Every finding on record at New Hope Hospice of Bullhead City, Inc.

Upon patient record review 1 of 14 (Patient #2) 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 #2: Patient reportedly declined spiritual counselor visit. MSW and RN documented "not assessed" for spiritual assessment. No evidence of spiritual assessment completed.

Upon patient record review, 2 of 14 (Patient #3, 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 #3: During home visit noted patient to have Oxygen, it is not listed on the medication profile. Patient taking Tylenol Arthritis Ex Strength 650 mg (2) tabs every am for pain and Vitamin D 1000 IU daily. Not listed on the medication profile. Patient #10 : Fentanyl 25 mcg patch on med profile since 8/2/23. Used approximately one time per patient. Duplicate listing for generic name and trade name with different dosage frequency: 7/6/23 Acetaminophen - Oxycodone 325/10 q 12 hrs and Percocet 325/10 every 6 hours prn. Pantoprazole 40 mg oral delayed release 1 tab 2xdaily - on medication profile since 7/6/23. Patient/spouse report not taking "for a long time."

Upon patient record review, 1 of 14 (Patient #10) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #10: There is not evidence that RN ensured continuous assessment of the patient and family needs to coordinate activities, in that the patient underwent Left Total Knee Replacement and Outpatient PT 2x weekly.

Upon patient record review, 2 of 14 (Patient #3, 10) 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 #3: On Oxygen therapy. There is a problem for COPD, but it does not specifically address oxygen therapy, rate/frequency, safety precautions. Patient is on anticoagulant therapy, (Clopidogrel 75 mg), but there is no related problem with goals/interventions, including bleeding precautions Patient #10: Patient has 7/6/24 order for Oxygen 2-6 liters continuous. There is no related problem, goals or interventions that include Oxygen and safety precautions. Patient has Prostate Cancer. There is no related problem, goal, interventions specific to the diagnosis.

Upon patient record review, 1 of 14 (Patient #3) 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: During home visit noted patient to have Oxygen, there is not a plan of care order for oxygen. In addition, the patient is taking Tylenol Arthritis Ex Strength 650 mg (2) tabs every am for pain and Vitamin D 1000 IU daily. There is no evidence of a plan of care order for either.

Upon patient record review, 2 of 14 (Patient #10, 13) 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: Patient underwent left total knee replacement 8/12/24, but there was no update to care plan problems, goals, interventions. Patient #13: Patient had indwelling catheter insertion with no update to care plan problems, goals, interventions.

Upon client record review, 3 of 14 (Patient #3, 6, 13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #3: During home visit, it is noted that patient has Oxygen in home. RN instructs regarding 2L/NC, as needed. There is no order for oxygen rate or frequency. Patient #6: Patient record contains reference to foot wound and treatment provided. 5/23/24 SN visit performed wound care - right foot decub stage 1. (Wound onset 5/16.) Cleansed with wound cleanser and applied nonadherent dressing; 5/16/24 note SN identified right foot decub stage 1 clean and dry, covered with Kerlix and secured with tape. There was no order for wound treatment/s. Patient #13: 9/15/23 SN Visit Note inserted Foley #14 10cc balloon. No physician order documented.

Upon patient record review, 2 of 14 (Patient #3, 10) 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 #3: Aide Care Plan does not include Oxygen flow rate, Oxygen safety precautions and bleeding precautions for patient with Oxygen therapy and anticoagulant therapy. Patient #10: Aide Care Plan does not include Oxygen flow rate or Oxygen safety precautions.

Upon patient client record review, 14 of 14 (Patient #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14) 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 #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14: Hospice Election Statement only includes National Hospice Management, Inc heading and not the particular hospice, for legal organization with multiple hospices.

Upon patient client record review, 1 of 14 (Patient #1) 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: 8/22/24 Prep note/communication note by RN, begins with 86 yo with primary dx; systolic and diastolic heart failure .... DNR... greeted at front door by spouse, Joyce...." with details inconsistent with information specific to Patient #1. Upon interview, staff confirmed entry was inadvertently made in wrong record for a different patient with same last name.

Upon client record review, 1 of 14 (Patient #2) 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 #2: The SNF resident was admitted 6/5/23 with suprapubic catheter in place. The hospice POC does not reference SNF staff and/or delineate responsibility for catheter maintenance including but not limited to catheter care, changes, assessment for complications. Upon interview, hospice staff confirm that hospice staff manages suprapubic, including but not limited to routine changes.