Every finding on record at Nevada Caring Hearts, LLC

Upon patient record review, 1 of 9 (Patient #9) did not contain evidence that the Hospice had developed an individualized written Plan of Care for each patient inclusive of all problems identified in the initial and/or comprehensive assessments. Patient #9: The nursing visit note dated 08/08/22 reflected that this patient had a Pacemaker. This pertinent information was not included on the 08/17/22 IDG POC.

Upon patient record review, 2 of 9 (Patients #1 and 3) did not contain a Plan of Care which included all services necessary for the palliation and management of the terminal illness and related conditions, specifically DME and Supply needs: Patients #1 and 3: During Surveyor-attended home visits on 09/15/22 these patients reported, and were observed to have, a wheel chair. These patients' current Plan(s) of Care did not include this DME.

Upon patient record review, 1 of 1 applicable (Patient #9) deceased patient, did not contain documented evidence that the Hospice had established a Bereavement Plan of Care post death, or subsequently offered/provided any Bereavement counseling/interventions, reflecting the needs of the bereaved.

Upon patient record review, 8 of 9 (Patients #1, 3, 4, 5, 6, 7, 8, and 9) did not contain a patient-signed Election of Hospice Benefit Statement, in accordance with 418.24. These patient-signed Election Statements did not include the following required content: • As a Medicare beneficiary who elects to receive Hospice care, you have the right to request at any time, in writing, the "Patient Notification of Hospice Non-Covered Items, Services, and Drugs" addendum that lists conditions, items, services, and drugs that the Hospice has determined to be unrelated to your terminal illness and related conditions, and that will not be covered by the Hospice. The Hospice must furnish this notification within 5 days, if you request this form on the start of care date, (and within 72 hours (or 3 days) if you request this form during the course of Hospice care. • As a Medicare Hospice beneficiary, you have the right to contact the Beneficiary and Family-Centered Care Quality Organization (BFCC-QIO), to request immediate advocacy if you disagree with any of the Hospice's determinations. The BFCC-QIO that services your area is: BFCC-QIO Name: _______ BFCC-QIO Phone Number: ______

Upon patient record review, 5 of 9 (Patients #2, 5, 6, 7, and 9) did not contain evidence that all documentation entries in the clinical record were clear, and/or appropriately authenticated, and dated, in accordance with the organizations policies and procedures, and currently accepted standards of practice: Patient #2: The 09/14/22 IDG POC contained an entry, "Patient declines Chaplain and Social Work care/services." However, the same POC also contained the following entry, "MSW 1x per week with 3 p.r.n., and Chapalin1x month with 2 p.r.n." These contradictory entries are unclear. Patient #5: On the 08/02/22 SN visit, the nurse documented, "Wound care treatment done to coccyx", without the details of the wound care process provided nor documented the appearance/status of these wounds that she had observed. On the 08/04, 08/08, and 08/11/22 SN visits, the nurse documented, "Wound care treatment done as per Plan of Care", without the details of the wound care process provided nor did the SN document the appearance/status of these wounds that she had observed. Patient #6: The Aide home visit reports for June 8, 10, 13, 15, 17, 20, 22, 24, 27, 29, and July 1, 6, 11, 13, and 15, 2022, had not been signed/dated by the Aide providing the care/services, to include credentials. Patient #7: The Aide home visit reports for June 10, 13, 15, 17, 20, 22, 24, 27, 29, and July 1, 4, 6, 7, 11, and 12, 2022 had not been signed/dated by the Aide providing the care/services, to include credentials. Patient #9: The Aide home visit reports for August 3, 4, 5, 8, 10, 12, 15, 17, and 18, 2022, had not been signed/dated by the Aide providing the care/services, to include credentials. On the 08/01, 08/04, and 08/08/22 SN visits, the nurse documented, "Wound care treatment done as per Plan of Care", without the details of the wound care process provided nor did the SN document the appearance/status of these wounds that she had observed.

Upon patient record review, 3 of 3 applicable (Patients #4, 5, and 9) did not contain a Discharge Summary, which included all CMS-required content, as follows, None of these DC Summaries included the following required content: • A summary of the patient's stay, including treatments, symptoms and pain management • The patient's current Plan of Care • The patient's latest Physician orders

Upon patient record review, 2 of 9 (Patients #1 and 2) did not contain evidence that the written policies and procedures for managing/disposal of controlled drugs had been provided, and discussed, with all patients. The Hospice utilized a form entitled, "Patient Acknowledgement Form", for which the 8th entry reflected the patient having received and understood the Hospice's P/P for the disposal of controlled drugs. There was no documented evidence of these patients having received/signed/dated such form.