Every finding on record at Icare Health Services LLC

Upon patient record review, 2 of 5 (Patient #1, #2) 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 #1: There is evidence in the medical record that the patient is on Oxygen and the Plan of Care identifies Oxygen Precautions. The aide plan of care did not include Oxygen Precautions. Patient #2: There is evidence in the medical record that the patient is on Oxygen and the Plan of Care identifies Oxygen Precautions. The aide plan of care did not include Oxygen Precautions.

Upon personnel record review, 1 of 13 (Personnel #7 ) did not have evidence that all Medical Social Services are provided by a qualified Medical Social Worker in accordance with the state's Social Work Practice Act, the hospice's policies and procedures and/or job descriptions. Personnel #7: Upon review and discussion with the agency that there is no evidence an MSW is employed and/or contracted and serves as an active advisor for the BSW.

Upon patient record review, 1 of 5 (Patient #3) there was no evidence in the patient record that the comprehensive assessment considered the severity of symptoms for this bedbound patient with a high risk Braden scale score of 11 and a Stage 3 pressure ulcer on the R buttocks. Given that the patient was bedbound and required complete assistance, the comprehensive assessment did not include measurements and the detailed description (odor, drainage, surrounding skin) of the stage 3 pressure ulcer on the R buttocks.

Condition of Participation: Interdisciplinary Group, Care Planning, and Coordination of Services. L536

Upon patient record review, 1 of 5 (Patient #3) there was no evidence in the patient record of ongoing assessment including measurements and the detailed description (odor, drainage, surrounding skin) of the stage 3 pressure ulcer on the R buttocks that was noted on admission.

Upon patient record review, 1 of 5 (Patient #3) There was no evidence that the patient and family received instruction and training as appropriate to the care for the bedbound patient's foley catheter care and stage 3 pressure ulcer, which was identified in the comprehensive assessment. There was no documented evidence in record how education and training was or will be provided to the patient and caregivers for this patient's that has an assessed inability to care for self.

Upon patient record review, 1 of 5 (Patient #3) There was no evidence in the patient record that the hospice developed an individualized written plan of care that reflected patient goals and interventions based on the problems identified in the initial comprehensive assessment and included all services required for the palliation and management of the terminal illness and related conditions. The initial comprehensive assessment indicated that the patient had a stage 3 pressure ulcer on the R buttocks area, no specific wound care instructions (treatments, frequency, and who will perform wound care) for the patient that was assessed with inability to perform self-care being bedbound and needed assistance.

Upon patient record review, 1 of 5 (Patient #3) There was no evidence in the patient record that the hospice developed an individualized written plan of care that reflected patient goals and interventions based on the problems identified in the initial comprehensive assessment and included all services required for the palliation and management of the terminal illness and related conditions. The initial comprehensive assessment indicated that the patient had a stage 3 pressure ulcer on the R buttocks area, no specific wound care instructions (treatments, frequency, and who will perform wound care) for the patient that was assessed with inability to perform self-care being bedbound and needed assistance.

Upon patient record review, 5 of 5 (Patient #1,2,3,4 &5) did not have evidence the plan of care included all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient #1 had Hospital Bed, Oxygen Concentrator, 3 in 1 Commode, Shower Bench, Grab Bars as assessed in the comprehensive assessment on 9-13-23 which were not included in the plan of care. Patient #2 had walker, scooter, cane, oxygen concentrator, shower chair as assessed in the comprehensive assessment on 9-11-23 which were not included in the plan of care. Patient #3 had hospital bed, overbed table, wheelchair, oxygen concentrator as assessed in the comprehensive assessment on 9-18-23 which were not included in the plan of care. Patient #4 had shower chair, commode, oxygen concentrator, wheelchairs as assessed in the comprehensive assessment on 6-23-23 which were not included in the plan of care. Patient #5 had wheelchair, walker, shower chair, oxygen concentrator as assessed in the comprehensive assessment on 7-10-23 which were not included in the plan of care.

Upon client record review, 1 of 5 (Patient #3) There was no evidence that the plan of care included the level of understanding and involvement of the patient and family, and if they did agree to perform the care for the patients' foley catheter and stage 3 pressure ulcer treatments, management, and prevention of exacerbation.

Upon patient record review, 1 of 5 (Patient #3) did not have evidence that all entries were legible, clear, complete, and appropriately authenticated in accordance with the organizations policies and procedures and currently accepted standards of practice. The physician order dated 9-18-23 indicated admit patient to another agency, Connect Hospice.

Upon client record review, 2 of 5 (Patient #4 &5) did not have evidence that upon revocation and discharge from hospice services, in accordance with §418.26, the hospice forwarded to the patient's attending physician a copy of the following; • The hospice discharge summary • The patient's clinical record, if requested