Every finding on record at Intrepid of Houston Texas, Inc.

Upon patient record review 1 of 14 (Patient #4) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient 4: No evidence that initial spiritual assessment was completed within 5 days of admit. Patient admitted on 12/30/2023. Visit completed on 01/10/2024.

Upon patient record review, 2 of 14 (Patient #3,7) 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 3: Duplicate drug therapy - Miralax 17grams daily PRN for constipation, Dulcolax 10MG rectal supp daily PRN. No evidence that instructions were given on which medication for constipation to take first. Patient 7: Miralax powder 17gram 1 daily as needed for constipation. Senna-Plus daily as needed for constipation. No evidence that instructions were given on which medication for constipation to take first. Miralax powder 17grams daily as needed. No evidence that instructions were given on how diluent the powder or the amount of diluent to use.

Upon patient record review, 1 of 14 (Patient #4) 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 4: No evidence that initial bereavement risk assessment was completed within 5 days of admit. Admitted on 12/30/2023, assessment completed on 01/10/2024.

Upon patient record review, 2 of 14 (Patient #3,7) 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 3: Duplicate drug therapy - Miralax 17grams daily PRN for constipation, Dulcolax 10MG rectal supp daily PRN. No evidence that instructions were given on which medication for constipation to take first. Patient 7: Miralax powder 17gram one daily as needed for constipation. Senna-Plus daily as needed for constipation. No evidence that instructions were given on which medication for constipation to take first. Miralax powder 17grams daily as needed. No evidence that instructions were given on how diluent the powder or the amount of diluent to use .

Upon patient record review 1 of 14 (Patient #3) 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 3: Aide plan of care has for patient to receive a full shower at every visit. Patient is bedbound and is unable to stand. Aide performed a bed bath during home visit.

Upon client record review, 1 of 14 (Patient #3) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 3: Plan of care has chaplain frequency as one routine visit a month. No evidence that patient received a visit for the month March. No missed visit notes or physician orders entered to skip visits for the month.