most recent Hospice Plan of Care. The most recent POC in the SNF records was dated 07/2023.