Every finding on record at Paradigm Living Concepts, LLC

Upon patient record review 3 of 27 (Patients #4, 13, 17) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patients #4, 13, 17: There was no evidence of an initial spiritual care assessment being completed by any discipline.

Upon patient record review, 1 of 27 (Patient #3) did not have evidence that a Registered Nurse is designated to ensure 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 #3: On 12/05/25, the patients spouse and facility staff called stating that patient was experiencing symptoms of a UTI. Augmentin was ordered and called in, however, there was no visit made, and no follow up on infection or new medication until 12/11/25. In the meantime, on 12/7/25, the facility called stating patient fell but there was no injury followed by a call from the facility the next day on 12/8/25 stating they needed antibiotic cream for abrasions on face received from fall the day prior. No visit that day and no follow up visit or phone call until 12/11/25.

Upon patient record review, 9 of 27 (Patient #2, 3, 4, 5, 7, 8, 12, 14, 16) 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 #2: The patient is on Melatonin, however there are no interventions or goals on the POC for sleep. The patient has Music Therapy, however there is no POC with interventions or goals for the Music Therapist. The patient is on several medications for constipation, however, there is no evidence of interventions or goals in the POC for constipation. Patient #3: The patient has been prescribed Boost as a nutritional supplement. There is no evidence of interventions or goals for use of supplements in a nutritional POC. The patient is on Melatonin, however there are no interventions or goals on the POC for sleep. The patient has Music Therapy, however there is no POC with interventions or goals for the Music Therapist. Patient #4: The patient is prescribed phenylephrine for cough, there is no evidence of interventions or goals for cough on the POC. The patient is on service for intestinal cancer. They are prescribed Loperamide and Zofran for GI upset - there is no evidence of interventions or goals for GI disturbance on the POC. Patient #5: The patient is taking Seroquel and Sertraline for depression. There is no evidence of interventions or goals related to depression on the POC. The patient is on Melatonin, however there are no interventions or goals on the POC for sleep. Patient #7: The patient has Music Therapy, however there is no POC with interventions or goals for the Music Therapist. Patient #8: The patient is on service with Cirrhosis. The patient is receiving warfarin. Although there is a bleeding precautions POC, there is no evidence of interventions or goals for education on the use of anticoagulants. The patient is a full code, however there is no evidence of interventions or goals regarding advanced directives. The patient is on Melatonin, however there are no interventions or goals on the POC for sleep. Patient #12: This patient is on service for ALS. She has DME including a Trilogy ventilator, a suction machine, and a cough assist. There is no evidence of interventions or goals for these DME items. In addition, there is no evidence of interventions or goals for cough included on the respiratory POC. The patient has a peg tube. There are interventions and goals for the peg tube, however there is no evidence of interventions or goals for the site care ordered for the peg tube. Patient #14: The patient is on service with pulmonary fibrosis and has a nebulizer with nebulized medications. There is no evidence of interventions or goals related to use of a nebulizer on the POC. Patient #16: The patient is on service for Senile degeneration of the brain and co-morbidity of Lewy bodies dementia. The patient is prescribed Zyprexa, citalopram, and Trazadone for depression and anxiety. There is no evidence of interventions or goals for depression or anxiety on the POC.

Upon patient record review, 2 of 27 (Patients #5, 12) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #5: On 12/28/25, the facility nurse called stating patient was experiencing nosebleeds. The orders were to discontinue aspirin. There was no update to the POC. Patient #12: On 12/23/25, spouse called stating the patient was experiencing increased gas and bloating. New medications ordered, including Simethicone. There was no update to the POC.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. The Volunteer services equaled 1.4% in Quarter #1 of 2025. The total in Quarter #2 was 2.4%. The total in Quarter #3 was 1.52%, and the total for Quarter #4 was 2.004%.

Upon patient record review, 1 of 20 (Patient #20) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient 20: The medical record did not contain evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death.

Upon patient record review, 2 of 20 (Patient #7,#15) 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: Patient 7: The Medication profile contains Polyethylene Glycol 17gm (1 packet) by mouth daily. There is no evidence of a diluent. Corrected on site. Patient 15: The Medication profile contains Polyethylene Glycol take 1 scoop or 17gm by mouth daily. There is no evidence of a diluent. Corrected on site.

Upon patient record review, 1 of 20 (Patient #13) did not have evidence that each patient and family received education and training provided as appropriate to their responsibilities for the care and services identified in the plan of care. Patient 13: The medical record contains documentation by the nurse on 12-20-22 "pt wanted to go out and smoke". There is evidence the patient is a current smoker and on oxygen continuous and there was no evidence of no smoking education done since admission. Corrected on site.

Upon patient record review, 1 of 20 (Patient #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 9: The medical record contains documentation by the nurse that patient had sustained falls on 1-3-23 and 1-5-23 there was no evidence of a fall risk care plan added. Corrected on site.

Upon patient record review, 3 of 20 (Patient #7,#9,#15) 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 7: The POC contains Polyethylene Glycol 17gm (1 packet) by mouth daily. There is no evidence of a diluent. Corrected on site. Patient 9: The POC contains orders for Oxygen 4-5 liters. The medical record contains documentation by the LPN on 1-23-23 " Pt is wearing O2 currently set at 2L PNC". There was no evidence of an order for the oxygen to be set at 2L. Corrected on site. Patient 15: The POC contains Polyethylene Glycol take 1 scoop or 17gm by mouth daily. There is no evidence of a diluent. Corrected on site.

Upon client record review, 3 of 20 (Patient #9, 13, 17) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 9: The POC contains a visit schedule for the MSW for 3 times a week. There is evidence the MSW is visiting 3 times per Month. Corrected on site. Patient 13: The POC contains visit orders for the nurse 2 times per week. There is evidence the nurse made 3 visits in the week of 12-25-22--12-31-22. There is no evidence of the third visit being PRN or an order for an extra visit that week. Corrected on site. Patient 17: The medical record contains documentation by the RN on 1-3-23 "1x1cm spot on her lower back applied dressing for protection". There is not evidence of an order for wound care. Corrected on site.

Upon patient client record review, 7 of 20 (Patient #4,#5,#7,#9,#16,#18,#20) 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 4: The medical record contains documentation on 1-4-23 by the Aide "Communicate to RNCM any changes that need reported." There is no evidence that RNCM is an approved abbreviation. Corrected on site. Patient 5: The medical record contains documentation by the nurse on 12-14-21 using "DIL". There is no evidence "DIL" is an approved abbreviation. The medical record contains documentation on 1-4-23 by the RN in the intervention section, Foley catheter identified on 1-18-23. Corrected on site Foley note updated by nurse. Patient 7: The medical record contains documentation on 1-24-23 by the nurse "FSN applied betadine prior to CM visit". There is no evidence FSN and CM are approved abbreviations. Patient 9: The medical record contains documentation on 12-22-22 by the RN "Updated FSN Jessica". There is no evidence that FSN is an approved abbreviation. 1-20-23 "Skin is C/D/I", "LCTA in all fields" There is no evidence of C/D/I and LCTA being approved abbreviations. 1-23-23 "Pt is wearing O2 currently set at 2L PNC" There is no evidence that PNC is an approved abbreviation. Patient 16: The medical record contains documentation by the nurse on 12-26-22 "CG 8 hours a day". There is no evidence CG is an approved abbreviation. 1-23-23 the nurse documents "agreed to speak with CHAP". There is no evidence CHAP is an approved abbreviation. Patient 18: The medical record contains documentation by the RN "Foley catheter changed per orders". There was no evidence of how the intervention was completed. Patient 20: The medical record contains documentation by the RN on 4-8-22 "RHC". There is no evidence RHC is an approved abbreviation.