Every finding on record at Premiere Hospice and Palliative Care, Inc.

Upon observation during 1 of 3 home visits, there was no evidence that during the initial assessment visit in advance of furnishing care, the hospice provided the patient and/or family with verbal (meaning spoken) and written notice of the Patient's Rights and Responsibilities in a language and manner that the patient understands. Patient#3: During home visit it was noted that patient primary language is Armenian. Patient requires interpreter and is able to answer questions appropriately. There is no evidence of the patient rights and responsibilities being provided in his primary language.

Upon patient record review, 1 of 14 (Patient #1) 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#1: The record indicates a wound started 3/20/25. The RN did see the patient every 14 days and perform wound care. However, there is no evidence of wound assessment or measurements documented from 3/20/25- 7/14/25.

Upon patient record review, of 14 (Patient #2) 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#2: The record indicates patient taking Levetiracetam 500mg for seizures. LVN documents patient had seizure on 7/24 visit. There is no evidence of seizure precautions on plan of care. This was corrected on site as agency updated plan of care with these Seizure precautions.

Upon client record review, 3 of 14 (Patient #1, #5, #7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient#1: There is an order for LVN 1 visit per week, RN 1 visit every other week, and an order for SN visit 2 visit per week. - all orders are active. The LVN is going once a week only and RN is going once every other week only. This was corrected on site as agency discontinued the order for SN visit 2 visits per week. The order for LVN 1 time per week and RN 1 visits every other week remains active. Patient#5: The Plan of care indicates that SN is to perform diabetic foot exam and care at every visit. There is no evidence of documentation that this was completed on LVN visits on 6/15/25 and 6/29/25 or for RN visits on 6/6/25 and 7/18/25. Patient#7: The Plan of care indicates that SN is to perform diabetic foot exam and care at every visit. There is no evidence of documentation that this was completed on RN visits 7/15/25, 7/22/25, 7/29/25.

Upon patient record review, 2 of 14 (Patient #1,#2) 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#1: The plan of care indicates patient requires aspiration and skin precautions. There is no evidence of aspiration or skin precautions noted on the aide plan of care. This was corrected on site as agency updated plan of care with these needs. Patient#2: The plan of care indicates patient requires bleeding and seizure precautions. There is no evidence of these noted on the aide plan of care. This was corrected on site as agency updated plan of care with these needs.