Every finding on record at L&H Hospice Care, Inc

Upon patient record review, 1 of 14 (Patient #3) 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, Order reads, administer 2L/M of oxygen if oxygen drops below 93%. No evidence of route documented.

Upon patient record review, 6 of 14 (Patient #1,2,4,6,12,14) 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 #1,2,4, Patient visits being made and no evidence of initial care plans for SC or MSW. Patient #4, No evidence of initial care plan for cardiac. Patient was admitted with diagnosis of Arteriosclerotic Heart Disease. Patient #6,12,14, Patient visits were being made and no evidence of initial care plan on Plan of care. Care plans spot was empty.

Upon patient record review, 11 of 14 (Patient #1,2,3,4,5,6,7,8,9,10,11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1,2,3,4,5,6,7,8,9,10,11, No evidence of telephone visit order. All SC visits completed via telephone. Patient #5, Frequency order LVN 1x/week effective 6/9/23. No evidence of visit until 6/27/23. RN frequency every 2 weeks, visits completed 12/31/23, 1/3/24, 1/13/24. Patient #7, Frequency orders for MSW and SC for every recertification, Patient was seen every month for both MSW and SC. No evidence frequency was followed. Patient #8, Frequency for MSW states declined. Visits made without order.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #2, No evidence nurse washed hands prior to removing items from her nursing bag.

Upon patient record review 3 of 14 (Patient #1,8,10) 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 #1, Care plan written by RN directs aide to complete street clothes, aspiration precaution, and encourage fluids. No evidence this was completed as boxes left blank. Patient #8, Care plan written by RN directs aide to complete street clothes. No evidence this was completed as box was left blank on 4/26/24. Patient #10, Care plan written by RN directs aide to complete bed in low position, wheelchair, turn and reposition. No evidence this was completed as boxes left blank on 2/16/24.

Upon patient record review, 1 of 14 (Patient #1) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #1, No evidence of effective date documented on election statement form.

Upon patient record review, 1 of 14 (Patient #3) 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 #3, IDG note on 1/29/24, no evidence of MD signature.