Every finding on record at La Mision Palliative Care and Hospice LLC

Upon patient record review 2 of 14 (Patient #3,6) 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 #3, Patient was admitted on 11/24/23, psychosocial assessment completed on 11/30/23. Patient #6, Patient was admitted on 7/7/23, psychosocial assessment completed on 7/14/23.

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 in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient #1,2,3,4,5,6,7,8,9,10,11,12,13,14, No evidence of imminence of death documented in comprehensive assessment.

Upon patient record review, 1 of 14 (Patient #2) 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 #2, Order written on 12/5/23 to discontinue simethicone. Medication list dated 12/8/23, no evidence simethicone was discontinued, remains as a current medication.

Upon patient record review, 5 of 14 (Patient #1,3,5,9,10) 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, No evidence of care plan for self care deficit. Patient receives aide services 3x/week. Patient #3, Wound care order to left dorsal foot missing on care plan. Care plan was not personalized to patient care. No care plan for self care deficit, patient is receiving aide services every day. Patient #5, resolved pressure ulcer without care plan for alteration in skin integrity, Patient developed another ulcer. Upon home visit, daughter states she put on a patch. No direction in plan of care for wound care. Patient #9, Wound care orders silvadene, every day to ulcer on buttock. Care plan for skin integrity without direction for wound care. Care plan was not personalized to patient wound. Patient #10, No evidence of care plan with wound care orders, Wound care to sacral wound cleanse with ns pat dry, cover with gauze.

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 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 #1,2,3,4,5,6,7,8,9,10,11,12,13,14, All initial orders have frequency with 2 PRN/week. Totaling 90 days of 24 PRNs and 60 day cert of 16 PRNs for change in condition.

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, the RN sanitized their hand then proceeded to go into back multiple times without sanitizing hands each time they enter their nursing bag. Per bag technique policy, states they are to hand sanitize each time they enter their nursing bag.

Upon patient record review, 1 of 14 (Patient #11) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #11, Aide frequency order is 3x/week. Aide visit on 7/14/23, 7/15/23. Patient was only seen 2x for the first week.

Upon patient client record review, 1 of 14 (Patient #14) 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 #14, Patient has diagnosis of Alzheimer disease, both nursing comprehensive and MSW comprehensive documents patient is alert and oriented. Patient signed their own consents.

Upon observation, there was no evidence the organizational chart matches the hospice's information submitted to CMS and/or State licensing agencies for ownership and management personnel. The organizational chart identifies titles, no evidence of name of person in that position.