Every finding on record at Ozark Hospice Family, LLC

Upon patient record review, 1 of 14 (Patient #7) did not contain evidence that a Registered Nurse had been designated to ensure the continuous assessment of the patient and family's needs, and to coordinate activities with other members of the Interdisciplinary Group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family: Patient #7: The RN 06/10/24 SOC assessment documented that the patient had foam gauze on the coccyx area, which was dated 06/10/24, and which the patient's in-home caregiver's requested not to be removed during that visit. At the RN visit the following day, there was no mention of an assessment of the coccyx area specifically, nor of the presence of or absence of, a gauze dressing.

Upon patient record review, 2 of 14 (Patients #5 and 10) did not contain evidence that the Hospice had 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 #5: SOC was 08/07/24. The SOC Physician CTI and RN SOC assessment reflected that the patient had a LLQ colostomy, which was to be changed Q 3 days. This colostomy was not addressed on the POC. Patient #10: The RN SOC assessment noted that the patient had a Cardiac Pacemaker. This was not included on the POC.

Upon patient record review, 1 of 14 (Patient #4) did not contain evidence that a revised Plan of Care included information from the patient's updated comprehensive assessment(s), and must note the patient's progress towards outcome/goals from the Plan of Care: Patient #4: This patient was receiving tube feedings. There was nothing on the most recent 08/06/24 IDG POC regarding the monitoring and site care responsibilities of such insertion site. Upon interview, the Case Manager reported that the patient's in-home caregiver had been provided split 4x4s to apply to surrounding the site. Neither was this physician-ordered dry dressing intervention on the POC.

Upon patient record review, 1 of 14 (Patient #10) did not contain evidence that the IDG had ensured that the care and services were provided in accordance with the Plan of Care: Patient #10: The RN 04/19/24 SOC assessment reflected that the patient had a coccyx blister, and documented that a dressing change had been completed per the Plan of Care. There was no Physician order located for a coccyx dressing change.

Upon patient record review 1 of 14 (Patient #2) did not contain evidence that the Hospice Aide had provided services that were: • Ordered by the Interdisciplinary Group • Included in the Aide Plan of Care Patient #2: During the Surveyor-attended home visit on 08/19/24, the Aide reported that at each home visit she: 1) Applies Diclofenac Ointment to the patient's bilateral knees and ankles; 2) Applies anti-fungal powder to the patient's groin area; and 3) Applies A&D Ointment to the patient's buttocks and panti-line. These interventions were not ordered/assigned on the Aide's current Plan of Care.

Upon patient record review, 1 of 14 (Patient #6) did not contain evidence that all entries are clear and complete: Patient #6: The RN SOC assessment noted six (6) different wound locations. The POC included Physician orders to, "Cleanse all skin tears with wound cleanser, pat dry, apply topical ATB, and leave open to air." For each of these described wound locations, the RN had documented on the SOC assessment that, "Wound Cleansing/Dressing Change per Plan of Care completed," without the details of such wound care having been provided.

Upon patient record review, 1 of 14 (Patient #11) did not contain evidence that the completed Discharge Summary included all CMS-required information: Patient #11: Discharged 02/10/24. The DC Summary did not include all CMS-required content as follows: • A summary of the patient's stay, including treatments, symptoms and pain management • The patient's current Plan of Care • The patient's latest Physician orders