Every finding on record at Precise Hospice Inc.

Upon patient record review, 3 of 14 (Patient #8, 9, 14) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #8, 9, 14 - There is no evidence that the patient or representative right to choose their attending physician was honored. Admission paperwork left blank to "question regarding attending physician".

Upon patient record review, 4 of 14 (Patient #7, 8, 9,11) 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 - Medication profile contains O2 at 2L/M as needed - does not have frequency, route or modifier for "as needed". Calmoseptine ointment apply on affected areas as needed - does not have frequency, area to apply or modifier for as needed. Voltaren Arthritis gel - apply to affected areas for pain management does not have frequency or area to apply. Patient #8 - Medication profile contains O2 at 2L/M as needed - does not have frequency route or modifier for "as needed". Patient #9 - Medication profile contains O2 at 2L/M nasal cannula as needed - does not have frequency or modifier for "as needed". Patient #11 - Patient on oxygen but not on Medication profile.

Upon patient record review, 9 of 14 (Patient #6,7,8,9,10,11,12,13,14) 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 #6,7,8,9,10,11,12,13,14 - did not have evidence in the patient record that the comprehensive assessment includes a bereavement component.

Upon patient record review, 4 of 14 (Patient #7,8,9,11) 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 #7 - POC contains O2 at 2L/M as needed - does not have frequency, route or modifier for "as needed". Calmoseptine ointment apply on affected areas as needed - does not have frequency, area to apply or modifier for as needed. Voltaren Arthritis gel - apply to affected areas for pain management does not have frequency or area to apply. Patient #8 - POC contains O2 at 2L/M as needed - does not have frequency route or modifier for "as needed". The record indicated the patient was admitted with indwelling Foley catheter and no related orders for the care and management of the Foley catheter. Foley catheter pulled out by patient on 07/04/25 - Foley catheter not reinserted but no order to not reinsert. Patient #9 - POC contains O2 at 2L/M nasal cannula as needed - does not have frequency or modifier for "as needed". Patient 11 - Patient on oxygen but not on POC.

Upon personnel record review, 4 of 14 (Personnel # 3,5,7,8) did not have evidence that the hospice routinely provide substantially all core services directly by hospice personnel (The hospice issues a W-2 form for the employee). These services include: • Physician services (may contract for physician services) • Nursing • Medical social services • Counseling Employees #3, 5, 7, 8 - RN/Alternate DPCS, LPN/VC, SC/BC and MSW all W-9 employees.

Upon patient record review, 6 of 14 (Patient #5, 10, 11, 12, 13, 14) 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 #5 - No frequency for the tasks shower, shampoo, mouth care or nail care. Patient #10 - No frequency for the tasks shower, shampoo, hair care, mouth care or perineal care. Patient #11 - No frequency for the task nail care. Frequency for task hair care, feeding, and mobility - PRN or as necessary. Oxygen not on aide care plan. Patient #12 - No frequency for the tasks shower, shampoo, mouth care or nail care. Patient #13 - No frequency for the tasks bed bath or nail care. Patient #14 - POC has bed bath and bath chair but no documentation patient is functionally and cognitively to make decision. No frequency for the tasks shampoo, mouth care, dressing or nail care.

Upon patient record review 1 of 14 (Patient #9) 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 #9 - No aide supervisory visits made 07/05/25 - 07/26/25.

Upon personnel record review, 1 of 12 (Personnel #5) did not have evidence the individual who supervises volunteers is qualified by meeting the hospice's policies and procedures and/or job description criteria and is a designated hospice employee. Personnel #5 is not a designated hospice employee but rather a W-9.

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. Annual report 2024 3.6% use of volunteers providing day to day administrative and/or direct patient care services - does not meet 5% requirement.

Condition of Participation: Organization and Administration of Services.

Upon observation, there was no evidence the hospice is directed by a Board of Directors/governing body which assumes full legal authority and responsibility for the operation of the hospice as evidenced by use of contract staff for core services (nursing, counselor, social services, volunteer coordinator).

Upon patient client record review, 8 of 14 (Patient #6,7,8,9,10,12,13,14) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #6, 7, 10, 12, 13, 14 - Patient or caregiver requested Patient Notification of Hospice Non-Covered Items, Services, and Drugs on admission but no documentation that agency furnished the addendum. Patient #8, 9, 14 - There is no evidence that the patient or representative right to choose their attending physician was honored. Election of benefit form left blank to "question regarding attending physician".

Observed in Record Review. In 1 of 5 patient records reviewed, During RR# 1's patient record review, it was noted the organization had not ensured it maintained complete and accurate patient records. For example: review of RR# 1's patient record revealed the patient was discharged. Further review of RR# 1's patient record revealed a Licensed Vocational Nurse visit note dated approximately 58 days after RR# 1 was discharged. This was reviewed and discussed with the designee Administrator/DPCS and validated.