Every finding on record at La Hospice Center, Inc.

Upon patient record review, 14 of 14 (Patient #1,2,3,4,5,6,7,8,9,10,11,12,13,14) did not have evidence that the hospice obtained the patient's or representative's signature confirming that they received a copy of the Patient's Rights and Responsibilities. Patient#1,2,3,4,5,6,7,8,9,10,11,12,13,14, All patient had not signed copy of Patient's Bill of Rights.

Upon patient record review, 10 of 14 (Patient #1,2,3,4,5,6,7,10,11,14) 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 #1,2,7, No DME on POC, patient has a walker. Patient #3, No DME on POC, patient has a cane, walker, shower chair. Patient #4,6,10,11, No DME on POC, patient has a cane and a walker. Patient #5, No DME on POC, patient has a cane. Patient #14, Missing hospital bed and nebulizer under DME on POC.

Upon client record review, 5 of 14 (Patient #1,6,7,11,13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1, LVN frequency 1x/wk, patient was admitted on 1/5/23, LVN first visit was 1/14/23. Patient #6, LVN frequency 1x/wk, patient was admitted on 4/5/23, first visit for LVN was 4/11/23. Patient #7, LVN frequency 1x/wk, patient was admitted on 2/2/23, first visit for LVN was 2/10/23. Patient #11, LVN frequency 1x/wk, patient was admitted on 4/13/23, first visit for LVN was 4/20/23. Patient #13, LVN frequency 2x/wk, visits 7/8/22, 7/18/22, 7/22/22, 7/25/22.

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, 3, LVN washed hands and placed gloves on hands, then LVN went in and out of her nursing bag without changing gloves or sanitizing hands each time.

Upon patient record review 1 of 14 (Patient #13) 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 #13, Aide Care Plan directed feeding assistance. Aide assignment sheet on 7/12/22 was not documented as completed nor documentation this was reported to RN.

Upon patient client record review, 7 of 14 (Patient #3,5,6,7,8,10,13) 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, RN assessment was not signed by RN completing assessment. Patient #5, LVN note on 4/20/23, 4/27/23, 5/4/23 not signed by LVN completing visit. RN assessment on 4/30/23 was not signed RN completing visit. Patient #6, LVN note on 4/11/23, 4/18/23, 4/25/23, 5/2/23, was not signed by LVN that completed note. Patient #7, MSW visit note on 4/13/23 was signed by MSW completing note. Patient #8, LVN note on 1/14/23, 2/25/23, 4/29/23, 5/6/23, was not signed by LVN completing note. Patient #10, LVN note on 5/5/22, 3/15/23, was not signed by LVN completing note. MSW note on 3/1/23 was not signed by MSW. Patient #13, Aide note on 7/12/22 was not signed by Aide completing visit.