Every finding on record at New Century Hospice Delaware, LLC

Upon patient record review, 1 of 19 (Patient #7) 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: There was no evidence that patient received policy on advanced directives.

Upon patient record review 2 of 19 (Patient #10, #12) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient 10: No evidence of an initial comprehensive spiritual assessment. Patient 12: No evidence of an initial comprehensive spiritual assessment.

Upon patient record review, 4 of 19 (Patient #4, #6, #7, #8) 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 4: The medication profile contained active instructions to administer Doxycycline effective 11/13/25 after agency investigation the course of antibiotics was completed but not removed from medication profile. Corrected. Patient 6: The medication profile contained an order for Atropine with inappropriate administration route of eye for excess secretions. Corrected Patient 7: During medication reconciliation, the facility and hospice medications did not match. The facility medication profile contained order for Lorazepam 0.25ML (0.5MG) to be administered every 4 hours as needed. However, the hospice medication profile contained order for Lorazepam 0.5ML to be administered every 4 hours as needed. The facility medication profile contained order for Lorazepam 0.25ML (0.5MG) to be administered at bedtime. However, the hospice medication profile contained order for Lorazepam 1MG to be administered at bedtime. The facility medication profile contained order for Metoprolol Tartrate 50mg to be administered twice daily. However, the hospice medication profile contained order for Metoprolol Succinate ER 50mg to be administered once daily. The facility medication profile contained order for Mirtazapine 15mg to be administered at bedtime. However, the hospice medication profile contained order for Mirtazapine 7.5mg to be administered at bedtime. Patient 8: The medication profile contained an order for aspercream with no administration location identified. Corrected with order clarification.

Upon patient record review, 1 of 19 (Patient #12) 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 12: The initial bereavement assessment was completed on 10/2/25 with start of care 9/25/25.

Upon patient record review, 3 of 19 (Patient #6, #7, #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 6: The medication profile contained an order for Atropine with inappropriate administration route of eye for excess secretions. Corrected onsite with updated physician's order. Also, on 10.24.25 RN documented UA was ordered but no evidence of order. Patient 7: During medication reconciliation, the facility and hospice medications did not match. The facility medication profile contained order for Lorazepam 0.25ML (0.5MG) to be administered every 4 hours as needed. However, the hospice medication profile contained order for Lorazepam 0.5ML to be administered every 4 hours as needed. The facility medication profile contained order for Lorazepam 0.25ML (0.5MG) to be administered at bedtime. However, the hospice medication profile contained order for Lorazepam 1MG to be administered at bedtime. The facility medication profile contained order for Metoprolol Tartrate 50mg to be administered twice daily. However, the hospice medication profile contained order for Metoprolol Succinate ER 50mg to be administered once daily. The facility medication profile contained order for Mirtazapine 15mg to be administered at bedtime. However, the hospice medication profile contained order for Mirtazapine 7.5mg to be administered at bedtime. Patient 8: The medication profile contained an order for aspercream with no administration location identified. Corrected with order clarification.

Upon patient record review, 2 of 19 (Patient #2, #6) 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 2: Nursing documentation upon admission identified patient use of raised toilet seat and shower chair. There was no evidence of orders for the DME included in the plan of care. Corrected onsite with order. Patient 6: Nursing documentation identified patient use of hospital bed and over the bed table. There was no evidence of orders for the DME included in the plan of care. Corrected onsite with order.

Upon patient record review, 1 of 19 (Patient #10) 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 10: Order to discontinue SW frequency on 10/27/25, however SW tasks to be completed remain on the plan of care. Corrected on site by updating the plan of care.

Upon client record review, 2 of 19 (Patient #1, #9) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: Order for chaplain visit frequency of two visits a month. There was no evidence of second visit made in November. Patient 9: Request made for volunteer visit frequency of two visits a month and entered onto POC. There was no evidence of second visit made in November. Corrected on site with missed visit note.

Upon personnel record review, 1 of 14 (Personnel #6) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel 6: Upon review of personnel file, there was no evidence of competency assessment on obtaining temperature, pulse and respirations.

Upon patient record review, 3 of 19 (Patient #1, #3, #6) 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: Order for aide visit frequency of one time a week, however the aide care plan indicates aide to provide a shower and shampoo on the second visit weekly. Corrected on site with updated aide care plan. Patient 3: RN documentation that aide feeds patient, however there is no task to feed patient on aide care plan. Corrected on site by updating aide care plan. Patient 6: Order for aide visit frequency of twice weekly, however the aide care plan indicates aide to provide a shower on the second and third visit weekly. Corrected with updated aide care plan.

Upon patient record review 1 of 19 (Patient #5) 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 5: Order for aide visits two times weekly. There was no evidence of second visit made week of 11/23/25.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. Agency volunteer utilization rate for 2024 was 4.39%. Year to date 3.45%.

Upon personnel record review, 2 of 14 (Personnel #7, #9) did not have evidence the hospice employees and contract employees have received orientation on the hospice philosophy. Personnel 7: Upon review of the personnel file, there was no evidence of contracted therapist having received hospice philosophy orientation. Personnel 9: Upon review of the personnel file, there was no evidence of contracted therapist having received hospice philosophy orientation.

Upon patient client record review, 2 of 19 (Patient #6, #13) 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 6: The election form identified the patient elected to receive the Notification of Hospice Non-Covered items upon admission 6/18/24 but was not furnished until 7/2/25. Patient 13: The election form identified the patient elected to receive the Notification of Hospice Non-Covered items upon admission 3/27/25 but was not furnished until 4/3/25.

Upon client record review, 1 of 19 (Patient #6) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed. Patient 6: There was no evidence patient was provided written policies and procedures for managing controlled drugs. Patient had orders for Lorazepam and Morphine since 7/2/24.

Upon client record review, 1 of 19 (Patient #5) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient 5: Wound order written on 12/5/25 did not identify location of wound or facility responsibility. Correct onsite with order clarification.

Upon patient record review 1 of 11 (Patient #4) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #4: The patient admitted on 02/11/2022 and the comprehensive spiritual assessment was not completed until 2/17/2022.

Upon patient record review, 6 of 11 (Patient #1, #3, #6, #7, #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: The medication profile listed artificial tear drops four times a day without evidence of directions for specific eye(s) and also listed wound cleanser which was discontinued on 11/30/2022. (Corrected on site) Patient #3: The medication profile listed Voltaren 1% gel topical four times a day without evidence of directions of specific affected area. In addition, contained duplicate orders for cannabis topical. (all corrected on site) Patient #6: The medication profile listed artificial tears 1 drop four times a day and nasal mist 0.9% PRN without evidence of specific eye or eyes and nostril. (Corrected on site) Patient #7: The medication profile listed acetaminophen tablets 325mg 2 tablets twice a day PRN pain/fever and acetaminophen suppositories 650mg every 4 hours PRN fever without evidence of maximum allowable amount on suppository medication. (Corrected on site) Patient #9: The medication profile listed acetaminophen 650mg every 4 hours PRN pain/fever without evidence of maximum allowable dose. Patient #10: The medication profile listed refresh tears PRN without evidence of direction for specific eye or eyes.

Upon patient record review, 5 of 11 (Patient #4, #5, #7, #8, #10) 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 #4: The patient admitted on 02/11/2022 and the record indicated the bereavement assessment was completed on 02/17/2022. Patient #5: The patient admitted on 10/05/2022 and the record indicated the bereavement assessment was completed on 10/17/2022. Patient #7: The patient admitted on 11/15/2022 and the record indicated the bereavement assessment was completed on 12/05/2022. Patient #8: The patient admitted on 11/22/2022 and the record indicated the bereavement assessment was completed on 11/30/2022. Patient #10: The patient admitted on 06/09/2022 and there was no evidence a bereavement assessment was completed.

Upon patient record review, 3 of 11 (Patient #1, 7, 11) 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 #1: The patient admitted with basal cell carcinoma of R eye and comprehensive assessment indicated patient does have pain and was on several pain meds however, there were no problems/interventions/goals for altered comfort or pain. (Corrected on site) Patient #7: The nurse noted skin tear with new treatment orders for wound care on 12/06/22 however, the plan of care was not updated with problems/interventions/goals related to wound care. (Corrected on site) Patient #11: The notes indicated patient was imminent beginning 09/25/22 however, the plan of care was not updated with problems/interventions/goals related to imminence of death and patient expired 10/02/2022.

Upon patient record review, 5 of 11 (Patient #1, #3, #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: Order for artificial tears drops without evidence of directions including specific eye or eyes. The order for wound cleanser was still active however, the wound was healed on 11/30/2022. (all corrected on site) Patient #3: Order for Voltaren 1% gel topical four times a day without evidence of directions for site of application. (Corrected on site) Patient #6: Order for artificial tears 1 drop four times a day and nasal mist 0.9% PRN without evidence of specific eye or eyes and nostril. (Corrected on site) Patient #9: Order for acetaminophen 650mg every 4 hours PRN pain/fever without evidence of maximum allowable dose. Patient #10: Order for refresh tears PRN without evidence of direction for specific eye or eyes.

Upon patient record review, 1 of 11 (Patient #6) 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 #6: The comprehensive assessment indicated patient had hospital bed and bedside commode however, there was no evidence of these listed in plan of care. (Corrected on site)

Upon patient record review, 3 of 11 (Patient #3, #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 #3: The nurse visit frequency was ordered 2 per week and 4 PRN however, the week of 11/22/22 there was only evidence of one routine visit and 1 PRN visit. (Corrected on site) Patient #4: The nurse visit frequency was 2 per week beginning 12/08/22 however, there were no visits documented 12/8/22 through the end of week. (Corrected on site) Patient #8: The volunteer visit frequency was weekly beginning on 11/26/22 for respite visits however, there was no evidence of visits that week. (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 #2 had fall on 11/18/2022 however, there was no evidence this adverse event was reported for tracking purposes. (Corrected on site)

Upon patient record review 2 of 11 (Patient #2, #5) 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 #2: The aide visit frequency was ordered 1 per week. There was no evidence of visit or missed visit note for the week of 11/27/2022. (Corrected on site) Patient #5: The aide visit frequency was ordered 2 per week. There was no evidence of visit or missed visit note for the week of 10/23/2022. (Corrected on site)

Upon contract review, 2 of 4 (RS, WE) did not have evidence of a contract to fulfill the role of medical director or alternate medical director, if applicable. There was no evidence in medical director or alternate medical director contracts specifying the physician who assumes the medical director responsibilities and obligations.

Upon patient record review, 2 of 11 (Patient #7, #9) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patients #7 and #9: The patient and or representative elected to receive the addendum for notice of non-covered items however, there was no evidence this was delivered.

Upon patient client record review, 1 of 11 (Patient #1) did not have evidence that each patient record contains Advance Directives. Patient #1: The plan of care noted the patient elected DNR status however, there was no evidence of signed DNR or POLST. (Corrected on site)