Every finding on record at Parentis Hospice and Health Care, Inc

Based on interview and record review, the hospice failed to ensure the comprehensive assessment was completed no later than five calendar days after the election of hospice care for one of three sampled patients (Patient 3).  This failure had the potential for not addressing the care needs for this patient.Findings: --- The hospice's P&P titled Comprehensive Assessment revised July 2025 showed a comprehensive patient assessment will be performed by the interdisciplinary group no later than 5 calendar days after the election of hospice care in consultation with the attending physician.  Review of Patient 3's clinical record was initiated on 5/29/26.  The clinical record showed the SOC was 4/3/26.  The patient was certified for hospice services during the certification period from 4/3/26 to 6/1/26.  The Informed Consent and Treatment Authorization dated 4/1/26, showed the patient's legal representative signed for the hospice. Further review of the Informed Consent and Treatment Authorization form included a section for the election of hospice benefit.  The election of hospice benefit was dated 4/6/26.   Review of the clinical record showed the SC had performed the initial comprehensive assessment dated 4/9/26.   However, the SC had performed the initial comprehensive assessment more than five days from the election of hospice benefit as per the hospice's P&P.  On 5/29/26 at 1354 hours, an interview and concurrent clinical record review was conducted with the DPCS and Director of QAPI/LVN.  The Director of QAPI/LVN was asked when the election of benefit was signed.  The Director of QAPI/LVN reviewed the clinical record and replied, it was a typo error, the election of benefit was signed on 4/1/26, and the SOC was on 4/3/26.   The DPCS was asked the timeline of the completion of the SC's initial comprehensive assessment.  The DPCS replied, it should be completed within five days from the SOC.  The DPCS was informed and acknowledged the finding.

Based on record review and interview, the hospice failed to ensure care and services were provided in accordance with the POC for two of three sampled patients (Patients 1 and 3).  This failure created the risk of not providing appropriate, consistent, and quality care to these patients.Findings: --- The hospice’s P&P titled The Plan of Care revised July 2025 showed a written individualized patient and family/caregiver plan of care will be established and maintained for each individual admitted in the hospice program.  The care provided to the patient must be in accordance with the plan of care.  The plan of care will meet the documentation requirements of the physician-directed medical orders and the care planning process.  1.  Review of Patient 1’s clinical record was initiated on 5/27/26.  The clinical record showed the SOC was 1/31/26.  The patient was certified for hospice services during the certification period from 4/1/26 to 5/30/26.a.  The Physicians Order dated 4/18/26, showed a wound care order: "Wound care to coccyx: cleanse wound cleanser, pat dry apply collagen particles to wound bed, cover medihoney, cover calcium alginate, cover dry dressing to be done 3x weekly or as needed for soiled or dislodged dressing, to be done by hospice nurse or caregiver." Review of the SN visit notes dated 5/20/26, showed RN 1 had performed wound assessment and treatment to the patients’ left buttock pressure injury.   RN 1 documented the wound treatment as follows: cleansed with wound cleanser, patted dry, covered with  calcium alginate (wound dressing), covered with a dry dressing, and to be done three times weekly or as needed for soiled or dislodged dressing, to be done by the caregiver or hospice nurse. However, RN 1 failed to cover the wound with Medihoney (wound dressing) as ordered by the physician. b.  The hospices' P&P titled Missed Visits revised July 2025 showed if a visit is missed for any reason, the clinician should attempt to reschedule it for the same week so that the physician ordered frequency is maintained and would not be considered a missed visit. The POC/IDG dated 5/12 and 5/26/26, cited SN visits three times per week plus two PRN visits for follow up. Review of the clinical record showed the following:-During Week 5 (4/26/26 to 5/2/26), the SN had visited the patient two times on 4/27 and 4/29/26, instead of three times as ordered by the physician. -During Week 6 (5/3/26 to 5/9/26), the SN had visited the patient two times on 5/4 and 5/6/26, instead of three times as ordered by the physician.-During Week 8 (5/17/26 to 5/23/26), the SN had visited the patient two times on 5/18 and 5/20/26, instead of three times as ordered by the physician. In addition, there was no documented evidence of the missed visit was re-scheduled in the same week as per the hospice's P&P. On 5/29/26 at 1445 hours, an interview and concurrent clinical record review was conducted with the DPCS.   The DPCS was informed and acknowledged the findings. 2.   Review of Patient 3's clinical record was initiated on 5/29/26.  The clinical record showed the SOC was 4/3/26.  The patient was certified for hospice services during the certification period from 4/3/26 to 6/1/26. The Physicians Order dated 4/4/26, showed an order for a podiatry consult for evaluation and treatment.However, review of the clinical record failed to show documented evidence of a podiatry consult as ordered by the physician.                                                   On 5/29/26 at 1354 hours, an interview and concurrent clinical record review was conducted with the DPCS.   The DPCS was asked if the physician's order was followed.  The DPCS reviewed the clinical record and replied, no.  The DPCS was informed and acknowledged the findings.

Based on interview and record review, the hospice failed to ensure the individualized care plan was developed for one of three sampled patients (Patient 1).  This failure had the potential to cause inconsistent delivery of care which can result in the decline or lack of improvement of the patients' health conditions. Findings: --- The hospices' P&P titled Interdisciplinary Group Plan of Care revised July 2025 showed the interdisciplinary group (in collaboration with the attending physician, if any) will conduct assessments, develop and update the plan of care, and review the effectiveness of care a minimum of every 15 calendar days.Review of Patient 3's clinical record was initiated on 5/29/26.  The clinical record showed the SOC was 4/3/26.  The patient was certified for hospice services during the certification period from 4/3/26 to 6/1/26.Review of the Visit Note RN dated 5/12, 5/15, 5/19, 5/22, and 5/26/26, showed RN 2 had performed skin assessment.  The assessment included the following:-number: 2-open date: 5/12/26-location: right groin area  -description: rash bilateral groin-status: treat-treatment/intervention: nystatin powder*  However, review of the POC/IDG dated 5/12 and 5/26/26, failed to show documented evidence of a care plan developed to address the patient's bilateral groin rash.On 5/29/26 at 1354 hours, an interview and concurrent clinical record review was conducted with the DPCS.   The DPCS was informed and acknowledged the findings.

Based on interview and record review, the hospice failed to ensure the revised POCs included the visit frequency of the services provided for one three sampled patients (Patient 1).  This failure had the potential of not providing necessary services for this patient.Findings: --- The hospice’s P&P titled Plan of Care revised July 2025 showed the plan of care reflects patient and family goals and interventions that are based on the problems identified in the initial, comprehensive, and updated assessments performed by members of the interdisciplinary group.  The plan of care will identify the patients' needs and service to meet those needs.  It must state in detail the scope and frequency of services to meet the patient's and family/caregiver's needs, goals and outcome achievement.  The plan of care includes but is not limited the frequency/amount/duration and type of services.Review of Patient 1’s clinical record was initiated on 5/27/26.  The clinical record showed the SOC was 1/31/26.  The patient was certified for hospice services during the certification period from 4/1/26 to 5/30/26.The POC/IDG Reviews dated 4/14 and 4/28/26, showed the IDG's discussions for nursing, spiritual, and psychosocial.  The POC/IDG also included the plan of care with goals and interventions.  The POC/IDG also included a section for the visit frequency.*  However, the POC/IDG failed to include the visit frequency for the disciplines needed as the section was left blank. On 5/29/26 at 1445 hours, an interview and concurrent clinical record review was conducted with the DPCS.  The DPCS was asked if the POC needed to include the disciplines' visit frequency.  The DPCS reviewed the clinical record and replied yes, it was missed, maybe during the electronic merging.  The POC should include the visit frequency.  The DPCS was informed and acknowledged the findings.

Based on interview and record review, the hospice failed to ensure the POCs included measurable outcomes for three of three sampled patients (Patients 1, 2, and 3).  This failure had the potential risk of not evaluating the POC and providing appropriate care and services to these patients.Findings: --- The hospice’s P&P titled Plan of Care revised July 2025 showed the plan of care reflects patient and family goals and interventions that are based on the problems identified in the initial comprehensive and updated assessments.  The plan of care will contain but will not be limited to measurable outcomes anticipated from implementing and coordinating the plan of care.  1.  Review of Patient 1’s clinical record was initiated on 5/27/26.  The clinical record showed the SOC was 1/31/26.  The patient was certified for hospice services during the certification period from 4/1/26 to 5/30/26.The POC/IDG Review dated 4/14, 4/28, 5/12, and 5/26/26, showed the patient's identified problems with the established goal and interventions.  However, the POC failed to include measurable outcomes for the patient's identified problems.  For example:-ADL: will meet all of her ADL needs-Gastrointestinal: will have reduced episodes of diarrhea and maintain comfort, skin integrity and hydration status,-Genitourinary: elimination needs met at an acceptable level,-Neurological/mental: care needs will be safely met daily,-Pain: will not interfere with sleep,-Respiratory: measures to manage SOB -Sleep: will not have any sleep disturbance.However, there was no documented evidence of what an acceptable level was, needs were met, and what the measures to manage shortness of breath and sleep disturbance were for the patient.On 5/29/26 at 1445 hours, an interview and concurrent clinical record review was conducted with the DPCS.  The DPCS was informed and acknowledged the findings.2.  Review of Patient 2's clinical record was initiated on 5/28/26.  The clinical record showed the SOC was 4/4/26.  The patient was certified for hospice services during the certification period from 4/4/26 to 6/2/26.The POC/IDG Review dated 4/14, 4/28, 5/12, and 5/26/26, showed the patient's identified problems with the established goal and interventions.  However, the POC failed to include the measurable outcomes for the patient's identified problems.  For example:- Cardiovascular: achieve and maintain peripheral circulation for patient comfort- Gastrointestinal: facilitate bowel elimination and comfort by monitoring "BM".- Nutrition: will have adequate food and fluids as tolerated or desired - Respiratory: to remain comfortable daily.However, there was no documented evidence as to what the level of peripheral circulation, bowel elimination, adequate food and fluid to maintain comfort as tolerated were for the patient.On 5/29/26 at 1415 hours, an interview and concurrent clinical record review was conducted with the DPCS.   The DPCS was informed and acknowledged the findings. 3.   Review of Patient 3's clinical record was initiated on 5/29/26.  The clinical record showed the SOC was 4/3/26.  The patient was certified for hospice services during the certification period from 4/3/26 to 6/1/26.The POC/IDG Review dated 4/14, 4/28, 5/12, and 5/26/26, showed the patient's identified problems with the established goal and interventions.  However, the POC failed to include the measurable outcomes for the patient's identified problems.  For example:- Cardiovascular: patient's discomfort will be managed- Neurological/mental: acceptable behavior- Nutrition: meet all of the nutritional needs- Pain: demonstrate acceptable pain level and remain comfortable- Respiratory: meet all her oxygen needs- Sleep: will not have sleep disturbance. *  However, there was no documented evidence of what an acceptable level for pain was.  There were no quantifiable information as to what meeting all of the patient's nutritional and oxygen needs and sleep disturbance for the patient.On 5/29/26 at 1354 hours, an interview and concurrent clinical record review was conducted with the DPCS.  The DPCS was informed and acknowledged the findings.

Based on interview and record review, the hospice failed to ensure the IDG had reviewed/revised the patient’s POCs no less frequently than every 15 calendar days for one of three sampled patients (Patient 3).  This failure had the potential for not providing appropriate, consistent, and quality care to this patient.Findings: --- The hospices' P&P titled Interdisciplinary Group Meeting revised July 2025 showed each patients' plan of care will be updated utilizing the results from the ongoing comprehensive assessments no less frequently than every 15 days or more frequently if patients' condition requires.  Review of Patient 3's clinical record was initiated on 5/29/26.  The clinical record showed the SOC was 4/3/26.  The patient was certified for hospice services during the certification period from 4/3/26 to 6/1/26.Review of the Visit Note RN dated 5/12, 5/15, 5/19, 5/22, and 526/26, showed RN 2 had performed skin assessment.  The assessment included the following:-number: 2-open date: 5/12/26-location: right groin area -description: rash bilateral groin-status: treat-treatment/intervention: nystatin powderHowever, review of the POC/IDG dated 5/12 and 5/26/26, failed to show documented evidence the IDG had reviewed and discussed the POC related to the patient's identified rash to the right groin. On 5/29/16 at 1354 hours, an interview and concurrent clinical record review was conducted with the DPCS.   The DPCS was informed and acknowledged the findings.

Based on interview and record review, the hospice failed to maintain a system of communication and integration in accordance with their P&P to ensure the IDG had maintained responsibility for directing, coordinating, and supervising the care and services provided for two of three sampled patients (Patients 1 and 2).  This failure had the potential of not addressing the care needs for these patients.Findings: --- The hospice's P&P titled Interdisciplinary Group Membership and Responsibilities revised July 2025 showed the interdisciplinary group responsibilities include but are not limited to: Provision and/or supervision and coordination of hospice care and services.The hospice's P&P titled Interdisciplinary Group Meeting revised July 2025 showed the procedures included referrals and admissions will be reviewed to established appropriateness for hospice care.  Obstacles to access of care issues will be identified and resolved.  Admission will be reviewed to ensure compliance with hospice policies and procedures.  It will note changes, response to treatment and progress toward targeted outcomes, which may include an increase or decrease in symptoms or acuity: conditions of skin/presence/status of pressure ulcers.The hospice's P&P titled Interdisciplinary Group Plan of Care revise July 2025 showed written evidence of care coordination will be found in the plan of care and/or interdisciplinary team meeting forms in the patient's clinical record and will involve the hospice patients' attending physician. The hospice's P&P titled Submission of Clinical Notes undated showed staff must complete and electronically sign all clinical visit notes within 24 hours of the patient encounter.1.  Review of Patient 1’s clinical record was initiated on 5/27/26.  The clinical record showed the SOC was 1/31/26.  The patient was certified for hospice services during the certification period from 4/1/26 to 5/30/26.a.  Review of the Visit Note RN dated 4/1, 4/3, 4/8, 4/10, 4/13, 4/15, 4/17, 4/20, 4/22, 4/24, 4/27, 4/29, 5/4, 5/6, 5/8, 5/11, 5/13, and 5/20/26, showed under the section of Integumentary - Skin,  RN 1 documented the patient's wound as "Stage IV/Deep injury."Further review of the Skin Assessment on the section of List of Current Location showed the patient was assessed to have left buttock pressure injury.  The Stage was documented as "U," which indicated unstageable.  The wound stage was inconsistent.On 5/29/26 at 1445 hours, an interview and concurrent clinical record review was conducted with the DPCS.   The DPCS was asked if the stage of the pressure injury was consistent.  The DPCS replied, it was inconsistent.  The DPCS also asked if the staging of pressure injury was discussed in the IDG meeting.    The DPCS reviewed the clinical record and replied that it was not discussed in the IDG meeting.  The DPCS was informed and acknowledged the findings. * The POC/IDG review dated 4/14, 4/28, 5/12 and 5/28/26, failed to show documented evidence the IDG had supervised the care and services related to the consistency of the SN's assessment of the patient's pressure injury.b.   Review of the Patient Consent for Medical Photography and Publications dated 1/29/26, showed a check mark indicating "I decline the use of my image for any purpose, including medical records and treatment purposes."However, review of RN 1's visit note dated 4/1, 4/3, 4/6, 4/8 and 4/10/26, showed the RN 1 performed wound care treatment to the patients’ pressure injury to the coccyx.  An updated photo was obtained and uploaded to the chart which was inconsistent with the patients’ consent.Further, review of the POC/IDG dated 4/14, 4/28, 5/12 and 5/28/26, failed to show documented evidence the IDG had discussed the wound photograph was taken even though the patient had signed the consent for the refusal for wound photography. * The IDG failed to supervise the care and services related to the patient's consent for medical wound photography.c.   The POC/IDG dated 5/12 and 5/28/26, cited SN 3 times per week plus 2 PRN visits for follow up. Review of the clinical record showed on Week 9 (5/24 to 5/30/26), the SN had visited the patient one time on 5/28/26.On 5/28/26 at 0827 hours an observation and interview was conducted with RN 1.  RN 1 was asked as to the frequency of the visit.  RN 1 replied three times a week.  RN 1 also reported she visited the patient last Sunday (5/24/26). However, review of the clinical record failed to show documented evidence of the visit note completed for the visit conducted on Sunday (5/24/26) as reported by RN 1.On 5/29/26 at 1445 hours, an interview and concurrent clinical record review was conducted with the DPCS.  The DPCS was asked as to the timeline for the submission of clinical notes.  The DPCS replied, within 24 hours of the visit.   The DPCS was also asked if there was a visit on 5/24/26.  The DPCS reviewed the clinical record and replied, there was one.   The DPCS was informed of no visit note for the visit on 5/24/26, and acknowledged the findings.* The IDG failed to supervise the care and services related to implementation of the P&P on the submission of the clinical notes. 2.  Review of Patient 2's clinical record was initiated on 5/28/26.  The clinical record showed the SOC was 4/4/26.  The patient was certified for hospice services during the certification period from 4/4/26 to 6/2/26.Review of the Visit Note Ancillary Support dated 4/10/26, showed a recommendation from the nutritionist for vitamin C (supplement) 500 mg BID for 10 to 14 days to support wound healing.* However, review of the POC/IDG dated 4/14 and 4/28/26, failed to show documented evidence of the IDG discussed and coordinated the recommendation of the nutritionist for the use of vitamin C 500 mg BID to support wound healing. On 5/29/26 at 1415 hours, an interview and concurrent clinical record review was conducted with the DPCS.  The DPCS was informed and acknowledged the findings.

Upon patient record review 1 of 16 (Patient #3) 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 3: No evidence of comprehensive spiritual assessment completed within 5 days, it was completed several weeks after admission.

Upon patient record review 2 of 16 (Patient #10,11) 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. Patient 10: There is no evidence of a spiritual care comprehensive assessment of the patient or family. Patient 11: There is no evidence of comprehensive spiritual assessment completed.

Upon patient record review, 2 of 16 (Patient #4,8) 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 4: Medication record dated 07/09/24 includes an order for Miralax powder, order does not include diluent. Patient 8: Medication record dated 11/28/23 includes orders for Nystatin powder and triamcinolone cream without a site of application.

Upon patient record review, 3 of 16 (Patient #1,3,6) 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 1: The current POC includes orders for ASA. There is no evidence of a risk for bleeding care plan with appropriate goals and interventions. Corrected on site, POC updated. Patient 3: The POC includes orders for ASA. Patient 6: The POC includes orders for ASA . There is no evidence of a risk for bleeding care plan with appropriate goals and interventions.

Upon patient record review, 2 of 16 (Patient #4,8) 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 4: POC dated 07/09/24 includes an order for Miralax powder, order does not include diluent. Patient 8: POC dated 11/28/23 includes orders for Nystatin powder and triamcinolone cream without a site of application.

Upon client record review, 1 of 16 (Patient #7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 7: Initial POC dated 04/02/24, POC(s) dated 4/2/24 through 09/17/24 include frequency for SC 1x monthly for 4 months starting 3/31/24. There is no evidence that SC visits were initiated. POC was not updated 7/31/24 as indicated.

Condition of Participation: Quality Assessment and Performance Improvement.

Upon observation, there was no evidence the program must use quality indicator data, including patient care, and other relevant data, in the design of the program. Agency was not able to provide evidence of 2024- QTR 1 or QTR 4 data and there is no evidence of data or QAPI in 2025.

Upon observation, there was no evidence the QAPI program uses quality indicator data, including patient care and other relevant data in the design of its program. The hospice must use the data collected to: • Monitor the effectiveness and safety of services and quality of care • Identify opportunities and priorities for improvement Agency was not able to provide evidence of 2024- QTR 1 or QTR 4 data and there is no evidence of data or QAPI in 2025.

Upon observation, there was no evidence QAPI activities focus on high risk, high volume, or problem prone areas. Agency was not able to provide evidence of 2024- QTR 1 or QTR 4 data or Performance improvement efforts (PIPs) and there is no evidence of data or QAPI engagement until December of 2025.

Upon observation, there was no evidence Quality Assessment and Performance Improvement activities focus on high risk, high volume or problem-prone areas. Considering incidence, prevalence, and the severity of problems. Agency was not able to provide evidence of 2024- QTR 1 or QTR 4 data and there is no evidence of data or QAPI in 2025.

Upon observation, there was no evidence Quality Assessment and Performance Improvement activities focus on high risk, high volume or problem-prone areas by understanding how they affect palliative outcomes, patient safety and quality of care. Agency was not able to provide evidence of 2024- QTR 1 or QTR 4 data and there is no evidence of data or QAPI in 2025.

Upon observation, there was no evidence of involvement of the governing body and organizational leaders in the Quality Assessment/Performance Improvement (QAPI) program. Agency was not able to provide evidence of 2024- QTR 1 or QTR 4 data and there is no evidence of data or QAPI engagement 2025.

Upon patient record review, 2 of 16 (Patient #1,11) 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 1: Most current aide POC does not include evidence of frequencies for tasks to be completed by hospice aide. Patient 11: Aide POC dated 8/2/24 does not include an acceptable frequency for footcare, oral care, clean/file nails, change linen and assist with ambulation. Frequencies state “when applicable”.

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. Agency was unable to provide evidence of volunteer use of at least 5% of the total patient care hours in 2024. The total usage for 2024 was 0.76%.

Upon client record review, 1 of 16 (Patient #4) did not have evidence that the discharge summary includes all required information. Patient 4: Discharge/Transfer summary dated 07/05/24 does not show evidence that all the required components were sent to receiving agency. Care summary section is blank.

Upon client record review, 1 of 16 (Patient #3) 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 3: Admission clinical assessment dated 7/30/24 indicates a stage 3 pressure ulcer with measurements 0.5cm (L) 0.3cm(W) 0.1cm (D) yellow slough. Indicates cleansed with wound cleanser, packed with hydrogel and foam dressing. Documentation of wound care completed in visit summary. Clinical note dated 8/1/24 indicated wound healed and barrier cream initiated. No evidence of a skin integrity care plan with appropriate goals and interventions. In addition, there were no physicians orders found for the wound care performed. In addition, the POC includes orders for ASA . There is no evidence of a risk for bleeding care plan with appropriate goals and interventions.

Upon client record review, 1 of 11 (Patient #11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #11, SN performed wound care on 9/9, 9/21 and 9/28/22 as follows: cleansed with normal saline, applied medihoney followed with cuticerin and covered with outer dressing. There was no evidence of orders for wound care included in the plan of care.

Upon patient record review, 1 of 11 (Patient #3) did not have evidence the hospice offers bereavement counseling that includes: • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient #3, No evidence on bereavement plan of care or frequency of service delivery.

Upon patient record review 2 of 11 (Patient #6,8) 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 #6, Aide ordered 2xwk effective 11/13. Aide performed visits on 11/17 and 11/22. No missed visits or change in order for second visits in both weeks. Patient #8, Aide ordered 2xwk effective 11/20. Aide performed visit on 11/23. No second visit performed for the week. No evidence of missed visit.