Every finding on record at Nurture Hospice, Inc.

Upon patient record review, 4 of 11 (Patient #1, #5, #8, #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: On admission, the nurse documented puree diet with thickened liquids and the need for aspiration precautions. There were no goals or interventions related to puree diet with thickened liquids or aspiration precautions included on plan of care. Patient #5: On admission, the patient was prescribed insulin for Diabetes. There were no goals or interventions related to blood sugar range to notify physician or the frequency blood sugar requires checking. Patient #8: On admission, the patient was prescribed insulin for Diabetes. There were no goals or interventions related to blood sugar range to notify physician. Patient #11: On admission, the social worker was ordered monthly and narrative on social worker visit note on 1/11/22 included providing social counseling and support. There were no goals or interventions related to psychosocial issues.

Upon patient record review, 3 of 11 (Patient #1, #3, #11) 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: The diet order from admission was for puree, NAS, with thickened liquids. The order was incomplete and did not include specific consistency for thickened liquids. Patient #3: Upon admission, the physician order included thickened liquids. The order was incomplete and did not include specific consistency for thickened liquids. Patient #11: The diet on admission was NPO and g-tube feedings. The RN documented instructions related to water flushes and checking residual. There were no physician orders which included water flushes before and after tube feeding, water flushes before and after medication administration, or to check residual.

Upon patient record review 1 of 11 (Patient #11) 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 #11: The aide plan of care included assigned tasks of record last BM every visit. On aide visit notes on 11/16/22 and 11/30/22, the aide failed to document last BM date.

Upon patient record review, 1 of 11 (Patient #4) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient's clinical information and provide written documentation that it is anticipated that the patient's life expectancy is 6 months or less. Patient #4: The recertification for BP #4 dates of 2/28/23 to 4/28/23 did not include the verbal order and the physician has not signed yet as of 3/9/23.