Every finding on record at Imed Hospice

Upon patient record review 1 of 14 (Patient 11) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 11 hospice aide assignment includes check vitals each visit. Hospice aide visit notes on 11/29/24, 11/26/24, 11/22/24 and 11/19/24 with no vitals obtained and no evidence of vitals attempted.

Upon patient client record review, 1 of 14 (Patient 11) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 11 interdisciplinary group minutes on 10/28/24 and 11/11/24 showed evidence of involvement from all disciplines but signatures and date of MSW and SCP was not obtained.

Upon observation, there was no evidence the organizational chart matches the hospice's information submitted to CMS and/or State licensing agencies for ownership and management personnel. Agency current Administrator does not match the Administrator's name on Organizational chart.