Every finding on record at Mercy Hospice LLC.

Upon patient record review, 1 of 5 (Patient #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 5: The medical record contained nursing documentation upon admission identifying patient issue with dysphagia. There was no evidence of problems, goals, and interventions related to dysphagia included in the plan of care. Corrected during survey.

Upon patient record review, 1 of 5 (Patient #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 5: The medical record contained nursing documentation on 05/17/2024 identifying patient use of a rollator. There was no evidence of orders for the equipment included in the plan of care. Corrected during survey.

Upon patient record review, 2 of 19 (Patients #7,#9) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable state law. Patient 7: The medical record contained evidence the hospice provided information on advance directives signed by a paid caregiver with no documentation giving legal authority to sign on the patient's behalf. The profile did contain contact information for a son. Patient 9: The medical record contained evidence the hospice provided information on advance directives signed 11/23/23 for patient admitted 11/22/23.

Upon patient record review, 2 of 19 (Patients #7,#9) did not have evidence that the hospice obtained the patient's or representative's signature confirming that they received a copy of the Patient's Rights and Responsibilities. Patient 7: The medical record contained consent identifying receipt of Patient Rights and Responsibilities signed by a paid caregiver with no documentation giving legal authority to sign on the patient's behalf. The profile did contain contact information for a son. Patient 9: The medical record contained consent identifying receipt of Patient Rights and Responsibilities signed 11/23/23 for patient admitted 11/22/23.

Upon patient record review, 2 of 19 (Patients #7,#9) did not have evidence that if a state court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with state law may exercise the patient's rights to the extent allowed by state law. Patient 7: The medical record contained an election and consents signed by a person defined as a paid caregiver. There was no evidence the representative had legal authority to sign on the patient's behalf and a son was also listed as a contact in the profile. Patient 9: The medical record contained admission consents signed by the spouse 11/23/23 for patient admitted 11/22/23.

Upon patient record review, 2 of 19 (Patients #7,#9) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient 7: The medical record contained evidence a paid caregiver chose an attending physician. The profile did contain contact information for a son. Patient 9: The medical record contained evidence the patient/representative chose an attending physician 11/23/23 for patient admitted 11/22/23.

Upon patient record review, 2 of 19 (Patients #7,#9) did not have evidence of the appropriate documentation for release of confidential information. Patient 7: The medical record contained evidence the hospice obtained release of confidential information signed by a paid caregiver with no documentation giving legal authority to sign on the patient's behalf. The profile did contain contact information for a son. Patient 9: The medical record contained evidence the hospice obtained release of confidential information signed 11/23/23 for patient admitted 11/22/23.

Upon patient record review, 2 of 19 (Patients #7,#9) did not have evidence that the patient received information about the services covered under the hospice benefit. Patient 7: The medical record contained consent identifying receipt of information about the services covered under the hospice benefit signed by a paid caregiver with no documentation giving legal authority to sign on the patient's behalf. The profile did contain contact information for a son. Patient 9: The medical record contained consent identifying receipt of information about the services covered under the hospice benefit signed 11/23/23 for patient admitted 11/22/23.

Upon patient record review, 2 of 19 (Patients #7,#9) did not have evidence that the patient received information about the scope of services that the hospice will provide and specific limitations on those services. Patient 7: The medical record contained consent identifying receipt of information about the scope of services signed by a paid caregiver with no documentation giving legal authority to sign on the patient's behalf. The profile did contain contact information for a son. Patient 9: The medical record contained consent identifying receipt of information about the scope of services signed 11/23/23 for patient admitted 11/22/23.

Upon patient record review, 8 of 19 (Patients #3,#4,#7,#9,#10,#12,#13,#14) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 3: The medication profile contained MiraLax oral powder with no instructions for a diluent. Corrected on site. Patient 4: The medical record contained nursing documentation upon admission identifying patient use of oxygen. There was no evidence oxygen on the medication profile. Corrected on site. Patient 7: During observation of home visit and medication reconciliation, the medication profile contained a discontinued Buspar. Corrected on site. Patient 9: The medication profile contained nystatin and triamcinolone topical medications with no area defined for administration. Corrected on site. Patient 10: The medication profile contained insulin with instructions per sliding scale. There was no evidence of dose defined per blood glucose readings. The medication profile also contained 2 listings of Zithromax dated 12/12/23 and 3/10/24 that were active in the profile. Corrected on site. Patient 12: The medication profile contained diclofenac topical medication with no area defined for administration. Corrected on site. Patient 13: The medication profile contained nitroglycerin with no instructions for frequency limitations. Instructions states as needed and did not define max dose. Corrected on site. Patient 14: The medication profile contained oxygen with no delivery method. Corrected on site.

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

Upon patient record review, 9 of 19 (Patients #4,#6,#7,#9,#10,#11,#12,#13,#14) 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 4: The medical record contained nursing documentation upon admission identifying patient issues with dyspnea, high fall risk, and use of an external condom catheter for urination. There was no evidence of problems, goals, and interventions related to respiratory and genitourinary dysfunction and fall safety included in the plan of care. Corrected on site. Patient 6: The medical record contained nursing documentation upon admission identifying patient issue with dyspnea. There was no evidence of problems, goals, and interventions related to respiratory dysfunction included included in the plan of care. Corrected on site. Patient 7: The medical record contained nursing documentation upon admission identifying patient issue with dysphagia. There was no evidence of problems, goals, and interventions related to dysphagia included in the plan of care. Corrected on site. Patient 9: The medical record contained nursing documentation upon admission identifying patient issue with dysphagia. There was no evidence of problems, goals, and interventions related to dysphagia included in the plan of care. Corrected on site. Patient 10: The medication profile identified the patient was administered insulin per sliding scale instructions based on blood glucose readings at meals. There was no evidence of problems, goals, and interventions related to endocrine dysfunction included in the plan of care. Corrected on site. Patient 11: The medical record contained nursing documentation upon admission identifying patient issue with dyspnea. There was no evidence of problems, goals, and interventions related to respiratory dysfunction included included in the plan of care. Corrected on site. Patient 12: The medical record contained nursing documentation upon admission identifying patient issue with dysphagia. There was no evidence of problems, goals, and interventions related to dysphagia included in the plan of care. Corrected on site. Patient 13: The medical record contained nursing documentation upon admission identifying patient issue with dyspnea. There was no evidence of problems, goals, and interventions related to respiratory dysfunction included included in the plan of care. Corrected on site. Patient 14: The medical record contained nursing documentation upon admission identifying patient issues with dyspnea, high fall risk, and cardiac symptoms. There was no evidence of problems, goals, and interventions related to respiratory and cardiac dysfunction, and fall safety included in the plan of care. Corrected on site.

Upon patient record review, 7 of 19 (Patients #3,#4,#9,#10,#12,#13,#14) 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 3: The medical record contained an order for MiraLax oral powder with no instructions for a diluent. Corrected on site. Patient 4: The medical record contained nursing documentation upon admission identifying patient use of oxygen. There was no evidence of an order for oxygen dose, frequency, and delivery method. Corrected on site. Patient 9: The plan of care contained orders for nystatin and triamcinolone topical medications with no area defined for administration. Corrected on site. Patient 10: The medical record contained an order for insulin with instructions per sliding scale. There was no evidence of dose defined per blood glucose readings. Corrected on site. Patient 12: The medical record contained an order for diclofenac topical medication with no area defined for administration. Corrected on site. Patient 13: The medical record contained an order nitroglycerin with no instructions for frequency limitations. Instructions states as needed and did not define max dose. Corrected on site. Patient 14: The medical record contained an order for oxygen with no delivery method. Corrected on site.

Upon patient record review, 10 of 19 (Patients #3,#4,#5,#6,#7,#8,#10,#11,#12,#13) 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 3: The medical record contained nursing documentation 1/12/24 identifying patient use of a Hoyer lift for transfers. There was no evidence of an order for the equipment included in the plan of care. Corrected on site. Patient 4: The medical record contained nursing documentation upon admission identifying patient use of oxygen. There was no evidence of an order for the equipment and supplies included in the plan of care. Corrected on site. Patient 5: The medical record contained an order for oxygen equipment and supplies in error. The agency confirmed the patient did not have an order for oxygen or equipment in the home. Corrected on site. Patient 6: The medical record contained nursing documentation upon admission identifying patient use of a cane and nebulizer, and IV equipment 3/29/24. There was no evidence of orders for the equipment included in the plan of care. Corrected on site. Patient 7: The medical record contained nursing documentation upon admission identifying patient use of bedrails. There was no evidence of an order for the equipment included in the plan of care. Corrected on site. Patient 8: The medical record contained nursing documentation upon admission identifying patient use of a hospital bed, rails, and commode. There was no evidence of orders for the equipment included in the plan of care. Corrected on site. Patient 10: The medical record contained an order for oxygen administration. There was no evidence of an order for the equipment and supplies included in the plan of care. Corrected on site. Patient 11: The medical record contained nursing documentation upon admission identifying patient use of a walker and wheelchair. There was no evidence of orders for the equipment included in the plan of care. Corrected on site. Patient 12: The medical record contained nursing documentation upon admission identifying patient use of a walker and commode. There was no evidence of orders for the equipment included in the plan of care. Corrected on site. Patient 13: The medical record contained nursing documentation upon admission identifying patient use of oxygen, walker, and trapeze. There was no evidence of orders for the equipment included in the plan of care. Corrected on site.

Upon observation, there was no evidence the hospice investigates all adverse events, incidents, accidents, variances or unusual occurrences that involve patient care and develops a plan of correction to prevent the same or similar event from occurring again. Patient 1: The medical record contained nursing documentation 2/14/24 identifying patient fall. There was no evidence of an investigation of the incident. Corrected on site.

Upon patient record review, 1 of 19 (Patient #7) did not have evidence in the patient record that hospice aide assignments and duties are specific to the patient care needs. Patient 7: The aide care plan did not contain transfer instructions for assistance needs. Corrected on site.

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 Patient 7: There was no evidence the aide completed the assigned tasks during visits completed 3/19/24, 3/26/24, and 3/28/24.

Upon patient record review, 1 of 19 (Patient #7) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient's clinical information and provide written documentation that it is anticipated that the patient's life expectancy is 6 months or less. Patient 7: The medical record contained CTI for benefit period 6 with improper entry of face to face completion 10/6/23. The face to face was completed 10/3/23.

Upon patient client record review, 2 of 19 (Patients #7,#9) 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 7: The medical record contained an election form and consent for receipt of Patient Rights signed by a paid caregiver with no documentation giving legal authority to sign on the patient's behalf. The profile did contain contact information for a son. Patient 9: The medical record contained an election form and consent for receipt of Patient Rights signed 11/23/23 for patient admitted 11/22/23.

Upon patient client record review, 1 of 19 (Patient #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 8: The medical record contained a missed visit coordination note 3/12/24 with no information in the template to explain reason for frequency not met. The provided template in the note was empty.