Every finding on record at Perfect Harmony Hospice Care, Inc.

Upon patient record review, 1 of 5 (Patient #2) 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: During home visit noted that patient has Vitamin D2 50,000 iu that she is taking once per week. (Prescription date on bottle 10/9/24). It is not on the medication profile. There is no MD order for it. Patient verifies she is taking the medication.

Upon patient record review, 1 of 5 (Patient #3) 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: Patient is on anticoagulant therapy including Aspirin 81 mg tablet daily and Brilinta 90 mg twice daily. There are no related problems, goals and interventions.

Upon patient record review, 1 of 5 (Patient #2) 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: During home visit noted that patient has Vitamin D2 50,000 iu that she is taking once per week. (Prescription date on bottle 10/9/24). It is not on the medication profile. There is no MD order for it. Patient verifies she is taking the medication.

Upon patient record review, 1 of 5 (Patient #5) 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: 12/20/24 LVN visit note, nurse documented SN treated patient's wound with triple antibiotic first aide topical ointment and advised cg to apply twice daily. There is no wound specified in problems, goals, interventions.

Upon client record review, 1 of 5 (Patient #5) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #5: 12/20/24 LVN visit note, nurse documented SN treated patient's wound with triple antibiotic first aide topical ointment and advised cg to apply twice daily. Location of wound is not specified in the visit note. The skin integrity section of the visit note note says no issues as do previous visit notes. There is no order for the specified ointment/wound care.

Upon patient client record review, 3 of 5 (Patient #2, 4, 5) 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 #2: 12/25/24 MD order MSW service declined. Patient was seen by MSW for initial assessment only. IDG Meeting Visit frequency sections say MSW monthly. 12/24/25 order SC on going evaluations monthly for spiritual counseling. Patient was seen by SC monthly. IDG Meeting Visit frequency of section says SC declined. Conflicting information Patient #4: DC Summary begins with 82 year old female residing at her home is admitted to Purple Heart Hospice under the care of ......The agency name is inaccurate. Patient #5: 11/12/24 order that SC service was declined. Patient was seen by SC for initial assessment only. IDG visit frequency section says SC 1/month which is conflicting information. Patient revocation filed effective 12/24/24. DC Summary contains information not clearly related to this patient: On December 24 received call from PCG reporting that patient had recent fall and has severe pain in hip area. She reported that the patient and patient's son decided to go to emergency and requested revocation. Patient discharged as of 12/24/24. All IDG members notified. The following (last) paragraph lists medications not prescribed for this patient, says patient received SN and SC, when in fact, SC was declined. Concludes with: On 7/18/21 received report that Patient and PCG made decision to seek aggressive treatment and request revocation of hospice benefits.

Upon client record review, 1 of 5 (Patient #5) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patient #5: Patient information sent to primary MD did not include advanced directives. Patient has DNR on file. Additionally information provided/sent in discharge summary included information inconsistent with patient record.

Upon observation, there was no evidence the hospice is in compliance with accepted professional standards and principles for all non-core services which includes physical therapy, occupational therapy and speech-language pathology. The agency does not have any volunteers although recruitment efforts are in place.

Upon observation, there was no evidence volunteers are used in day to day administrative and/or direct patient care roles. Currently no active volunteers. Recruitment efforts ongoing and documented