Every finding on record at Peoplefirst Homecare & Hospice of Ohio, LLC

Upon patient record review 2 of 23 (Patient #1,18) 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 #1: No evidence that the psychosocial assessment was completed within 5 days after election. Psychosocial assessment completed on 01/25/2024, admit date 01/19/2024. Patient #18:: No evidence that the psychosocial assessment was completed within 5 days after election. Psychosocial assessment completed on 04/01/2024, admit date 04/11/2024.

Upon patient record review 2 of 23 (Patient #11,18) 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 #11: No evidence that a spiritual assessment was completed at the time of survey. Corrected during survey. Patient #18: No evidence that a spiritual assessment was completed at the time of survey. Corrected during survey.

Upon patient record review, 2 of 23 (Patient #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 #7: Duplicate drug therapy - the MAR has both Colace and Milk of Magnesium listed as daily for constipation. No evidence that instructions were given to on which medication to give first for treating constipation. Corrected during survey. Also, the MAR has both Miralax 17G powder daily with no evidence that instructions were given on how to dilute the powder and Miralax 17G powder every 24hours for constipation dissolved in 8oz of water. Patient #8: Duplicate drug therapy - the MAR has both Colace and Milk of Magnesium listed as daily for constipation. No evidence that instructions were given to on which medication to give first for treating constipation. Corrected during survey.

Upon patient record review, 4 of 23 (Patient #1,8,9,11) 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 #1: No evidence that the bereavement risk assessment was completed within 5 days after the election. Completed on 01/26/2024. Patient admitted on 01/19/2024. Patient #8: No evidence that the bereavement risk assessment was completed within 5 days after the election. Completed on 01/23/2024. Patient admitted on 01/15/2024. Patient #9: No evidence that the bereavement risk assessment was completed within 5 days after the election. Completed on 12/12/2023. Patient admitted on 12/06/2023. Patient #11: No evidence that the bereavement risk assessment was completed within 5 days after the election. Completed on 04/09/2024. Patient admitted on 03/28/2024.

Upon patient record review, 1 of 23 (Patient #12) 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 #12: Record shows that the patient had a wound that was present upon admission but not assessed or measured between the time of admit, 03/23/2024 until the time that is was discontinued on 05/29/2024. Gentiva policy Clin.14, for at least weekly wound assessments and measurements.

Upon patient record review, 6 of 23 (Patient #3,6,9,12,13,14) 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 #3: The record indicates that patient suffers from depression. Currently on 2 medications for depression. No evidence that the plan of care included goals and interventions related to depression. The record indicates that the patient has an unsteady gait and jerky movement that impact his ability to walk. No evidence that the plan of care included goals and interventions related to altered mobility or safety with risk for falls. Corrected during survey. Patient #6: The record indicates that patient has dysphagia. Ongoing RN documentation stated that the patient is on swallowing precautions. Risk for aspiration on current aide plan of care. No evidence that the plan of care included goals and interventions related to dysphagia. Corrected during survey. Patient #9: The record indicates that patient has dysphagia. Ongoing RN documentation stated that the patient is on swallowing precautions. Risk for aspiration on current aide plan of care. No evidence that the plan of care included goals and interventions related to dysphagia. Corrected during survey. Patient #12: Patient admitted with COPD and chronic pain syndrome. No evidence that the plan of care included goals and interventions related to respiratory or pain. Patient #13: The record indicates that patient is taking Eliquis daily. No evidence that risk for bleeding precautions were added to the current plan of care. Ongoing RN documentation stated that the patient uses a gait belt and a walker for help with mobility. No evidence that risk for falls or altered mobility added to current aide plan of care. No evidence that the plan of care included goals and interventions related to risk for falls, risk for bleeding, or altered mobility. Corrected during survey. Patient #14: The record indicates that patient is taking Plavix daily. Patient admitted with dx of CVA/Dementia and a secondary dx of dysphagia and ongoing RN documentation stated that patient is at risk for falls and dysphagia. No evidence that the plan of care included goals and interventions related to risk for falls, risk for bleeding, or altered neurological status. Corrected during survey.

Upon patient record review, 3 of 23 (Patient #2,10,12) 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 #2: Wound care on supply list at the start of survey. Wound discontinued on 05/02/2024. Corrected during survey. Patient #10: The record indicates that the patient uses a wheelchair and a walker to perform ADL's. No evidence that a walker or wheelchair was added to the current DME supply list. Corrected during survey Patient #12: The record indicates that the patient uses a wheelchair and a cane to perform ADL's. No evidence that a walker or cane was added to the current DME supply list. Corrected during survey

Upon client record review, 2 of 23 (Patient #1,4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1: Social worker frequency ordered as once a month. No evidence that a visit occurred for the month of March 2024. No evidence that the visit was declined by the patient/caregiver or that an order was receive to miss the visit for that month. Missed visit note entered that stated that the visit was missed due the employee covering for another Social Worker. Patient #4: SN frequency ordered as twice a week. No evidence two visits occurred for the week of 05/26/2024. No evidence that the visit was declined by the patient/caregiver or that an order was receive to miss the visit for that month.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient 3: During home visit, RN took her tablet, blood pressure cuff, stethoscope, thermometer, and pulse ox out of her carrier bag while heading to the patient bedroom. Once she arrived at the patients bedside, she placed her tablet on the bedside table and placed the blood pressure cuff, stethoscope, thermometer, and pulse ox on top of the patients bed before starting her assessment. The nurse failed to place a barrier on the bedside table or on the patients bed before placing her equipment down.

Upon patient record review, 1 of 23 (Patient #10) 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 #10: Plan of care has IADL tasks that included changing linens for the first visit. No evidence that a complete frequency was given on when to change the linen, on the first visit of the week or of the month. Corrected during survey.

Upon patient record review 6 of 23 (Patient #2,3,8,9,10,12) 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 #2: No evidence that all the ordered tasks on the plan of care was completed by aide (provide hair, perineal, skin {lotion}, or oral care) on the following dates: April 17th and 24th; May 1st, 8th, 15th, 22nd, and 29th; June 5th. No evidence that the RN was notified of the changes to plan of care. Patient #3:Aide frequency ordered as twice a week. No evidence that 2 visits occurred for the week of May 26th. No evidence that the visit was declined by the patient/caregiver or that an order was receive to miss the visit for that week. Missed visit note entered that stated that the visit was missed due to it being a holiday. Patient #8: Aide plan of care has orders to change linen weekly and to shower the patient once a week, on the first visit of the week. The record shows that aide performed those task on all visits. Missed visit note entered that stated that the visit was missed due to it being a holiday. Also patient shower and linen changes were ordered to be completed on the first visit of the week. The record indicates that the task is being completed at every visit. Patient #9: Aide frequency ordered as twice a week. No evidence that 2 visits occurred for the week of May 26th. No evidence that the visit was declined by the patient/caregiver or that an order was receive to change the visit frequency for that week. Missed visit note entered that stated that the visit was missed due to it being a holiday. Patient #10: Aide frequency ordered as twice a week. No evidence that 2 visits occurred for the week of May 26th. No evidence that the visit was declined by the patient/caregiver or that an order was receive to change the visit frequency for that week. Patient #12: Aide frequency ordered as twice a week. No evidence that 2 visits occurred for the 1st week of the 1st benefit period. No evidence that the visit was declined by the patient/caregiver or that an order was receive to change the visit frequency for that week. Also nail care and linen changes were ordered to be completed weekly. The record indicates that the task is being completed at every visit.

Upon patient record review 2 of 23 (Patient #10,11) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient #10: No evidence that on-site supervised visits occurred every 14 days between March 26th and June 3rd. Patient #11: No evidence that on-site supervised visits occurred every 14 days between April 29th and May 14th. 15 days between supervised visits.

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 documented annual usage for the year 2023 was 3.61%

Upon patient client record review, 2 of 23 (Patient #1,9) 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 1: The record contained a missed visit coordination entered on 3/13/24 with no information in the template to explain the reason for the frequency not met. The provided template in the note was empty. Also, the missed visit coordination note entered on 01/29/2024 did not contain a visit date. Patient 9: The record contained a missed visit coordination entered on 5/28/24 did not contain a visit date and what MD was notified of the missed visit.

Upon client record review, 1 of 23 (Patient #12) 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 #12: SN frequency ordered as twice a week. No evidence that 2 visits occurred for the 1st week of the 1st benefit period. No evidence that the visit was declined by the patient/caregiver or that an order was receive to change the visit frequency for that week.