Every finding on record at Odyssey Healthcare of Kansas City, LLC

Upon patient record review, 1 of 14 (Patient #6) did not have evidence that the patient has received effective pain management and symptom control from the hospice for conditions related to the terminal illness. Patient 6: The medical record contained nursing documentation 5/20/26 identifying patient complaint of constant nausea not relieved with medication regimen. There was no evidence of symptom control documented in the record.

Upon patient record review, 3 of 14 (Patients #2,#6,#9) 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 2: During home visit medication reconciliation, the facility and hospice medication profiles did not match. The facility has sliding scale insulin that was not on hospice, hydrocodone-acetaminophen scheduled twice a day versus hospice once at bedtime, and the facility did not have oxygen listed as a treatment. Patient 6: The medication profile contained acetaminophen tablets with an alternate route of under the tongue. Patient 9: The medication profile contained clotrimazole topical cream with no area defined for administration.

Upon patient record review, 1 of 14 (Patient #6) 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 6: The medical record contained nursing documentation since admission identifying patient issues with nausea and vomiting. There was no evidence of problems, goals and interventions related to nausea included in the plan of care.

Upon patient record review, 3 of 14 (Patients #2,#6,#9) 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: During home visit medication reconciliation, the facility and hospice medication orders did not match. The facility has an order for sliding scale insulin that was not on hospice record, the hydrocodone-acetaminophen order was scheduled twice a day versus hospice once at bedtime, and the facility did not have oxygen orders as a treatment. Patient 6: The medical record contained an order for acetaminophen tablets with an alternate route of under the tongue. Patient 9: The medical record contained an order for clotrimazole topical cream with no area defined for administration.

Upon client record review, 1 of 14 (Patient #4) 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 4: There was no evidence of collaboration with the attending physician no less than every 15 days. Plan of care updates were only documented as sent to the physician on 4/8/26 and 4/28/26.

Upon patient record review, 1 of 14 (Patient #4) did not have evidence in the patient record that hospice aide assignments and duties are specific to patient needs. Patient 4: There was no evidence the aide care plan was updated to remove instructions regarding wound bandage after the wound was documented as healed 5/13/26.

Upon patient record review 2 of 14 (Patients #3,#5) 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 3: There was no evidence of a supervisory visit from 5/4/26 until time of review 5/26/26. Patient 5: There was no evidence of a supervisory visit from 5/12/26 until time of review 5/27/26.

Upon patient record review, 1 of 14 (Patient #2) did not have evidence that the hospice provided the following information: • Hospice election form and any Advance Directives specific to each patient • Physician certification and recertification of the terminal illness specific to each patient Patient 2: During home visit review of the facility's hospice binder there was no evidence the facility received the CTI and advance directive from the hospice.

Upon patient record review 2 of 14 (Patient #2, #4) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #2: The patient admitted 10/24/2022 however, the spiritual assessment was not performed until 11/01/2022. Patient #4: The patient admitted 02/24/2023 however, the spiritual assessment was not performed until 03/02/2023.

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: The medication profile included Miralax PRN daily for constipation however, there was no evidence of mixing directions. Also, included triamcinolone acetonide topical cream however, there was no specific area for application. COS Patient #10: The medication profile included nystatin topical cream however, there was no specific area for application. COS

Upon patient record review, 2 of 14 (Patient #4, #6) 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 #4: The patient admitted on 02/24/2023 however, the bereavement assessment was completed 06/05/2023. Patient #6: The patient admitted on 04/17/2023 however, the bereavement assessment was completed 04/28/2023.

Upon patient record review, 4 of 14 (Patient #3, 5, 6, 9) 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: Patient was admitted in a nursing facility for congestive heart failure however, there were no problems/interventions/goals for facility coordination or cardiac. COS Patient #5: The patient admitted 04/25/2023 as a full code however, on 05/04/2023 patient desired DNR which was completed and signed by patient and physician yet the plan of care still reflected patient was a full code. COS Patient #6: The patient plan of care stated DNR however, agency confirmed patient is a full code. COS Patient #9: Patient was admitted in a nursing facility however, there were no problems/interventions/goals for facility coordination. COS

Upon patient record review, 2 of 14 (Patient #3, #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 medications and treatments. Patient #3: The orders included Miralax PRN daily for constipation however, there was no evidence of mixing directions. Also, included triamcinolone acetonide topical cream however, there was no specific area for application. COS Patient #10: The orders included nystatin topical cream however, there was no specific area for application. COS

Upon patient record review, 1 of 14 (Patient #9) 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 #9: The nurse admission noted patient has hospital bed, over bed table, and wheelchair however, these were not listed on plan of care. COS

Upon client record review, 5 of 14 (Patient #4, #5, #6, #8, #9) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #4: The nurse visit frequency ordered 05/25/2023 was 2W2, 2W7, 4 PRN however, there was no evidence of visits for the week of 05/21. In addition, the social work visit frequency was ordered 05/25/2023 2M2, 2M1, 2 PRN however, there was no evidence of visits from 05/25/2023 through 05/31/2023. COS Patient #5: The chaplain visit frequency was ordered 04/25/2023 2M2, 3 PRN however, there was no evidence of visits on or after 04/25/2023 through 04/30/2023. COS Patient #6: The chaplain visit frequency was ordered weekly on 04/27 however, the week of 05/14 there was no evidence of visits. The social work visit frequency was ordered 05/11/2023 1M3, 3 PRN however, there was no evidence of routine visit after 05/11/2023 for the month of May. COS Patient #8: The documentation indicated patient had a wound on R great trochanter, per agency wounds are measured weekly and the measurements were completed 05/04, 05/17 and 06/05. Patient #9: The social work visit frequency ordered 05/04/2023 was 2M2, 1M1, 3 PRN however, the month of May there was no evidence of visits other than evaluation on 05/04. COS

Upon observation, there was no evidence the hospice investigates all adverse events, incidents, accidents, variances or unusual occurrences that involve patient care and develops a plan of correction to prevent the same or similar event from occurring again. Patient #8: The patient had documented UTI on 04/13 however, there was no evidence this was reported and investigated. COS

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. The nurse was observed for patient #1 and patient #2 beginning patient assessment without washing hands first and removing gloves during care without washing hands afterwards.

Upon patient record review 1 of 14 (Patient #7) 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 #7: The aide plan of care ordered shampoo weekly however, the aide noted shampoo performed 04/25, 04/28, 05/01, 05/05, 05/08, and 05/12.

Upon patient client record review, 1 of 14 (Patient #10) 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 #10: The patient selected on election statement to receive notice of non-covered items addendum however, there was no proof of delivery.

Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the hospice provided the following information tot eh SNF: • Hospice election form specific to each patient • Physician certification and recertification of the terminal illness specific to each patient but rather contained the state specific certification form and Medicaid election form.

Upon personnel record review, 1 of 10 (Personnel #4) did not have evidence that all Medical Social Services are provided by a qualified Medical Social Worker in accordance with the state's Social Work Practice Act, the hospice's policies and procedures and/or job descriptions. Personnel #4: The social worker file indicated she was a new graduate from May 2023 and did not have evidence of 1 year of social work experience in a healthcare setting.