Every finding on record at Prairie Wind Hospice, LLC

Upon patient record review, 1 of 19 (Patient #19) 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 #19 - Patient medication list contained Acetaminophen 325 mg PRN pain, Hydrocodone 325mg 7.5mg PRN pain and Morphine PRN pain but does not specify which medication to give for mild, moderate or severe pain.

Upon patient record review, 2 of 19 (Patient #7, 16) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #7, 16 - did not have evidence of the scope of services for the Aide - personal care.

Upon patient record review, 2 of 19 (Patient #16, 19) 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 #16 - Wound care order 05/16/25 "change daily and PRN" - does not have modifier for PRN Patient #19 - Patient POC contained Acetaminophen 325 mg PRN pain, Hydrocodone 325mg 7.5mg PRN pain and Morphine PRN pain but does not specify which medication to give for mild, moderate or severe pain.

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 #7 - During the home visits wound care was provided - the nurse did not wash or use hand sanitizer between glove changes. The nurse used a clear hand bag for medical equipment that did not have section for clean equipment.

Upon patient record review, 1 of 19 (Patient #3) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • 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 - did not have evidence the hospice developed a bereavement plan of care that reflects the bereavement services to be offered and the frequency of service delivery

Upon patient record review, 2 of 19 (Patient #9, 12) 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 #9 - Aide care plan has task shave patient every visit but did not specify type of razor. Patient on Plavix and ASA. Patient #12 - Aide care plan has task shave patient every visit but did not specify type of razor. Patient on Eliquis and ASA.

Upon patient record review 1 of 19 (Patient #6) 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 #6 - Aide supervisory visit completed 05/12/25 then again on 05/27/25 - 15 days between supervisory visit.

Upon patient client record review, 1 of 19 (Patient# 16) 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 #16 - SN visit on 05/27/25 and 06/04/25 SN documented provided wound care to coccyx - did not document specific wound care completed.

Upon client record review, 4 of 19 (Patient #6,10,11,15) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient #6 - Wound care to R forearm did not contain evidence of which provider is to provide wound care to the patient. Patient #10 - Wound care to R buttocks did not contain evidence of which provider is to provide wound care to the patient. Patient #11 - Venipuncture for TSH every 6 months did not contain evidence of which provider is to complete. Patient #15 - Wound care to R jaw did not contain evidence of which provider is to provide wound care to the patient.