Every finding on record at Infinite Healthcare Service LLC

Upon patient record review, 5 of 16 (Patient #2,4,5,11,12) 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 upon review an order dated 7/24/24 was written to increase Lactulose, however medication not added to medication profile. Patient #4 upon review an order dated 2/21/24 was written to discontinue routine meds,however all medications remain on medication profile. Patient #5 upon review an order dated 6/23/24 was written to discontinue routine meds and start comfort meds, however medication profile not updated. Patient #11 upon review an order dated 6/1/22 was written to discontinue routine meds, however all medications remain on medication profile. Patient #12 upon review an order dated 1/20/23 was written for Tylenol, Dulcolax, Atropine, Promethazine, Lorazepam and Morphine, however no medications are on medication profile.

Upon patient record review, 1 of 16 (Patient #15) 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 #15 a note dated by the RN on 10/1/20 notes that the patient has wounds and the initial orders state "refer to wound care order", upon review there is no evidence of a wound care order in place.

Upon client record review, 1 of 16 (Patient #9) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #9 a note dated 9/29/23 by the spiritual care provider states the family refused additional visits, upon review a visit was made on 11/16/23 with no evidence of an order in place.

Upon patient record review, 3 of 16 (Patient #4,6,8) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient #4: An initial bereavement call was made on 2/23/24, upon review there is no evidence of additional bereavement counseling. Patient #6: Patient had a 3 month call due 11/2023, a 6 month call due 2/2024, a 6 month mailing due 2/2024, a 9 month mailing due 5/2024, a 12 month mailing due 8/2024 and a 12 month call due 8/2024, upon review there is no evidence of the bereaved receiving any calls or mailings. Patient #8: The 12 month mailing was due 6/2023 and upon review there was no evidence of it being sent.

Upon patient record review, 1 of 16 (Patient #1) 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: The plan of care for patient shower, change linens and make bed states "often", no evidence of the specific frequency of these tasks.

Upon patient record review 6 of 16 (Patient #2,10,11,13,14,16) 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 #2: An order dated for 6/14/24 states the aide task of linen change is to be completed weekly and the aide is documenting the tasks are completed at visits on 8/24, 8/27, 8/28, 9/3 and 9/5/24. Patient #10: An order dated for 6/6/24 states the aide task of linen change is to be completed weekly and the aide is documenting the tasks are completed at visits on 6/6, 6/7, 6/10 and 6/11/24. Patient #11: An order dated for 5/26/22 states for the aide task of linen change, shave and shampoo to be completed weekly and the aide is documenting the tasks are completed at visits on 5/31 and 6/1/22. Patient #13: An order dated for 5/25/23 states for the aide task of linen change, shave and shampoo to be completed weekly and the aide is documenting the tasks are completed at visits on 7/7, 7/10, 7/11, 7/12 and 7/13/23. Patient #14: An order dated for 5/2/22 states for the aide task of linen change, make bed and shampoo to be completed weekly and the aide is documenting the tasks are completed at visits on 7/22, 7/25, 7/26, 7/28 and 7/29/22. Patient #16: An order dated for 11/3/21 states for the aide task of linen change and shampoo is to be completed weekly and the aide is documenting the tasks are completed at visits on 11/28, 11/29, 12/1, 12/3 and 12/6/21.

Upon patient record review 2 of 16 (Patient #2,13) 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 #2 received an on-site visit on 8/23, no evidence of an on-site visit being completed by 9/6/24. Patient #13 received on-site visits on 6/8 and 7/6/23 which were more than 14 days apart.

Upon personnel record review, 1 of 9 (Personnel #4 ) did not have evidence the alternate administrator's personnel record verifies that: • The employee has appropriate education and experience requirements • There is a signed job description for this role • The employee has been orientated to this role Personnel #4 has a signed job description approved by the governing body that states the employee must be a licensed nurse, licensed social worker or licensed therapist, upon review the employee does not hold any of the appropriate requirements.

Upon personnel record review, 1 of 9 (Personnel #5 ) did not have evidence that personnel credentialing activities are conducted to verify qualifications of all credentialed/licensed personnel in the positions they hold at the time of hire, at renewal or in accordance with specific state practice act requirements. Personnel #5 did not have evidence of verification of credentialing required for the position.

Upon patient record review, 1 of 6 (Patient #5) 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 #5 - The record had Triamcinolone on medication list with instructions as apply thin layer to the affected areas as needed PRN. There was no evidence of the location or frequency for the PRN.

Upon patient record review, 3 of 6 (Patient #3,4,5) 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 #3 - The record indicated the primary terminal diagnosis was Alzheimer's disease. There was no evidence in the record of a neurological or cognitive problem with individualized goals and interventions. Patient #4 - The plan of care contained a pain problem with goals but with no evidence of interventions. Patient#5 - The record indicated the primary terminal diagnosis was Alzheimer's disease. There was no evidence in the record of a neurological or cognitive problem with individualized goals and interventions.

Upon patient record review, 2 of 6 (Patient #2,5) 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 - The record contained an order from 9/15/21 for Acetaminophen Rectal Supp 325mg 1 supp insert rectal for fever PRN. There was no evidence of the frequency for the PRN. Patient #5 - The record indicated an order for Triamcinolone apply thin later to affected area PRN. There was no evidence a PRN frequency or location for application of the medication.

Upon patient record review, 2 of 6 (Patient #2,4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2 - Documentation revealed a chaplain made a telehealth visit on 9/17/21. There was no evidence of telehealth visits added to the in the plan of care. Patient #4 - SN visit note dated 9/13/20 indicated that the nurse cleaned the right buttock wound and applied a Duoderm. The visit note dated 9/14/20 said the same wound was open to air. There was no evidence of an order for wound care to the right buttocks.

Upon patient record review 2 of 4 applicable (Patient #1,3) did not have evidence that a hospice aide provides services that are ordered by the interdisciplinary group and included in the plan of care Patient #1 - The aide care plan indicated a partial bath/shower was assigned to be completed every visit. The aide visit notes dated 8/20, 8/27, 8/31, 9/3, 9/14, 9/17, 9/24, 9/28, 10/1 and 10/6 did not include documentation of completing the assigned task. Patient #3 - The aide care plan indicated the shampoo was to be completed weekly and the aide visits were ordered 2x/week. The aide documentation revealed that from 8/13/21-10/4/21 the shampoo was completed every visit.

Upon patient record review, 1 of 6 (Patient #6) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient's life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination: • The primary terminal condition • Related diagnosis • Current subjective and objective medical findings • Current medication and treatment orders • Information about the medical management of any of the patient's conditions unrelated to the terminal illness. Patient #6 - The narrative on the CTI said "patient shown gradual decline and now has a pleurx catheter draining ascites at home" There was no evidence of the terminal diagnosis or or co-morbidities included in the physician's narrative note.

Upon patient record review, 3 of 6 (Patient #1,3,5) 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 #1- The records contained DNR orders which were signed by the physician but there was no evidence of the date of the signature. The chaplain wrote a note in the 5/5/21 POC update for the IDG meeting with information from the wrong patient. His note said he made a visit on 4/10/21 to a 72 y/o male residing at home with wife..... The documentation of the visit revealed the chaplain made the visit on 5/1/21 and the patient is an 84 y/o female that lives in a group home. Patient #3 - The record indicated on the initial plan of care dated 8/12/21 and orders on 9/9/21 and 9/28/21 that the primary diagnosis was Respiratory Failure. The order to admit written on 8/12/21, the nurses initial note and the physician narrative on the CTI said the primary diagnosis is Alzheimer's Disease. COS Patient #5 - The records contained DNR orders which were signed by the physician but there was no evidence of the date of the signature.

Upon client record review, 3 of 3 applicable (Patient #4,5,6) did not have evidence that the discharge summary includes all required information. Patient #4 - No evidence of discharge summary including summary of the patient's hospice stay including treatments, symptoms and pain management, current plan of care, and latest physician orders. Patient #5 - There was no evidence of a discharge summary in the patient record. Patient #6 - There was no evidence of a discharge summary in the patient record.