Every finding on record at Partners in Home Care, Inc.

Upon patient record review, 1 of 19 records reviewed (Patient #10) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient #10: The record indicated a comprehensive assessment was complete on 9/5/23. There was no evidence that the comprehensive assessment took into consideration the imminence of death. COS.

Upon patient record review, 7 of 19 records reviewed (Patient #1, #2, #3, #5, #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 #1: The record indicated on the MAR Oxygen 1-5 Liters Continuous. There was no evidence of the route of administration and no evidence of parameters. COS. In addition, Calmoseptine 44% - 20.6% per instructions daily topical skin protectant was listed on the MAR. There was no evidence of where to apply the skin protectant and no amount. COS. Patient #2: The record indicated on the MAR Voltaren Arthritis Pain 1% Topical gel per instructions Q4hours prn. There was no evidence of the site or how much to apply. COS. In addition, Oxygen 1-5 liters prn for breathing was on the MAR. There was no evidence of the route of administration and any parameters listed i.e. 1-2 for mild SOB, 3-5 for moderate/severe SOB. COS. Patient #3: The record indicated on the MAR Senna S 1-4 tablets daily prn constipation. There was no evidence of parameters. i.e. 1-2 tablets for mild constipation and 3-4 tablets for moderate constipation. COS. Also, during the home visit the patients wife verbalized the nurse had scheduled his Senna S 2 tablets every other day as scheduled in addition they may titrate the Senna S to 3-4 tablets every other day prn constipation, hold for loose stools. There was no evidence on the MAR of this instruction. COS. Patient #5: The record indicated on the MAR Atropine 0.01% eye drops 2 drops as directed prn opthalmic (eye)-alternate route by mouth Q3hours secretions. There was no evidence to be clear that this was to be used by mouth for increased secretions and not in the eyes. COS. In addition, Metronidazol 500mg/100ml in sodium chloride (ISO) Intravenous piggyback 10ml daily IV alternate route on the skin. There was no evidence to be clear that this was for topical use of the skin and where to apply it and not give IV. COS. Patient #6: The record indicated on the MAR oxygen CPAP per instructions Oxygen nightly H2O with 3 Liters oxygen supplementation, patients personal machine. There was no evidence of the CPAP settings and or the route of administration. COS. Patient #7: The record indicated on the MAR Morphine 20mg/ml 0.125ml - 1.0 ml Q2 hours prn SOB. There was no evidence of parameters. COS. Patient #8: The record indicated on the MAR Morphine 20mg/ml 0.125ml - 1.0 ml Q2 hours prn SOB. There was no evidence of parameters. COS.

Upon patient record review, 1 of 19 records reviewed (Patient #4) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #4: The record indicated the Bereavement Risk Assessment was due by 8/22/23, the start of care was 8/17/23. There was no evidence of the bereavement risk assessment being completed until 8/23/23.

Upon patient record review, 7 of 19 records reviewed (Patient #1, #2, #3, #5, #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 #1: The record indicated an MD order for Oxygen 1-5 Liters Continuous. There was no evidence of the route of administration and no evidence of parameters. COS. In addition, Calmoseptine 44% - 20.6% per instructions daily topical skin protectant was ordered. There was no evidence of where to apply the skin protectant and no amount. COS. Patient #2: The record indicated an MD order for Voltaren Arthritis Pain 1% Topical gel per instructions Q4hours prn. There was no evidence of the site or how much to apply. COS. In addition, Oxygen 1-5 liters prn for breathing was ordered. There was no evidence of the route of administration and any parameters listed i.e. 1-2 for mild SOB, 3-5 for moderate/severe SOB. COS. Patient #3: The record indicated an MD order for Senna S 1-4 tablets daily prn constipation. There was no evidence of parameters. i.e. 1-2 tablets for mild constipation and 3-4 tablets for moderate constipation. COS Patient #5: The record indicated an MD order for Atropine 0.01% eye drops 2 drops as directed prn opthalmic (eye)-alternate route by mouth Q3hours secretions. There was no evidence to be clear that this was to be used by mouth for increased secretions and not in the eyes. COS. In addition, Metronidazol 500mg/100ml in sodium chloride (ISO) Intravenous piggyback 10ml daily IV alternate route on the skin. There was no evidence to be clear that this was for topical use of the skin and where to apply it and not give IV. COS. Patient #6: The record indicated an MD order for oxygen CPAP per instructions Oxygen nightly H2O with 3 Liters oxygen supplementation, patients personal machine. There was no evidence of the CPAP settings and or the route of administration. COS. Patient #7: The record indicated an MD order for Morphine 20mg/ml 0.125ml - 1.0 ml Q2 hours prn SOB. There was no evidence of parameters. COS. Patient #8: The record indicated an MD order for Morphine 20mg/ml 0.125ml - 1.0 ml Q2 hours prn SOB. There was no evidence of parameters. COS.

Upon patient record review 1 of 19 (Patient #1) 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 #1: The record indicated a Hospice Aide frequency order effective on 5/2/24 for 2 X W. There was no evidence of a second visit during this time period.

Upon patient record review, 1 of 19 records reviewed (Patient #5) did not have evidence that the hospice provided the following information: • The most recent hospice plan of care specific to each patient • Hospice election form and any Advance Directives specific to each patient • Physician certification and recertification of the terminal illness specific to each patient • Names and contact information for hospice personnel involved in hospice care of each patient • Instructions on how to access the hospice's 24-hour on-call system • Hospice medication information specific to each patient • Hospice physician and attending physician (if any) orders specific to each patient Patient #5: During the on site visit the facility chart was reviewed. The patients record did not have the second benefit period CTI on the chart or the names and contact information for the hospice personnel involved in hospice care. Both were COS.