Every finding on record at Rapid Hospice Care, Inc.

Upon patient record review, 12 of 14 (Patient #1, 2, 4, 5, 7, 8, 9, 10, 11, 12, 13, 14) 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. Patients #1, 2, 4, 5, 7, 8, 9, 10, 11, 12, 13, 14: Patients have orders for SC and visits are provided, but there are no problems, goals, interventions related to spiritual services. Patient #9: Patient with documented seizure disorder and Phenytoin prescribed, has no related goals, interventions specific to seizure precautions.

Upon patient record review, 13 of 14 (Patient #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13: Frequency orders for SC read Initial assessment within 5 days from admission, recert and as needed for spiritual support. As needed is not quantified.

Upon client record review, 7 of 14 (Patient #1, 2, 4, 5, 7, 8, 12) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1, 2, 4, 5, 7, 8, 12: Frequency orders for SC read Initial assessment within 5 days from admission, recert and as needed for spiritual support. As needed is not quantified. Visits made as follows: Patient #1: SOC: 3/25/25. Patient was seen monthly Patient #2: SOC 4/2/25. Patient was seen monthly except 2 visits in June and none in July. Patient #4 SOC 4/29/25. Patient was seen monthly, except 2 visits in July and none in June. Patient #5. SOC 5/22/25. Patient was seen monthly. Patient #7: SOC 6/1/25. Patient was seen monthly except 2 visits in August Patient #8: SOC 6/27/25. Patient was seen monthly. Patient #12: SOC 12/23/24. Patient was seen monthly.

Upon patient record review, 2 of 14 (Patient #6, 9) 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 #6: Patient on Oxygen 2lpm via NC continuously. Flow rate/frequency included in aide assignment, but Oxygen precautions not specified. Patient #9: Patient on Oxygen 2lpm via NC as needed. Flow rate/frequency included in aide assignment, but Oxygen precautions not specified. Consultant presented Policy CC-127 Administration of Oxygen Therapy and Home Safety and referenced: (5.9) "When a patient has a CHHA: the box in the oxygen section of the aide care plan will be checked off to indicate that the oxygen safety has been assessed/completed." Policy is not clear as to Oxygen flow rate being all inclusive of oxygen precautions and is not considered clear guidance for hospice aide. Provided education that rate/frequency and safety are separate interventions to be assigned.

Upon patient record review 2 of 14 (Patient #6,9) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #6: SOC 4/21/25 with hospice aide frequency of 2x/wk. Last documented visit is 8/29/25. No change in order, IDG frequency unchanged and no reference to frequency change in documented supervisory visits. No explanation upon interview. Patient #9: SOC 6/1/25 with hospice aide frequency of 2x/wk. Last documented visit is 8/30/25. No change in order, IDG frequency unchanged and no reference to frequency change in documented supervisory visits. No explanation upon interview.

Upon patient record review, 2 of 5 (Patients #4 and 5) 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 4: On SOC SN assessment patient found to be high risk for falls, scored "8", over 4 is considered fall risk. there was no evidence of Fall risk in the HHA POC. Patient 5: On SOC SN assessment patient found to be high risk for falls, scored "8", over 4 is considered fall risk. there was no evidence of Fall risk in the HHA POC.