Every finding on record at Paradise Hospice Inc

Upon patient record review 1 of 14 (Patient #2) 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: Patient was admitted on 7/31/25, there is no evidence of initial comprehensive spiritual assessment being completed by any discipline until 8/21/25.

Upon patient record review, 1 of 14 (Patient #8) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient 8:The patient was admitted on 4/23/25. The RN comprehensive assessment does not assess for imminence of death.

Upon patient record review, 4 of 14 (Patient #2,6,7,8) 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:Medication profile contains orders for hydrocortisone cream without a site of application. Corrected on site, POC updated. Patient 6:Medication profile dated 12/4/25 contains orders for Lidocaine 4% Topical Pain patch without evidence of site of application. Corrected on site, POC updated. Patient 7:Medication profile dated 12/4/25 contains orders for Lidocaine 4% Topical Pain patch, Lidex 0.05% Topical cream, Diclofenac Sodium 1% topical gel, Bactroban 2% topical cream and hydrocortisone 2.5% topical cream, without evidence of site of application. Corrected on site, POC updated. Patient 8:Medication profile contains orders for hydrocortisone cream without a site of application. Corrected on site, POC updated.

Upon patient record review, 6 of 14 (Patient #1,2,4,5,6,8) 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 1,2,4,5,6,8:The current Medication Record/POC includes orders for aspirin. There is no evidence of a risk for bleeding care plan with appropriate goals and interventions. Corrected on site, POC updated.

Upon patient record review, 4 of 14(Patient #2,6,7,8) 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:Order for hydrocortisone cream without an application site. Corrected on site, medication record updated. Patient 6:Orders for Lidocaine 4% Pain patch without a site of application. Corrected on site, medication record updated. Patient 7:Orders for Lidocaine 4% Pain patch, Lidex 0.05% Topical cream, Diclofenac Sodium 1% topical gel, Bactroban 2% topical cream and hydrocortisone 2.5% topical cream without a site of application. Corrected on site, medication record updated. Patient 8:Order for hydrocortisone cream without an application site. Corrected on site, medication record updated.

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:Current POC includes orders for Aide 2x weekly ordered 6/25/25, medical record does not show evidence of any Aide visits being completed since the time of order. Corrected on site, POC updated.

Upon personnel record review, 3 of 11(Personnel #5,6,8 ) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel 05:Handwashing competency evaluation and Hand Hygiene with alcohol based formulation competency evaluation are marked as direct observation (DO); Initial orientation form(s) indicate “Staff Demonstrated competency in handwashing: Yes or No , neither are marked. Competency orientation checklist/Hospice Chaplain does not show evidence of self assessment per policy or dates of completion. Core competency skill(s) 1,2,3 &4 do not indicate if employee is competent or when competency was completed. Personnel 06:Handwashing competency evaluation and Hand Hygiene with alcohol based formulation competency evaluation are marked as direct observation (DO); Initial orientation form(s) indicate “Staff Demonstrated competency in handwashing: Yes or No , neither are marked. Personnel 08:Handwashing competency evaluation AND Hand Hygiene with alcohol based formulation competency evaluation are marked as direct observation (DO); Initial orientation form(s) indicate “Staff Demonstrated competency in handwashing: Yes or No , neither are marked.

Upon patient record review, 1 of 11 (Patient #8) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient 8: The medical record contained a CTI identifying NP as an attending physician. There was no evidence that the patient/representative elected the NP as an attending for continued involvement with treatment.

Upon patient record review 1 of 11 (Patient #2) 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: There was no evidence of a spiritual assessment completed until 11/14/22. Patient admitted 9/6/22.

Upon patient record review, 1 of 11 (Patient #1) 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 1: The medical record contained nursing documentation upon recertification 10/11/22 identifying patient had increased dyspnea including shortness of breath during bedside care. There was no evidence of problems, goals, and interventions related to respiratory dysfunction.

Upon patient record review, 1 of 11 (Patient #11) 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 11: The medical record contained nursing documentation upon admission identifying patient use of a shower chair. There was no evidence of the shower chair included as DME on the plan of care.

Upon patient record review, 1 of 11 (Patient #5) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • 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 5: The aide care plan contained both bath types of shower and bed bath, and tasks including shower, bed bath, shave, clean nails, and soak feet with instructions as needed.

Upon patient record review 1 of 11 (Patient #11) 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 Patient 11: The medical record contained aide documentation 4/27/22 and 5/4/22 identifying the aide showered the patient. There was no evidence of a task to shower included on the plan of care. The tasked bath type was for a bed bath.

Upon patient record review, 1 of 11 (Patient #8) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient's life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination: • The primary terminal condition • Related diagnosis • Current subjective and objective medical findings • Current medication and treatment orders • Information about the medical management of any of the patient's conditions unrelated to the terminal illness Patient 8: There was no evidence of a verbal certification received timely upon admission. The written CTI was signed 8/21/22 with start of care 5/27/22.

Upon patient record review, 1 of 11 (Patient #5) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient's clinical information and provide written documentation that it is anticipated that the patient's life expectancy is 6 months or less. Patient 5: There was no evidence of a face to face completed for determination of eligibility upon recertification for the third benefit period.

Upon patient client record review, 4 of 11 (Patient #1, 5, 6, 7) 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: The medical record contained consents and an election of benefit form signed by an unidentified patient representative. The reason patient was unable to sign consents and the relationship of person signing was blank on the forms. Patient 5, 6, 7: The medical record contained an election of benefit form and notice of non-coved items form with no reason patient was unable to sign entered on the documents.

Upon patient client record review, 1 of 11 (Patient #2) did not have evidence that each patient record contains Physician certification and recertification of terminal illness. Patient 2: There was no evidence of a certification of terminal illness upon admission received from the elected attending physician. Agency received documentation 9/7/22 identifying the attending did not want to follow the patient, however there was no evidence of communication with the patient/representative or change of physician acknowledged.