Every finding on record at Liberty Healthcare Group, LLC

Upon patient record review, 1 of 19 (Patient#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 7:The medication profile includes an entry for lidocaine patch to be applied daily. There is no evidence that the entry includes the location for application. COS

Upon patient record review, 1 of 19 (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:The patient was admitted to hospice on 10/26/23. There is no evidence that a bereavement risk assessment was completed prior to 11/1/24.

Upon patient record review, 2 of 19 (Patient #4,#6) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual's attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient's progress toward desired outcomes • Reassessment of the patient's response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient 4:The medical record indicates that comprehensive assessments were completed 12/5/23, 3/4/24 and 4/15/24 with visit frequency otherwise being met by LPN. There is no evidence that the RN visited the patient to update the comprehensive assessment no less frequently than every 15 days. Patient 6:The medical record indicates that comprehensive assessments were completed 4/25/24 and 5/23/24 with visit frequency otherwise being met by LPN. There is no evidence that the RN visited the patient to update the comprehensive assessment no less frequently than every 15 days.

Upon patient record review, 3 of 19 (Patient #1,#3,#4) 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 medical record contains an order for anticoagulant therapy of Xarelto 20mg po daily and nursing documentation of bleeding precautions. There is no evidence of problems, goals and interventions for the risk and management of anticoagulant therapy. COS Patient 3:The medical record contains a comorbidity of cirrhosis of liver including physician and nursing documentation that patient was experiencing symptoms of jaundice. There is no evidence of problems, goals and interventions for the management of liver disease on the plan of care. COS Patient 4:The medical record contains an order entered on 5/3/24 for Cipro 250mg BID for treatment of UTI. There is no evidence of problems, goals and interventions for management of an active infection on the plan of care. COS

Upon patient record review, 1 of 19 (Patient #4) 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 4:The medical record includes nursing documentation that the patient's equipment needs include a wheelchair. There is no evidence that a wheelchair is included as equipment needs on the plan of care. COS

Upon patient record review, 1 of 19 (Patient #1) 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 1:The patient's plan of care includes bleeding and fall precautions. There is no evidence that the Aide plan of care includes bleeding and fall precautions. COS

Upon patient record review 1 of 19 (Patient #7) 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 7:The aide plan of care includes the task of linen change to be completed weekly on Tuesday and Thursday. The aide documented that the task was completed on Wednesday, 4/10/24.

Upon patient record review 1 of 19 (Patient #4) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient 4:There is no evidence in the medical record that registered nurse on-site visits were completed to assess the quality of care and services provided by the aide from 2/5/24 until 3/4/24 and from 3/4/24 until 4/15/24.