Every finding on record at Mt. Rose Health Center Palliative Care and Hospice Inc.

Upon patient record review, 3 of 14 (Patient #5, 8, 9) 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 #5 - During the home visit it was noted what was in the SNF medication list and what was in the agency list were different. Ergocalciferol, Vitamin B6, and Cyanocobalamin oral tablet was on the SNF list but not on agency list. Agency had Cyanocobalamin IM and fleets enema on medication profile but not on SNF med profile. Hospice had Mirtazapine 15mg at bedtime but SNF had Mirtazapine 7.5 mg give 1 tablet a bedtime. Patient #8 - Medication profile has oxygen as directed PRN - doesn't include route, dosage or modifier for PRN. Patient #9 - Medication profile contained Nystatin for 7 days several months prior but remained on med list. Oxygen 2L/Min did not have route.

Upon patient record review, 1 of 14 (Patient #9) 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 #9 - Bereavement Coordinator made visit to patient and sister on 02/04/24 - coordinator documented that the patient or the sister did not want bereavement services - so she didn't complete the initial bereavement assessment.

Upon patient record review, 2 of 14 (Patient #7, 8) 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 #7 - SN initial assessment documentation that patient needs assistance with ADLs, bladder incontinence, assistance with transfer and potential for falls, appetite poor 25% intake noted and SOB with minimal exertion and has oxygen in use. Problems, interventions and goals noted on POC caregiver fatigue, Bereavement, Grief, Communication and Confusion. Patient #8 - SN initial assessment documentation that patient needs assistance with ADLs, bladder incontinence - Foley catheter, SOB and has oxygen in use. Problems, interventions and goals noted on POC Comfort, Bereavement, and Grief.

Upon patient record review, 6 of 14 (Patient #7, 10, 11, 12, 13, 14) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #7, 10, 11, 12, 13, 14 - MSW visit frequency PRN which is not a detailed statement of scope and frequency to meet patient needs.

Upon patient record review, 1 of 14 (Patient #8) 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 #8 - Medication profile has oxygen as directed PRN - doesn't include route, dosage or modifier for PRN.

Upon patient record review, 4 of 14 (Patient #5, 6, 11, 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 #5 - Patient has hospital bed and receiving diapers, linen savers and aide supplies for personal care but not on POC dated 04/09/24. Patient #6 - Patient has hospital bed, W/C, walker but not on POC dated06/06/24 Patient #11 - Patient has AAP mattress, oxygen concentrator, hospital bed and Foley catheter supplies but not on POC dated04/23/24. Patient #13 - Patient has oxygen concentrator, CPAP, and nebulizer but not on POC dated 03/18/24

Upon patient record review, 1 of 14 (Patient #9) 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 #9 - POC dated 04/30/24 not updated to include SOB with minimal exertion and Oxygen use, Depression or poor appetite. Only problems, interventions or goals are: addition, comfort/pain and decrease ADLs.

Upon patient record review 1 of 14 (Patient #8) 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 #8 - Aide visit frequency week of 06/02/24 8 x week - only 6 visits made - no documentation of reason for missed visits.

Upon patient record review 3 of 14 (Patient #5, 7, 11) 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 #5 - Aide supervisory visit made on 05/09/24 then again on 05/24/24 - greater than 14 days. Patient #6 - Aide first visit 05/23/24 - Aide supervisory visit made on 06/07/24 - supervisory visit should have been made on 06/06/24 - 14 days after the aide started care. Patient #11 - Aide supervisory visit made 05/07/24 then again on 05/22/24 - greater than 14 days.

Upon patient client record review, 2 of 14 (Patient #8, 10) 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 #8, 10 - Election statement did not include the effective date of the election - it was blank.

Upon client record review, 1 of 14 (Patient #11) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #11 - POC dated 04/23/24 no orders for changing Foley catheter but SN documented Foley catheter changed on 04/26/24 and 05/22/24.