Every finding on record at Novel Hospice Care Inc

Upon patient record review, 3 of 14 (Patient #4,8,14) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #4: There was no evidence the patient chose or declined an attending physician on the Informed Consent and Election of Benefits form due to that portion being blank. Patient #8: There was no evidence the patient chose or declined an attending physician on the Informed Consent and Election of Benefits form due to that portion being blank. Patient #14: There was no evidence the patient chose or declined an attending physician on the Informed Consent and Election of Benefits form due to that portion being blank.

Upon patient record review, 3 of 14 (Patient #7,#8,#12) 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:The patient declined chaplain at admission, but Chaplain 1 x month was documented on the care plan beginning 12-26-25. Patient #8: The patient declined an aide, but the care plan dated 3-17-26 and 3-31-26 documented aide visits 3 x week. Patient #12: The patient was diagnosed with Diastolic Heart Failure, CAD, HTN and A-Fib, but there was no evidence of a care plan for cardiac.

Upon client record review, 2 of 14 (Patient #3,#5) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient #3: IDG plan of care review was conducted on 8-5-25 and not again until 9-3-25 indicating greater than 15 days. Patient #5:IDG plan of care was conducted on 2-17-26 and not again until 3-17-26 indicating greater than 15 days.

Upon client record review, 3 of 14 (Patient #9,12, 13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient#9:The Chaplain was visiting once a month, but the plans of care dated 3-17-26, 3-31-26 and 4-14-26 had no frequency documented for the chaplain. Patient#12: The nurse, chaplain and social work were accepted by the patient and family, but the plan of care dated 2-17-26 had no frequencies documented for the Nurse, Aide or Social Work. Patient #13: The plan of care dated 3-17-26, 3-31-26 and 4-17-26 indicate the chaplain is visiting 2 x month, but there is evidence of only 1 visit in March.

Upon patient record review 3 of 14 (Patient #5,#7,#12) 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:An aide supervisory visit was completed on 3-2-26 and not again until 4-1-26 indicating greater than 14 days. Patient #7: An aide supervisory visit was completed on 3-4-26 and not again until 4-9-26 indicating greater than 14 days. Patient #12: An aide supervisory visit was conducted on 3-2-26 and not again until 3-19-26 indicating greater than 14 days.

Upon patient client record review, 4 of 14 (Patient #4,#6,#8,#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 #4: There was no evidence the patient chose or declined an attending physician on the Informed Consent and Election of Benefits form due to that portion being blank. Patient #6: There was no evidence the patient was informed of the right to receive the election statement addendum as the declined or chosen statement was left blank. Patient #8: There was no evidence the patient chose or declined an attending physician on the Informed Consent and Election of Benefits form due to that portion being blank. Patient #14: There was no evidence the patient chose or declined an attending physician on the Informed Consent and Election of Benefits form due to that portion being blank.

Upon client record review, 2 of 14 (Patient #2,#3) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patient #2,#3: There was no evidence of a discharge summary forwarded to the attending.

Upon client record review, 2 of 14 (Patient #2,#3) did not have evidence that the discharge summary includes all required information. Patient #2, #3: There was no evidence of a discharge summary.

Upon patient record review, 3 of 14 (Patient #1, 4, 5) 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 Patient 1: The patient's oxygen does not appear on the medication list. (corrected onsite) Patient 4: The patient's saline flushes and heparin locks do not appear on the medication list. Additionally, the medication list indicates clonidine 0.1mg 1 tablet by mouth weekly apply 1 patch weekly to rotating sites. The correct clonidine order is for the 0.1mg transdermal patch, rather than the oral tablet. (corrected onsite) Patient 5: The patient's oxygen does not appear on the medication list. (corrected onsite)

Upon patient record review, 1 of 14 (Patient #3) 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 3: The patient was admitted for hospice services on 08.19.2022; however the initial bereavement assessment was not completed until 09.17.2022.

Upon patient record review, 1 of 14 (Patient #4) 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 patient was admitted for hospice services with a primary terminal diagnosis of stomach cancer. She receives her primary nutrition per TPN infusion via her CVAD. Due to her decreased swallow ability, the patient receives no oral medication by tablet/capsule. The comprehensive nursing assessment and physician's CTI indicate the patient must maintain positional considerations to ensure she does not choke. However, no comprehensive care plan has been developed related to aspiration precautions. Additionally, an outside agency manages the patient's TPN, and a copy of the order for her nutrition is present in the patient's record. However, no care plan has been developed related to either the parenteral nutrition or management of the CVAD. (corrected onsite)

Upon patient client record review, 4 of 14 (Patient #1, 3, 8, 9) 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, 3, 8, 9: Electronic medical record care planning templates contained incomplete entries as they were left with blanks in them. These were not material in any way to the care plans, but should have been deleted on activation of the selected care plan. For example, the care plan indicated the caregiver will verbalize understanding of medication instructions ________, where the blank in the goal statement needed to be deleted and then appropriate interventions followed. (corrected onsite)