Every finding on record at Rc Harmony Hospice and Palliative Care Inc.

Upon patient record review 1 of 14 (Patient #6) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient #6: The patient was admitted on 11/14/24. There was not a psychosocial assessment completed within 5 days either by the MSW or RN to meet the necessary components of the initial psychosocial assessment including but not limited to the mental health, economic, and social components of the patient and family.

Upon patient record review, 10 of 14 (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10) 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 Patients #1-10: There was no evidence in the record of an ongoing process to monitor effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate therapy and or drug therapy currently associated with laboratory monitoring when there are medication changes. The place for documentation of this in the EMR was in the IDG meetings and was left blank on every IDG meeting.

Upon patient record review, 9 of 14 (Patient #1, 2, 3, 4, 6, 7, 8, 9, 10) 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, 3, 4, 6, 7, 8, 9, 10: The patients are provided a suction machine. There is an order to suction if needed, though there are no interventions or goals for use of suction machine. Patient #1:The patients is on Keppra for history of epilepsy and has history of subdural hematoma. There are no interventions or goals for seizure on the plan of care. The patient sees MSW monthly, though there are no interventions or goals for psychosocial. Patient #2: The patient was prescribed Robitussin for cough, however, there is not interventions or goals related to cough on plan of care. Patient #3: The patient has a foley but also has multiple recurrent UTI's including one present at admission. There are no interventions related to frequent UTI's on plan of care. The patient has a stage 4 wound there is no interventions or goals related to wound orders in the plan of care. Patient #8: The patient is in Aspirin. There are no interventions or goals related to bleeding of use of anticoagulants.

Upon patient record review, 3 of 14 (Patient #1, 2, 3) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #1: The patient was admitted on antibiotic for UTI. On 07/18/25, Antibiotic was changed for continuation of UTI - There was no update to the plan of care. Patient #2: There were documented falls on 06/06/25 and 09/03/25. There were no updates to the plan of care. Patient #3: The patient had a UTI and was prescribed Cephalexin on 05/23/25 There was no change to plan of care. The patient was diagnosed with a UTI on 06/20/25. Ciprofloxacin was initiated with no changes to the interventions and goals of the plan of care. The patient was prescribed Azithromycin on 08/11/25 for a UTI with no change to the interventions and goals in the plan of care. On 08/11/25, the patient was prescribed Azithromycin for "congestion". There were no changes or updates to the interventions or goals in the respiratory plan of care. On 08/13/25, the patient orders were changed for oxygen. She had been receiving 2 liters/minute prn and the orders were changed to 5 liters continuous for shortness of breath. There were no changes to the interventions and goals in the plan of care.

Upon personnel record review, 1 of 12 (Personnel # 9) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel #9: There was no evidence in the personnel file that the following competency assessment items were performed with a patient or pseudo patient: ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination

Upon client record review, 2 of 14 (Patients #11, 12) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patients #11, 12: There was no evidence that a hospice discharge summary was forwarded to the patient's attending physician.

Upon client record review, 2 of 14 (Patients #11, 12) did not have evidence that the discharge summary includes all required information. Patient's #11, 12: There was no evidence of a summary of the patients stay including treatments, symptoms and pain management, the patient's plan of care, or latest physician orders.

Upon patient record review, 4 of 5 (Patients #2,#3,#4,#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 Patients #2, #3, #4: The medical record contained documentation that the patient was using oxygen. Oxygen therapy was not included on the medication profile. Patient #5: The medication profile contained Milk of Magnesia with no frequency indicated.

Upon patient record review, 4 of 5 (Patient #2,#3,#4,#5) 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 medical record contained nursing documentation on 5/25/22 and 6/2/22 that the patient had symptoms of constipation. There were no problem statements with goals, interventions, and progress toward outcomes related to constipation. Patient #3: The medical record contained nursing documentation on 9/12/22 that the patient had symptoms of constipation. There were no problem statements with goals, interventions, and progress toward outcomes related to constipation. Patient #4: The medical record contained documentation that the patient was having symptoms of pain and constipation. The medical record did not contain problem statements, goals, or progress towards outcomes related to pain and constipation. Morphine and Senna were ordered to manage the symptoms. Patient #5: The medical record contained documentation that the patient was having symptoms of constipation. The medical record did not contain problem statements, goals, or progress towards outcomes related to pain and constipation. Milk of Magnesia was ordered to manage the symptom.

Upon patient record review, 4 of 5 (Patients #2, #3, #4, #5) 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 #2: The medical record contained documentation that suction was available for the patient to use. There was no indication, frequency, or route identified for the suction and the nebulizer on the plan of care. Patient #3 and 4: The medical record contained documentation that suction was available for the patient to use. There was no indication, frequency, or route identified for suction on the plan of care. Patient #5: The medical record contained documentation that suction was available for the patient to use. There was no indication, frequency, or route identified for suction on the plan of care. The medical record contained orders for Milk of Magnesia with no frequency indicated.

Upon patient record review, 1 of 5 (Patient #2) 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 equipment and supply needs. Patient #2: The medical record contained documentation that a nebulizer was available for the patient to use. There was no evidence of an order for the nebulizer on the plan of care.

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. During a home visit with the Chaplain it was observed that an eye shield was not worn at the start of the visit. The Chaplain pulled the eye shield down to cover his eyes in the middle of the visit. The facility's COVID policy is posted upon entry and states "mask and eye shields must be worn".

Upon patient record review 1 of 2 applicable (Patient #3) 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 Patient #3: The aide visit frequency was ordered 3 x/week. There was evidence 1 visit was made the week of 5/22/22-5/28/22, the week of 5/29/22-6/4/22, 4 visits were made, and the week of 7/3/22, 1 visit was made.

Upon patient client record review, 1 of 5 (Patient #3) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #3: The medical record contained documentation of duplicate aide visits dated 9/2/22. The medical record contained an error in nursing documentation on 9/12/22 that patient does not currently have any equipment.