Every finding on record at Reliable Hospice Care,Inc.

Upon patient record review, 1 of 11 (Patient #4) 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 4: The medical record identified the patient's primary hospice diagnosis as lung cancer. There was no evidence of problems, goals, and interventions related to respiratory dysfunction included on the plan of care.

Upon patient record review, 1 of 11 (Patient #1) 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 1: The medical record contained nursing documentation upon admission identifying patient use of walker. There was no evidence of the walker included as DME on the plan of care.

Upon patient record review 1 of 6 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: During observation of the home visit, the aide was observed obtaining vital signs of the patient. There was no evidence of a task to obtain vital signs included on the aide care plan.

Upon patient client record review, 2 of 11 (Patients #9,#11) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patients 9 and 11: The medical record indicated patient requested Notice of Hospice Non-covered Items. There was no evidence patient or representative received requested information.

Upon patient client record review, 2 of 11 (Patients #2 and 9) did not have evidence that each patient record contains Physician certification and recertification of terminal illness. Patients 2 and 9: There was no evidence the medical director composed a narrative on the initial CTI to reflect the patient's individual clinical circumstance. The narrative read, "Based upon the above (referring to nursing documentation of assessment upon admission), it is my medical judgement that the patient remains terminally ill with a prognosis of 6 months or less if the illness runs its expected course. Specifically, this patient is most likely to die from cardiac arrest or sepsis."