Every finding on record at Quality Palliative Care, Incorporated

Upon patient record review, 2 of 14 record reviewed (Patient #3, #5) 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 #3: The medication profile indicated the patient was taking Bisacodyl 10mg PR prn constipation, Carvedilol 6.25mg po once a day for HTN, Donepezil 5mg po once a day for Alzheimer's. There was no evidence of the medications in the home at the time of the home visit with the nurse. COS. Patient #5: The medication profile included acetaminophen 500 mg 2 tabs TID prn pain and Hydrocodone 10/325mg PO Q4hours prn pain. There was no max dose of acetaminophen in a 24 hour period documented. COS.

Upon patient record review, 1 of 14 record reviewed (Patient #14) 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 #14: The record indicated the patient had an RN visit on 3/7/24 with documentation indicating the patient was expected to have a rapid decline and the patient had weakness increased considerably. There was no evidence of increased visits and or no follow up until 03/10/24 when the patient was pronounced.

Upon patient record review, 6 of 14 records reviewed (Patient #3, #4, #6, #7, #8, #9) 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 indicated while the nurse was completed the psychosocial comprehensive assessment there was a need for a social worker due to the patient having a potential for non compliance. There was no evidence of an individualized written plan of care that reflected the patient/family goals and interventions based on this problem identified in the initial comprehensive assessment. COS. Patient #4: The record indicated the patient was on Plavix 75mg po Q Day at the time of admission. There was no evidence of an individualized written plan of care that reflected the patient/family goals and interventions based on this problem identified in the initial comprehensive assessment to include bleeding precautions. COS. Patient #6: The record indicated the patient was on Plavix 75mg po Q Day at the time of admission. There was no evidence of an individualized written plan of care that reflected the patient/family goals and interventions based on this problem identified in the initial comprehensive assessment to include bleeding precautions. COS. Patient #7: The record indicated the patient was on Xarelto 20mg po daily. There was no evidence of an individualized written plan of care that reflected the patient/family goals and interventions based on this problem identified in the initial comprehensive assessment to include bleeding precautions. Patient #8: The record indicted the patient was admitted to hospice on 05/01/24. There was no evidence of an MD order to admit the patient at the time of the survey. COS. Patient #9: The record indicted the patient was admitted to hospice on 04/26/24. There was no evidence of an MD order to admit the patient at the time of the survey. COS.

Upon patient record review, 2 of 14 records reviewed (Patient #5, #14) 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 #5: The record indicated an MD order for acetaminophen 500 mg 2 tabs TID prn pain and Hydrocodone 10/325 PO Q4hours prn pain. There was no max dose of acetaminophen in a 24 hour period. Patient #14: The record indicated an MD Order written on 2/14/23 to change Foley catheter Q14th of the month and as needed if indicated due to soiling obstruction leakage or any other clinical need. There was no evidence of a Foley catheter order to include the catheter size, balloon size with amount of fluid and or type of fluid ordered.

Upon client record review, 10 of 14 record reviewed (Patient #1-#10) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient #1-#10: The record indicated there was an IDG meeting scheduled on 10/04/24. There was no evidence of this meeting being completed at the time of the survey.

Upon client record review, 10 of 14 records reviewed (Patient #1, #2, #3, #4, #5, #6, #7, #8, #9, #0) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1: The record indicated the social worker made a visit on 05/25/24 and 06/21/24, there was no frequency order for this visit . COS. Patient #2: The record indicated an MD Order on 9/2/24 BC to assess and evaluate bereavement and grieving risk factors within 5 days of admission. The record indicated the visit was completed by the SC (Chaplain) not the Bereavement Coordinator. COS. In addition there was an MD Order on 9/2/24 that states the IDG to review patient Q14days to evaluate changes in condition, there was not evidence of this being completed on 10/04/24 with the last meeting being on 9/20/24. COS. Patient #3: The record indicated an MD order on 09/04/24 for MSW to evaluate and assess for needs initial evaluation within 5 days of admission, recertification as needed for psychosocial counseling and support, MSW may do visit by phone call, face time or other technological options. The nurse completed the psychosocial assessment and there was no evidence the MSW made this visit ordered by the physician. Patient #4: The record indicated an MD order on 08/30/24 for the BC to assess and evaluate bereavement and grieving risk factors within 5 days of admission. The bereavement assessment was not completed by the Bereavement Counselor. COS. In addition, there is an MD Order on 08/30/24 for the MSW to evaluate and assess for needs, initial evaluation in 5 days. The record indicated the RN completed the psychosocial assessment and referred the SW to visit due to the patient having extreme anxiety. There was no evidence this was completed at the time of the survey. Patient #5: The record indicated the Chaplain made visits on 05/18/24 and 09/13/24. The record also indicated the Social Worker made visit on 05/21/24, 07/16/24 & 09/16/24. There was no evidence of frequency orders. COS. Patient #6: The record indicated the Chaplain made visits on 05/15/24 and 8/11/24. Also the Social Worker made visits on 05/15/24 and 08/12/24. There was no evidence of frequency orders. COS. In addition, the record indicated an MD order on 05/14/24 for the BC to assess and evaluate grieving risk factors within 5 days. This visit was completed by the Spiritual Counselor (Chaplain). Patient #7: The record indicated the Chaplain made visits on 05/12/24, 8/7/24, 7/16/24, and 9/4/24. Also the Social Worker made visits on 05/15/24 and 08/08/24. There was no evidence of frequency orders for the Chaplain and or Social Worker . In addition: the record indicated an MD order on 05/10/24 for the BC to assess and evaluate grieving risk factors within 5 days. This visit was completed by the Spiritual Counselor (Chaplain). Also there was an MD Order on 5/10/24 for the Volunteer Coordinator to assess if the patient would like a volunteer and to offer monthly. There was no evidence of these visits. COS. Patient #8: The record indicted the Chaplain made visits on 5/2/24 and 7/30/24. There were no frequency orders. COS. Patient #9: The record indicted the Chaplain made visits on 4/28/24 and 8/23/34, the Social Worker made visits on 04/28/24 and 8/23/24. There were no frequency orders. COS. Patient #10: The record indicated the Chaplain made visits on 04/10/24 and 07/06/24. Also the Social Worker made visits on 04/11/24, 07/08/24 and 10/07/24. There was no evidence of frequency orders for the Chaplain and or Social Worker. COS. In addition: the record indicated an MD order on 04/08/24 for the BC to assess and evaluate bereavement and grieving risk factors within 5 days of admission. The bereavement assessment was not completed by the Bereavement Counselor

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: Upon observation of the home visit the nurse when washing her hands did not have a paper towel readily available and turned off the faucet with her hand then proceeded to the kitchen from the bathroom to get a paper towel. Policy No. 6-006.2 Risk Management: Infection and Safety Control # 4 states use a dry disposable towel to turn off the faucet. In addition the bag was unzipped going in the home and leaving the home, dirty equipment was placed in a zip lock bag and put back in the nursing bag. Policy No. 6-013.1 Bag Technique states under #2 Hand washing will always be completed before opening the bag. #5 states when a visit is completed, reusable equipment will be cleaned using alcohol, soap and water, or appropriate solution, hands will be washed, and equipment and supplies will be returned to the bag.

Upon patient record review, 1 of 14 (Patient #13) 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 #13: The record indicated the patient died on 09/26/23. There was no evidence of a bereavement plan of care having been developed and or followed after death at the time of the survey and there was not a post death bereavement assessment.

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: The record indicated the RN made monthly visits on 5/3/24, 6/3/24, 7/3/34, 8/3/24, 9/3/24. The aide supervisory visits were due on 05/10/24, 05/24/24, 06/07/24, 06/21/24, 07/05/24, 07/19/24, 08/02/24, 08/16/24, 08/30/24, 09/03/24 and 09/27/24. There was no evidence of any hospice aide supervisory visits being completed every 14 days.

Upon patient record review, 1 of 14 record reviewed (Patient #10) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient's clinical information and provide written documentation that it is anticipated that the patient's life expectancy is 6 months or less. Patient #10: The record indicated the patient was in their 3rd benefit period from 10/05/24 to 12/03/24. At the time of the survey there was no evidence the physician had completed a face to face, written a narrative and or had signed the CTI within the 2 days deadline by 10/07/24. This CTI was blank at the time of the survey. Agency submitted handwritten document after deficiency noted however, this was not in the EMR.