Every finding on record at Intrepid of Edina, Inc.

Upon patient record review, 2 of 14 (Patient #4,5) 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 4: MAR has "Miralax 17 Grams oral powder packet daily PRN for constipation" and Bisacodye rectal suppository daily PRN for constipation". No instructions on either medication as to which medication for constipation to give first and which to use second. Patient 5: MAR has "Miralax oral powder packet 17 Grams daily by mouth every 24 hours PRN for constipation". No diluent or amount of diluent listed in medication instructions.

Upon patient record review, 1 of 14 (Patient #10) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient 10: On plan of care, chaplain frequency listed as PRN. No evidence of a routine frequency order on chart.

Upon patient record review, 2 of 14 (Patient #4,5) 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 4: MAR has "Miralax 17 Grams oral powder packet daily PRN for constipation" and Bisacodye rectal suppository daily PRN for constipation". No instructions on either medication as to which medication for constipation to give first and which medication to use second. Patient 5: Plan of care order has "Miralax oral powder packet 17 Grams daily by mouth every 24 hours PRN for constipation". No evidence of a diluent or the amount of diluent listed in medication instructions.

Upon client record review, 2 of 14 (Patient #2,10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 2: Plan of care has volunteer services ordered at twice monthly. Volunteer coordination notes showed visits occurred on 12/29/2022 and 01/06/2023. No evidence that any other visits occurred. No evidence that an order was entered to discontinue visits. Patient 10: No evidence that volunteer services were ordered on plan of care. Volunteer visited patient on 07/07/2023, 07/19/2023, 08/02/2023, 08/16/2023, 08/30/2023. Orders entered during survey. On plan of care, chaplain frequency listed as PRN. No evidence of a routine frequency order on chart. Chaplain visited patient on 07/07/23, 08/16/23, and 09/14/2023 and wrote in several notes that the patients scheduled frequency was once a month. No order for monthly visits.

Upon observation, there was no evidence the hospice is in compliance with accepted professional standards and principles for all non-core services which includes physical therapy, occupational therapy and speech-language pathology. Did not have evidence of a contract for Speech Therapy on day one of survey. Corrected on day 2 of survey.