Every finding on record at Nurse Call Hospice Care Inc

Upon patient record review, 3 of 14 (Patient #1,#2,#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 #1: The patient's hospice diagnosis was Frontotemporal Neurocognitive disorder, but there was no evidence of a care plan for Neurological interventions or goals. Patient #2: The patient's hospice diagnosis was Alzheimer's, but there was no evidence of Neurological interventions or goals. Patient #12: The plan of care throughout the benefit period was not individualized as evidenced by uncompleted documentation under goals for Coping as "other_____"; Sleep: Achieve optimal rest in" _______" period of time, and Anxiety: patient will demonstrate decreased anxiety level within" _____"period of time.

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. The 2025 Volunteer Annual Report to the Governing Board showed 3% as the percentage of volunteer hours that provided day to day administrative or direct patient care.

Upon patient client record review, 2 of 14 (Patient #4,#11) 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 #4:The patient was ordered Hydromorphone which was on the medication profile, however on 04/27/26 the nurse documented the patient was using Morphine for pain. Patient #11: The patient was ordered Hydromorphone which was included on the medication profile, but on 09/09/25 the LVN documented the patient was using Roxanol for pain.

Upon patient record review and on direct observation during the home visits, 8 of 14 (Patient #1, 2, 5, 6, 7, 8, 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 Patient 1: The patient's oxygen did not appear on the medication list. Also, the patient's DuoNebs for inhalation were listed on the medication list for use once daily. However, during the home visit, the patient mentioned that she utilized the medication PRN for SOB episodes, and the physician order confirmed this as the correct frequency for the medication order. (corrected onsite) Patient 2: The medication list indicates timolol/latanoprost 0.5/0.005% ophthalmic solution q HS; however, there is no indication of which eye(s) it is to be used in. (corrected onsite) Patient 5: The patient's oxygen did not appear on the medication list. Also, the patient's medication list indicates diclofenac 1% topical gel q 8 hours PRN pain; however, there is no indication of a location for use of the topical medication. The medication list also indicates both morphine and Roxanol for PRN use, which is a duplicate drug order. (corrected onsite) Patient 6: The patient's oxygen did not appear on the medication list. (corrected onsite) Patient 7: The medication list indicates carbidopa/levodopa 2 x weekly. However, the RN case manager and verification of physician's orders confirms that the patient takes this medication 2 x daily. (corrected onsite) Patient 8: The patient's oxygen did not appear on the medication list. (corrected onsite) Patient 9: The patient's oxygen did not appear on the medication list. (corrected onsite) Patient 10: The medication list indicates acetaminophen q 4 hours. However, the RN case manager and verification of physician's orders confirms that the patient takes this medication PRN basis for pain or fever. (corrected onsite)

Upon patient record review, 4 of 14 (Patient #1, 5, 7, 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 equipment and supply needs. Patient 1: The patient requires the use of a nebulizer for management of the terminal illness; however, this DME does not appear on the plan of care. (corrected onsite) Patient 5: The patient requires the use of a rollator walker for management of the terminal illness; however, this DME does not appear on the plan of care. (corrected onsite) Patient 7: The patient requires the use of a cane, wheelchair, and walker for management of the terminal illness; however, this DME does not appear on the plan of care. (corrected onsite) Patient 10: The patient requires the use of a nebulizer for management of the terminal illness; however, this DME does not appear on the plan of care. (corrected onsite)

Upon client record review, 1 of 14 (Patient #6) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 6: There was no evidence of orders for the chaplain to make ongoing visits to see the patient; however, the chaplain saw the patient on 03.16.2023 and 05.04.2023.

Upon patient record review 1 of 14 (Patient #2) 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 HA care plan indicated that the aide should visit the patient 2 x weekly to provide ordered personal care services; however, the aide has seen the patient every Monday, Wednesday, and Friday (3 x weekly) from the time of hospice admission.

Upon patient client record review, 2 of 14 (Patient #3, 6) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient 3, 6: On admission to hospice, the patient/caregiver requested the Notification of Noncovered Services; however, this document was not returned within 5 days, as required.