Every finding on record at Integral Hospice, Inc.

Upon patient record review, 2 of 14 (Patient #5, 6) 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 Patient 5: The medication list indicates glipizide ER tab 5mg po bid. This does not include the complete medication order as the dosage quantity of 1 tablet was not present on the medication list. (corrected onsite) Patient 6: The patient's medication list contained a duplicate entry for Immodium 2mg 1 tab po daily PRN diarrhea. (corrected onsite)

Upon patient record review, 2 of 14 (Patient #1, 9) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient 1, 9: The initial comprehensive bereavement risk assessment was not complete, while it included a narrative summary; there was no evidence of an identified primary bereaved party/family member who was a part of this assessment. (corrected on site)

Upon patient record review, 3 of 14 (Patient #4, 5, 6) 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 equipment and supply needs. Patient 4, 5, 6: The patient requires the use of a cane for management of the terminal illness; however, this DME does not appear on the plan of care. All DME utilized by the patient, whether supplied by the hospice or previously owned by the patient, must appear on the plan of care. (corrected onsite)

Upon personnel record review, 1 of 11 (Personnel #6) did not have evidence the alternate administrator's personnel record verifies that: • There is a signed job description for this role Personnel #6: The alternate administrator's HR file contained a job description; however, it was not signed by the employee. For clarification, all required orientation and competencies were completed at the time of hire, just the job description was unsigned. (corrected onsite)

Upon observation and contract review, there was no evidence that when the hospice provides durable medical equipment under contract, then the DMEPOS provider is accredited by a CMS approved accreditation organization.