Every finding on record at Lifecare, LLC

Upon patient record review 2 of 5 (Patient #3, #4) 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: The record indicated the start of care was on 05/24/24. The nurse made a referral for spiritual counselor /bereavement coordinator to complete the spiritual assessment. There was no evidence of a spiritual comprehensive assessment until 6/4/24. Patient #4: The record indicated the start of care was on 05/20/24. The nurse indicated a referral for spiritual counselor /bereavement coordinator as the "patient/family requested clergy". There was no evidence of a spiritual comprehensive assessment until 05/31/24.

Upon patient record review, 4 of 5 (Patient #2, #3, #4, #5) 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 #2: The record indicated the patient was admitted on 06/12/24, there was no evidence of a comprehensive bereavement risk assessment being completed within 5 calendar days. The assessment was completed on 7/23/24. Patient #3: The record indicated the patient was admitted on 05/24/24, there was no evidence of a comprehensive bereavement risk assessment being completed within 5 calendar days. The assessment was completed on 06/04/24. Patient #4: The record indicated the patient was admitted on 05/20/24, there was no evidence of a comprehensive bereavement risk assessment. Patient #5: The record indicated the patient was admitted on 03/21/24, there was no evidence of a comprehensive bereavement risk assessment.

Upon client record review, 1 of 5 (Patient #2) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2: The record indicated a MSW 1 X per benefit period. A BSW social worker made all visits. COS.

Upon patient client record review, 5 of 5 (Patient #1, #2, #3, #4, #5) 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 #1: The record indicated the patient/authorized representative elected to received the non covered items by hospice but did not receive a copy. COS. Patient #2: The record indicated the patient/authorized representative elected to received the non covered items by hospice but did not receive a copy. COS. Patient #3: The record indicated the patient/authorized representative elected to received the non covered items by hospice but did not receive a copy. COS. Patient #4: The record indicated the patient/authorized representative elected to received the non covered items by hospice but did not receive a copy. COS. Patient #5: The record indicated the patient/authorized representative elected to received the non covered items by hospice but did not receive a copy. COS.

Upon observation, there was no evidence the agency has conducted exercises to test the emergency plan every two years.

Upon patient record review 3 of 7 (Patient #1,#3,#4) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient#1: There is not evidence of a spiritual or psychosocial assessment completed. The nurse only answered HIS questions on admit visit. Patient#3,#4: There is no evidence of a spiritual assessment being completed. On admit visit nurse only answered HIS questions.

Upon patient record review, 1 of 7 (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: The record indicates on 9/3/24 LPN requested Calmoseptine for rash under breast in communication note. On 9/14/24 LPN documented a communication note to follow up on order, Calmoseptine still not listed on MAR. COS

Upon patient record review, 4 of 7 (Patient #1,#2,#3,#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#1,#4: Upon review of the record, the bereavement assessment was done by the nurse, however it was incomplete. No primary bereaved was indicated. There was no information on what was assessed or any needs, concerns or cultural factors. Nurse checked non for both patient and caregiver. No narrative was present to indicate what was assessed. COS. Patient#2: The record indicates the initial bereavement assessment was assigned to nurse at admit visit, However it was incomplete. Documentation indicates 2 boxes were checked for the assessment. For patient the box denial of illness was checked, and for caregiver the none box was checked. Patient#3: On 5/24 nurse was assigned bereavement assessment. There was nothing checked or indicated for the caregiver. For patient document that patient stated she was not going to die and has anxiety. There is no other documentation for this assessment.

Condition of Participation: Interdisciplinary Group, Care Planning, and Coordination of Services. L536

Upon patient record review, 2 of 7 (Patient #1,2) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient#1: The record indicates the patient called in on 9/20/24 to report a chest pain episode. Note state patient has no nitroglycerin and episode lasted a short time. LPN noted this was communicated to RN. There is no evidence of any follow-up with patient. Administrator indicates that MD was notified and called in nitroglycerin. There is no evidence of this documented in chart. COS Patient#2: The record indicates on 6/26/24, the RN uploaded a picture of wound to chart, no measurements noted. A physician evaluated and measured on 7/24. On 8/1 nurse documented wound healed. No other assessments or measurements noted in chart.

Upon patient record review, 4 of 7 (Patient #1,#2,#3,#5) 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 record indicates the patient was admitted with atherosclerotic heart disease, in addition is a high risk for falls, has nutritional needs and concerns per the nurse assessment. There is no evidence of problems, interventions, or goals related to these patient issues related to the terminal illness. COS. Patient#2: The record indicates has diagnosis of diabetes type II, schizophrenia, and HTN. Patient is actively taking medication for these diagnosis. There is no evidence that the plan of care reflected problems, interventions, or goals related to these diagnosis. Patient#3: The record indicates the patient is currently taking Keppra for seizure disorder. There is no evidence that the plan of care reflects problems, interventions, or goals related to seizure disorder. COS. Patient#5: The record indicates that the patient has dysphagia and a foley. There is no evidence that the plan of care reflects problems interventions or goals related the dysphagia or the foley.

Upon patient record review, 3 of 7 (Patient #2,#3,#7) 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#2: The record indicated for Calmoseptine on 9/12. There is no indication of a specified area for application. Corrected on site. Patient#3: The record indicated on 6/12 for lidocaine patch 50mg 1 every 12hours. There is no indication on specific area to apply the patch. The record indicates for Nitro 0.4mg tab 1 SL prn angina. There is no instruction on taking subsequent doses or a max of 3 doses. The record indicates for Triamcinolone acetonide 0.1 mg cream topical. There is no specified area of application noted. Corrected on site. Patient#7 : The record indicates for Zofran 4mg 1 tab every 6 hours prn. There is no route noted. Corrected on site.

Upon patient record review, 5 of 7 (Patient #1,#2,#3,#4,#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#1: The record indicates the patient requires the use of a walker and cane. There is no evidence of this equipment on the plan of care. COS. Patient#2: The record indicated patient required use of bed, half rails, shower chair, walker, incontinence supplies, and wheelchair. There is no evidence of items on the plan if care. COS. Patient#3: The record indicated for incontinence supplies (panty liners), bed, and half rails. There is no evidence of the half rails or the panty liners on the plan of care. COS. Patient#4: The record indicates the patient requires the use of cane walker and shower chair. There is no evidence of these items on the plan of care. Patient#5: The record indicates the patient requires the use of wound care supplies, oxygen concentrator, wheelchair, bed, OTB table, shower chair, and commode. Other than the oxygen concentrator, there is no evidence of the other items on the plan of care.

Upon patient record review, 1 of 7 (Patient #2) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient#2: The record indicates physician evaluated sacral wound on 7/23/24. There is no evidence of plan of care being updated. COS.

Upon client record review, 1 of 7 (Patient #4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient#4: The record indicated a nurse visit frequency of 1 time a week. The week of 6/12/24 visits were made on 6/12 and 6/13. The week of 6/26, visits were made on 6/26 and 6/27. COS.

Upon patient record review 1 of 7 (Patient #5) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient#5: The record indicates on 4/11/24 the LPN documented a communication note stating patient/family (Bob) requesting MSW to assist with needed support and light housekeeping. There is no evidence of any follow-up or if MSW contacted patient/family per their request. COS. The record indicates on 3/25 a referral was sent to Heal Well Solutions for a wound evaluation. There is no evidence of any follow-up or if referral was completed; per the administrator this was completed but they never obtained documentation from Heal Well.

Upon patient record review 1 of 7 (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: The aide plan of care indicated frequency of 1 time a week. There is no evidence of any aide visits documented since admit on 9/7/24. Per administrator the patient refused the visits. There is no evidence of missed visits documented in chart.

Upon patient record review, 2 of 7 (Patient #2,#3) did not have evidence that each patient record contains Advance Directives. Patient#2,#3: The admission documentation indicates patient has legal documentation indicating patient's wishes to be a full code. There is no evidence of this documentation in the patient chart. Document was found in patient home.

Upon client record review, 2 of 7 (Patient #5,#7) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patient#5: The record indicates on 5/30/24 patient was discharged due to patient improved and no longer meets criteria. There is no evidence of coordination of care, or discharge summary being communicated to community physician. Patient#7: The record indicates patient revoked on 12/1/23 to seek aggressive treatment at a hospital. There is no evidence of coordination of care or discharge summary being sent to hospital. The administrator added late note that family would not disclose which hospital patient was taken to.