Every finding on record at Odyssey Healthcare Operating A, LP

Upon patient record review, 1 of 19 (Patient 1) 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 #1 - The record indicated Questran Light 4 gram oral powder by mouth twice daily. The medication profile did not contain evidence of instructions for diluent. Corrected by agency upon discovery.

Upon patient record review, 2 of 19 (Patient 1, 5) 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 record indicated Questran Light 4 gram oral powder ordered by mouth twice daily. The order did not contain evidence of instructions for diluent Patient #5 - The record indicated in nurse documentation that patient receives enteral feedings BID. There was no evidence of feeding/diet or flush to be used on the plan of care. Corrected on site.

Upon client record review, 2 of 19 (Patient 2, 8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 2 - The record indicates Spiritual Care Provider frequency 4x Monthly as of 5/1/23. There was documentation of only 3 visits in the month of May. Patient 8 - The record reflects Skilled Nurse frequency 2x Weekly during 5/16/23-8/13/23 certification period. No evidence of a second visit found for the week of 5/21/23 with no missed visit notification documented. In addition, the record reflects volunteer visits were completed 3 times in March, 3 in April, and twice in May. There is no evidence of an order to initiate volunteer services until 6/2/23.

Upon patient record review 4 of 19 (Patients 3, 6, 12, & 13) 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 3 - The record indicates nail care was performed at each visit for the month of May with aide plan of care indicating task frequency of once weekly. Aide visit frequency was ordered at 2 x week. In addition, coordination notes authored by the HHA indicated on 4/21/23, " Completed bed bath and wound care along with private caregiver and wife, Nancy" and on 4/27, " Pt had a bed bath and all care plan listed interventions on his routine visit. Wound care provided." Patient 6 -The record reflects instructions on the aide plan of care dated 4/23/23 for the aide to call facility 30 minutes prior to arrival in order for patient to be medicated. Aide visit documentation indicates, "other services" (Please Describe) answered with "Y" on 4/25, 4/27, 5/2, 5/16, & 6/1 with no description of "other services" provided. There is no evidence in aide visit documentation or narrative notes of facility notification/coordination of visit time. Patient 12 - The record reflects on 5/26/23 the aide documented, "No BM occurred during this visit" in response to "Date of last BM" rather than indicate the actual date the patients bowels had last moved. Patient 13 - In review of the aide plan of care, nail care is indicated at a frequency of weekly. The aide visits twice weekly with nail care performed at each visit 5/30, 6/1, 6/6, & 6/8.

Upon patient client record review, 1 of 19 (Patient 3) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient 3 - The record indicated the patient requested notification of non-covered items on 4/8/23 (date of admission) with no evidence this was furnished and signed until 5/3/23.

Upon client record review, 1 of 19 (Patient 1) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 1 - Upon record review noted Spiritual Care provider frequency for benefit period beginning 3/15/23 was 1x monthly. The frequency was changed 4/1/23 to 2x monthly with no evidence of 2nd Spiritual care provider visit in the month of April.