Every finding on record at Oak Tree Hospice LLC

Upon patient record review, 7 of 16 (Patient# 1,2,5,8,11,13,16) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient 1,2,5,8,11,13,16 did not have evidence that the patient chose a health care provider, including an attending physician. The EOB form provided a space for the attending physicians name and was left blank.

Upon patient record review, 3 of 16 (Patient #1,2,9) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient: 1,2,9 There is no evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death.

Upon patient record review, 2 of 16 (Patient #3,12) 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: The medication profile for "Arginaid Powder for Solution", does not contain a diluent. The medication profile contains "Polyvinyl Alcohol 1.4% lubrication eye drops I drop ophthalmic every 6 hours", there is no direction for which eye(s). Patient 12: The medication profile contains "MiraLax Powder 17g /scoop" does not contain a diluent.

Upon patient record review, 4 of 16 (Patient #1,2,9,11) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient 1:SC ordered PRN. A discipline's ordered visit frequency cannot include a PRN visit frequency, without a baseline frequency to support it and must include number of PRN visits. Patient 2: The POC 4/23/25 contains an order for MSW one time a week then PRN for psychosocial support. The POC 4/23/25 contains an order for SC one time then PRN for spiritual support. A discipline's ordered visit frequency cannot include a PRN visit frequency, without a baseline frequency to support it and must include number of PRN visits. Patient 9: The POC 9/27/24 contains an order for MSW one visit then PRN for psychosocial support. A discipline's ordered visit frequency cannot include a PRN visit frequency, without a baseline frequency to support it and must include number of PRN visits. Patient 11: The POC 8/11/24 contains an order for MSW one visit then PRN for psychosocial support. A discipline's ordered visit frequency cannot include a PRN visit frequency, without a baseline frequency to support it and must include number of PRN visits.

Upon patient record review, 6 of 16 (Patient #2,3,4,9,11,12) 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 2: The POC on 4/1/25 contains an order "Foley catheter continued", the order does not contain a foley size, foley catheter care or how often to change the catheter. The RN assessment on 4/3/25 states, "SN received report from the treatment nurse" there is no evidence of wound orders on the plan of care. Patient 3: The POC on 4/1/25 contains an order for "Arginaid Powder for Solution", the order does not contain a diluent. The POC contains an order for "Polyvinyl Alcohol 1.4% lubrication eye drops I drop opthalmic every 6 hours", there is no direction in the order for which eye the drops are for. Patient 4: The POC on 3/26/25 contains an order for "foley catheter", the order does not contain a foley size, foley catheter care or how often to change the catheter. The RN assessment on 3/26/25 contains a treatment plan for "betadine external solution applied topically daily to all arterial ulcers for 30 days, cleanse, pat dray and cover with dry dressing. There is no evidence for a wound on the plan of care. Patient 9: The POC contains an order for "PleurX drain", the POC does not contain orders on care of the PleurX drain such as; drainage frequency, amount of fluid drained, color of fluid and symptoms. The order should contain the drain site with order frequency and details for dressing changes. Patient 11: The POC 8/11/24 contains an order for "foley catheter", the order does not contain a foley size, foley catheter care or how often to change the catheter on the POC. Patient 12: The POC on 7/2/24 contains an order for "MiraLax Powder 17g /scoop" the order does not contain a diluent.

Upon client record review, 1 of 16 (Patient #1) 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 1: On the 3/5/25 POC the SC is ordered prn the IDG notes 4/3/25, 4/17/25 and 4/25/25 did not contain evidence that spiritual care signed off on the IDG note .

Upon patient record review, 2 of 16 (Patient #14, 15) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patients: 14, 15 did not have evidence in the patient record that bereavement services were available to family and other individuals in the bereavement plan of care up to 1 year following the death of the patient.

Upon patient record review, 11 of 16 (Patient #1,2,3,4,5,6,8,9,11,12,13) did not have evidence in the patient record that hospice aide assignments and duties are: • 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: The 3/5/25 aide POC includes orders for the following: turn and reposition the patient, chair to bed, record bowel movements,change patient linens, but does not include a frequency. Patient 2: The 4/23/25 aide POC includes orders for the following: turn and reposition the patient, change patient linens but does not include a frequency. Patient 3: The 4/1/25 aide POC includes orders for the following: turn and reposition the patient, change linens, record bowel movements, but does not include a frequency. Patient 4: The 3/26/25 aide POC includes orders for the following: turn and reposition the patient, record patients bowel movements, change linens, but does not include a frequency. Patient 5: The 2/20/25 aide POC includes orders for the following: turn and reposition the patient, change linens, but does not include a frequency. Patient 6: The 1/28/25 aide POC includes orders for the following: turn and reposition the patient, record patients bowel movements, change linens, but does not include a frequency. Patient 8: The 10/03/24 aide POC includes orders for the following: turn and reposition the patient, change linens, but does not include a frequency. Patient 9: The 9/27/24 aide POC includes orders for the following: turn and reposition the patient, change linens, but does not include a frequency. Patient 11: The 8/11/24 aide POC includes orders for the following: turn and reposition the patient, change linens, but does not include a frequency. Patient 12: The aide POC includes orders for the following: turn and reposition the patient, change linens, but does not include a frequency. Patient 13: The 6/18/24 aide POC includes orders for the following: turn and reposition the patient, feeding assistance, change linens, but does not include a frequency.

Upon patient client record review, 7 of 16 (Patient #1,2,5,8,11,13,16) 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 1,2,5,8,11,13,16 The Hospice Medicare Election statement does not clearly identify the patient's choice for the attending physician. The EOB form provided a space for the attending physicians name and was left blank.

Upon patient client record review, 1 of 16 (Patient #2) did not have evidence that each patient record contains Advance Directives. Patient 2: There is evidence in the patient record that the patient has completed an Advance Directive but there is no Advance Directive in the medical record.

Upon patient client record review, 1 of 16 (Patient #16) did not evidence that each patient record contains physician orders. Patient 16: There is no discharge order from the hospice Medical Director on 1/10/24 when the patient was discharged due to no longer determined to be terminally ill.

Upon patient client record review, 2 of 16 (Patient #6,8) 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 6: The RN assessment on 1/31/24 contains an abbreviation "ANTB", this abbreviation is not included on the list of approved abbreviations. On the RN assessment 2/1/25, the RN documented "instructed to call FCN" FCN is not included on the list of approved abbreviations. Patient 8: The consent has a box on the form for Level of Care on admission, the continuous care box is checked, on the POC 10/3/24 there is an order for Routine Care.

Upon patient record review, 1 of 5 (Patient #1) 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 Had nebulizer medication ordered at SOC (1-18-22). The nebulizer equipment was not included in the DME section of POC. This was corrected on site.

Upon patient client record review, 1 of 5 (Patient #4) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #4 The "Patient Notification of Hospice Non-Covered Items, Services and Drugs" was check-marked on box designated to decline this form. However, the designated space that indicated for "Initials" and "Date" were left blank and not filled in. The full signature for beneficiary at bottom of EOB was signed and dated.

Upon patient client record review, 1 of 5 (Patient #5) 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 #5 The agency generated "Patient Acknowledgement" form was not complete. The form was signed appropriately at bottom of page. However, the checkmark boxes located above signature line for teaching (named the explained column) were not filled in and left blank.