Every finding on record at La Arc Hospice, Inc

Upon patient record review, 4 of 14 (Patient #1,2,5,9) 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 - The medication profile noted patient to take aspirin daily as a blood thinner. The plan of care did not include any problems, goals, or interventions related to the risk of bleeding. This was corrected onsite. Patient #2 - The medication profile noted patient to take aspirin daily as a blood thinner. The profile also had patient taking Imodium daily for diarrhea. The plan of care did not include any problems, goals or interventions related to bleeding risk or gastrointestinal concerns. These were corrected onsite. Patient #5 - Patients advanced directives showed patient chose to be a full code. The plan of care did not include any problems, goals, or interventions related to his full code status. This was corrected onsite. Patient #9 - Patients advanced directives showed patient chose to be a full code. The plan of care did not include any problems, goals, or interventions related to her full code status. The nursing comprehensive noted the patient to have a port-a-cath located in the right chest area. There were no problems, goals, or interventions related to the care of the catheter. Both were corrected onsite.

Upon patient record review, 1 of 14 (Patient #9) 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 #9 - The nursing comprehensive dated 03/23/25 noted patient had a port-a-cath in the right chest area. There was no evidence of an order for the management of this catheter. This was corrected onsite.

Upon patient record review, 1 of 14 (Patient #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 equipment and supply needs. Patient #5 - The nursing comprehensive dated 08/17/25, noted patient was incontinent of bowel and bladder. The incontinent supplies were not listed on the patient's plan of care. This was corrected onsite.

Upon client record review, 1 of 14 (Patient #8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #8 -RN comprehensive dated 4/1/25 prior to the Election of Benefit form stated 04/02/25.

Upon patient record review 1 of 14 (Patient #1) 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 - Upon home visit, noted the aide obtained an oxygen saturation utilizing a pulse oximeter and documented results. The aide plan of care dated 09/19/25, did not include as an aide task.

Upon patient client record review, 2 of 14 (Patient #7,8) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #7 - Page 1 of 1 on the Election of Benefit form, has a section for the patient/POA to choose the date that they wish to elect their hospice benefit to begin. This section was left blank. Patient #8 - Page 1 of 1 on the Election of Benefit form, has a section for the patient/POA to choose the date that they wish to elect their hospice benefit to begin. The EMR and nursing comprehensive both included a 04/01/25 election date. The Election of Benefit form stated 04/02/25.

Upon patient record review, 1 of 11 (Patient #4) 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: 7/1/22 MD Order "May natural supplement daily". Medication profile is unclear. Corrected on site.

Upon patient record review, 2 of 11 (Patient #4, 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 medications and treatments. Patient #4: 7/1/22 MD Order "May natural supplement daily". Order is unclear. Discussion occurred with staff and order was rewritten, specific/clarified. Patient #6: 7/27/22 MD Order for "A & D Ointment". No specific route/location, frequency. Discussion occurred with staff and order was rewritten, specific/clarified.

Upon personnel record review, 1 of 1 applicable (Personnel #4 ) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·(C) Shampoo, sink, tub, and bed Personnel #4: The competency form utilized by the agency at this time, does not differentiate the types of shampoo, but merely states "shampoo" for the competency, therefore, competency for shampoo for sink, tube, bed cannot be confirmed.