Every finding on record at Long Life Hospice Inc.

Upon patient record review, 1 of 14 (Patient #8) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient 8: On the RN comprehensive assessment the RN does not take into consideration the imminence of death.

Upon patient record review, 7 of 14 (Patient #1,2,3,5,6,9,10) 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 1: On the medication profile there is an order for Tylenol 500mg tablet every 6 hours as needed and Acetaminophen 650mg suppository one every 4 hours as needed, there is not a daily limit for Acetaminophen. Corrected on site Patient 2:On the medication profile there is an order for Tylenol 500mg tablet every 6 hours as needed and Acetaminophen 650mg suppository one every 4 hours as needed, there is not a daily limit for Acetaminophen. Corrected on site. Patient 3: On the plan of care there is an order for Tylenol 325mg 2 tablets every 8 hours as needed and Hydrocodone Bitartrate/Acetaminophen 5-325mg tablets one tablet as needed every 8 hours, there is not a daily limit of 4,000mg daily. Corrected on site. Patient 5: On 6/22/25 there is an order for mupirocin 2% topical ointment the order does not say where to apply the cream. On 6/22/25 there is an order for clotrimazole cream, the order does not say where to apply the cream. Corrected on site Patient 6:On the plan of care there is an order for Acetaminophen 325mg tablet 2 tabs every 6 hours as needed and an order for Acetaminophen suppository 650mg every 4 hours as needed, there is not a daily limit for Acetaminophen. On the plan of care there is an order for MiraLAX Powder 17g, there is no diluent. Corrected on site. Patient 9: On the plan of care there is an order for Hydrocodone/Acetaminophen 5-325mg, Acetaminophen 650mg suppository one every 6 hours as needed, Tylenol Extra Strength 500mg tablet every 6 hours as needed, there is not a daily limit for Acetaminophen listed on the plan of care. On 7/6/25 there is an order for MiraLAX Powder for solution 17g, there is no diluent. Corrected on site. Patient 10: On the plan of care there is an order for Acetaminophen Suppository 650mg one every four hours as needed , there is not a daily limit for Acetaminophen. Corrected on site.

Upon patient record review, 7 of 14 (Patient #1,2,3,5,6,9,10) 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 1: On the medication profile there is an order for Tylenol 500mg tablet every 6 hours as needed and Acetaminophen 650mg suppository one every 4 hours as needed, there is not a daily limit for Acetaminophen. Corrected on site. Patient 2:On the medication profile there is an order for Tylenol 500mg tablet every 6 hours as needed and Acetaminophen 650mg suppository one every 4 hours as needed, there is not a daily limit for Acetaminophen. On the plan of care there is an order, "SN may change Foley Catheter every 30 days or as needed if clogged, leaking, or dislodge", there is not an order for insertion of foley catheter, including size, how to care for catheter and how to secure it. Corrected on site. Patient 3: On the plan of care there is an order for Tylenol 325mg 2 tablets every 8 hours as needed and Hydrocodone Bitartrate/Acetaminophen 5-325mg tablets one tablet as needed every 8 hours, there is not a daily limit of 4,000mg daily. Corrected on site. Patient 5: On 6/22/25 there is an order for mupirocin 2% topical ointment the order does not say where to apply the cream. On 6/22/25 there is an order for clotrimazole cream, the order does not say where to apply the cream. Corrected on site Patient 6:On the plan of care there is an order for Acetaminophen 325mg tablet 2 tabs every 6 hours as needed and an order for Acetaminophen suppository 650mg every 4 hours as needed, there is not a daily limit for Acetaminophen. On the plan of care there is an order for MiraLAX Powder 17g, there is no diluent. Corrected on site. Patient 9: On the plan of care there is an order for Hydrocodone/Acetaminophen 5-325mg, Acetaminophen 650mg suppository one every 6 hours as needed, Tylenol Extra Strength 500mg tablet every 6 hours as needed, there is not a daily limit for Acetaminophen listed on the plan of care. On 7/6/25 there is an order for MiraLAX Powder for solution 17g, there is no diluent. Corrected on site. Patient 10: On the plan of care there is an order for Acetaminophen Suppository 650mg one every four hours as needed , there is not a daily limit for Acetaminophen. Corrected on site.

Upon client record review, 1 of 14 (Patient #1) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: On the plan of care 4/14/25 there is an order for SN two times per week, the SN made visits on 4/23/25, 4/30/25, 5/6/25, 5/14/25, the SN made visits one time per week and the order states SN two times per week. Corrected on site.

Upon patient record review, 10 of 14 (Patient #1,2,3,4,5,6,7,8,9,10) 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:On the aide plan of care there is an order to turn and reposition, dress street clothes, dentures, change patient linens however, there is not a frequency for these activities in the order. Corrected on site. Patient 2: On the aide plan of care there is an order for empty collection bag, record bowel movements, dress street clothes/ pajamas/gown however, there is not a frequency. Corrected on site. Patient 3: On the Aide plan of care there is an order for turn and reposition, dress pajamas/gown, change patient linens however, there is no frequency for these orders. Corrected on stie. Patient 4: On the aide plan of care there is an order to change linens without a frequency. Corrected on site. Patient 5 :On the aide plan of care there is an order for turn and reposition, dress pajamas/gown however, there is not an order for frequency. Corrected on site Patient 6: On the aide plan of care there is an order for turn and reposition, dress street clothes, change patient linens however, there is not an order for frequency. Corrected on site. Patient 7: On the aide plan of care there is an order for dress pajamas/gown, change patient linens however, there is not an order for frequency. Corrected on site. Patient 8: On the aide plan of care there is an order for turn and reposition, record bowel movements, dress street clothes, change patient linens however, there is not an order for frequency. Corrected on site. Patient 9: On the aide plan of care there is an order for turn and reposition, empty collection bag, record bowel movements, dress street clothes, encourage fluids as tolerated if not contraindicated, change patient linens however, there is not an order for frequency. Corrected on site. Patient 10: On the aide plan of care there is an order for record bowel movements, dress street clothes, encourage fluids as tolerated if not contraindicated, change patient linens however, there is not an order for frequency. Corrected on site.

Upon patient client record review, 3 of 14 (Patient #2,4,7) 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 2: On 7/23/25 RN documentation, “foley catheter changed today”, the documentation is not complete with the details of the foley catheter change by RN. Patient 4: On 7/25/25 the SN documented, “Wound care done on left lateral shin and tolerated well with no infections noted”, the documentation is not complete with details of the wound care performed. Patient 7: On 6/13/25 the RN documented, “RN changed GT site dressing and patient tolerated well”, the documentation is not complete with details of the gastric tube change performed.

Upon patient client record review, 1 of 5 (Patient #4) 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 #4: The Consent for Care and Service Agreement was signed by the patient but the date signed was left blank.