Every finding on record at Med-Care Health Options Inc

Upon patient record review, 2 of 14 (Patient #2, 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 #2: SN comprehensive assessment includes documentation of abdominal wound secondary to surgical wound dehiscence. There are no problem, goals, interventions identified on initial POC. Also RN documents caregiver is overwhelmed with role as caregiver and has financial burden for funeral expenses. There is no related problem, goals, interventions identified in initial plan of care. Patient #4: Admitted 6/14/22 with Foley catheter. There were no related problems, goals, interventions on initial IDG POC until 7/19/23 Problem to educate pt/cg on cleaning and/or irrigating urinary drainage device.

Upon patient record review, 4 of 14 (Patient #2, 4, 6, 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: 10/6/23 SOC RN assessment documents open wound from disruption of surgical wound to abdomen. (no reference to type of surveyr or related problem). Spouse performs wound care BID. Wound care performed this date -- cleanse with SNS and 4x4. Covered with foam adhesive gauze. Surrounding skin intact. There is no physician order for wound care. Upon interview, it is noted that wound is chronic in nature. Patient #4: SOC 6/14/22 with Foley catheter. Cath was documented as changed 6/24/23 per 7/19/23 visit note. Catheter was discontinued (in hospital) per 7/26/23 visit note. There are no catheter related physician orders. Patient #6 SOC 12/5/22. 7/31/23 Physician order Patient with minor skin tear to left elbow. Using clean technique, SN to cleanse with SNS and 4x4, apply TAO. Cover with transparent dressing. SN to monitor wound healing progress and instruct on s/sx of wound infection to report. MD order is incomplete in that it does not specify frequency and circumstances for repeating wound care/ change of dressing. Patient #7 SOC 3/19/23. Sacral Ulcer present on admission. RN performed wound care. Cleanse with SNS and 4x4. Apply CA Alginate to wound bed. Cover with foam dressing. There is no evidence of initial order for wound care. Update to POC 3/28/23 order for Wound care protocol changed due to increased wound drainage and maceration. New wound care as follows: using universal precaution and clean technique, cleanse with wound cleanser and 4x4. Pat dry with 4x4 gauze. Apply Mesalt dressing wound bed only and cover with bordered foam dressing or comparable dressing. The order is incomplete in that it does not address frequency or circumstance for repeated wound care and dressing change. 7/21/23 SN note that Patient's sacral wound continues to progressively heal. 8/31/23 Patient refused wound care and said she is just putting Polysporin on it at this time. Also note identified bilateral buttock that is deep red in color with thickened skin bilateral buttocks and patient states that she is treating with Bactroban ointment daily and is requesting bordered foam dressing. There is no related documentation of follow up coordination with physician and updated physician orders.

Upon patient record review, 1 of 14 (Patient #7) 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 #7: SOC 3/9/23. MD order 9/5/23 stating patients wound has resolved and agency staff will begin discharge instructions as patient's status has improved. There was a new order 10/5/23 for wound care to Stage 2 pressure ulcer sacral area, with no update to POC problem, goals, interventions.

Upon client record review, 2 of 14 (Patient #4, 8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #4 admitted 6/14/22 with Foley catheter. Cath was documented as changed 6/24/23 per 7/19/23 visit note. There were no physician orders related to Foley, including Foley catheter changes. Patient #8: SOC 8/17/22: 4/14/23-6/12/23. Volunteer Frequency 1x/month. No volunteer visits or related notes for this 4/14/23-6/12/23 benefit period.

Upon patient record review 2 of 14 (Patient #1, 2) 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 #1: SOC 6/9/22. RN's initial comprehensive assessment documented patient declined SC, but accepted MSW. Initial MSW visit was 7/26/22. No documentation related to delay. Patient #2: SOC 10/6/23 with ordered frequency HA 1/wk. Communication note by office staff regarding 10/16/23 wife's request for 2x/wk and information passed to RN. 10/18 IDG POC has no reference to request and no update to IDG POC.

Upon personnel record review, 3 of 14 (Personnel #9, 10, 11) did not have evidence the hospice employees and contract employees have received orientation on the hospice philosophy. Personnel # 9, 10, 11 do not have evidence of orientation to hospice philosophy.

Upon personnel record review, 1 of 13 (Personnel # 9) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel #9: There is no documented competency for role.

Upon patient client record review, 1 of 14 (Patient #3) 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 #3. Election statement has hospice benefit to begin 10/18/23. Papers signed 10/17/23. SN comprehensive assessment 10/19/23 and SOC and benefit period begin 10/19/23.

Upon patient client record review, 3 of 14 (Patient #1, 4, 8) 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 #1. SOC 6/9/23: 10/1/23 Recertification CTI has visit date of 10/1/23. CTI statements contain a visit date that agency administrator is unable to explain. It does not specify Face to Face. She said it does not reference that MD actually made a visit. It is just there as part of software format. In practice, it is apparently used as date physician completes CTI, as it matches physician's manual signature date. Also for Patient #1: SOC 6/9/23 HA acting as volunteer and also HA. Noted duplicate dates/times for volunteer and HA visit. Vol Visit 7/25/22 900-10, HA Visit 7/25/22 900-955; Vol Visit 8/15/23 600-655, 8/15/23 HA Visit 600-655. Patient #4: SOC 6/14/22. HA acting as volunteer and also HA. Noted duplicate dates/times for volunteer and HA visit: Vol visit 8/15/22 245-340 and HA visit 8/15/22 245-340; Vol Visit 9/5/22 1030-1125, HA Visit 9/5/22 1030-1125; Vol Visit 9/26/23 900-955, HA Visit 9/26/23 900-955. Patient #8 SOC 8/17/22. HA acting as volunteer and also HA. Noted duplicate dates/times for volunteer and HA visit: Vol 9/8/23 and HA 9/8/23 is 1500-1555 for both. 7/21/23 Vol 1500-1555 and same for HA.