Every finding on record at Radiant Hospice of Nevada LLC

Upon personnel record review, 1 of 11 (Personnel #8 ) did not have evidence Emergency Preparedness training including: • Initial training in emergency preparedness policies and procedures to all new and existing hospice employees, and individuals providing services under arrangement, consistent with their expected roles • Demonstrate staff knowledge of emergency procedures • Provide emergency preparedness training at least annually • Periodically review and rehearse its emergency preparedness plan with hospice employees (including nonemployee staff), with special emphasis placed on carrying out the procedures necessary to protect patients and others • Maintain documentation of all emergency preparedness training Personnel #8: There is no documented evidence that Medical Director received orientation to agency's emergency preparedness plan.

Upon patient record review, 1 of 5 (Patient #3) 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 #3: Patient admitted to hospice with gastrostomy tube and feeding. Initial and subsequent visits included SN visit documentation for CG education related to tube feedings an gastrostomy site care. Record includes specific physician order feeding/tube feedings and flushes, but there was no physician order specific to GT site care.

Upon patient record review, 2 of 5 (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, 2: Frequency of tasks not assigned.

Upon personnel record review, 1 of 11 (Personnel # 8) did not have evidence the hospice employees and contract employees have received orientation on the hospice philosophy. Personnel #8: There is no documented evidence that Medical Director received orientation to hospice philosophy.

Upon personnel record review, 1 of 11 (Personnel #8 ) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel #8: Medical Director personnel file did not include evidence of skills competency