Every finding on record at Quietude Hospice Care, Inc

Upon patient record review, 1 of 14 (Patient #9) 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 #9: Medication profile note Lidocaine 5% patch topically to affected area change q 12 hours HOWEVER during home visit patient states she quit taking the Lidocaine patch "a long time ago" and has been using Salonpas Patch. The Salonpas Patch was not listed on the medication profile.

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. Patients #1,2: SN failed to place a barrier between nursing bag and chair that she placed her bag.

Upon patient record review, 3 of 14 (Patient #1,8,10) 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: Aide care plan reflects assignment to check Oxygen each visit however the O2 is listed as O2 2L NC prn SOB and the medication profile denotes 02 2-5 L/NC prn SOB. Patient #8: Aide care plan to file nails q visit and as needed as well as empty trash/light housekeeping/dress assigned q visit and as needed. Patient #10: Aide assignment (8/22/23) assigned that patient is non-ambulatory however, during home visit I observed that patient walked from bathroom to bedroom without assistive device. Patient caregiver states this is normal status, nurse agreed. Care plan is not updated to new status

Upon client record review, 2 of 14 (Patient #11,12) did not have evidence that the discharge summary includes all required information. Patient #11,12: Revocation states reason for revocation as " revocation of hospice" rather that the accurate reason: pursuing aggressive treatment