Every finding on record at Residential Hospice Illinois, LLC

Upon patient record review, 3 of 27 (Patient #9,19,21) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #9 - Initial bereavement assessment completed 09/06/24 SOC 06/30/23, performed past 5 days. Patient #19 - Initial bereavement assessment completed 01/11/25 SOC 01/29/25 - completed prior to SOC. Patient #21 - Initial bereavement assessment completed 11/02/25 SOC 11/11/25 - completed prior to SOC.

Upon patient record review, 3 of 27 (Patient #8, 10, 12) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #8 - No measurements or assessment to left heel 05/30/25 - 06/11/25 - Agency policy is wound assessment every 7 days. Patient #10 - No measurements or assessment to left heel 05/06/25 - 05/20/25 - Agency policy is wound assessment every 7 days. Patient #12 - No measurements or assessment to left heel 05/28/25 - 06/09/25 - Agency policy is wound assessment every 7 days.

Upon patient record review, 1 of 27 (Patient #8) 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 #8 - POC 05/30/25" wound care to L heel M-W-F and PRN" - no modifier for PRN.

Upon patient record review, 2 of 27 (Patient #8, 10) 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 #8 - Patient has alternating pressure mattress not noted on the POC. Patient #10 - Patient has alternating pressure mattress not noted on the POC.

Upon client record review, 1 of 27 (Patient #14) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #14 - SN note, 05/12/25, references bolus feedings 120cc every 8 hours. SN states instructed on checking residual and on 05/23/35 caregiver performing g-tube care and applying dressing. There are no orders for nurse to perform residual or wound care for tube. POC orders has bolus feeding 120 at breakfast and lunch and 60mls at dinner.

Upon patient record review, 2 of 27 (Patient #14,25) 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 #14 - The record indicated aide visits 2 x a week. Aide documented missed visits every week due to caregiver refusal 05/11/25 - 06/13/25. No evidence that the plan of care was revised to reflect refusal of visits. Patient #25 - Aide care plan contain task - catheter care and empty drainage bag every visit - patient does not have a catheter.

Upon patient record review 4 of 27 (Patient #10, 20, 23, 25) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient #10 - Aide supervisory visit completed 04/17/25 then again on 05/20/25 - greater than 14 days. Patient #20 - Aide supervisory visit 05/27/25 then again on 06/11/25 - 15 days between supervisory visits. Patient #23 - Aide first visit on 05/13/25 no Aide supervisory visit as of 06/17/24. Patient #25 - Aide supervisory visit from 04/24/25 to 06/12/25 - SN documented every visit that patient doesn't have a aide.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. Agency did not meet minimum 5% for 2024 - was less than 1%.

Upon client record review, 1 of 27 (Patient #23) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #23 -The record indicated hospice SN visits 2 x a week and only 1 visit made the week of 05/11/25.

Upon client record review, 2 of 27 (Patient #8, 12) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient #8- Wound care does not distinguish who will provide wound care "by facility nurse and hospice nurse" Patient #12 - Wound care does not distinguish who will provide wound care "by facility nurse and hospice nurse"

Upon patient record review, 3 of 20 (Patient #13, 19, 20) 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. Patient #13 - Medication profile contained Haloperidol 2mg per g-tube, Lorazepam per g-tube and Morphine 100mg/5ml per g-tube but all medications were given orally per documentation. Patient #19 - Medication profile included oxygen 2LPM, no evidence of an increase to 4LPM per RN visit. Patient #20 - Medication profile did not contain IV solution or infusion rate for Ceftriaxone 2gm daily. Normal saline flush after each infusion did not include amount.

Upon patient record review, 5 of 20 (Patient #5, 14, 15, 16, 17) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #5 - There was no evidence of an initial bereavement assessment. Patient #14 - SOC date 11/23/2021, initial bereavement assessment completed 12/30/2021. Patient #15 - SOC date 04/08/2021, initial bereavement assessment completed 12/30/2021. Patient #16 - There was no evidence of an initial bereavement assessment. Patient #17 - SOC date 02/12/2022, initial bereavement assessment completed 02/23/2022.

Upon patient record review, 2 of 20 (Patient #13 and 20) 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 #13 - POC contained Haloperidol 2mg per g-tube, Lorazepam per g-tube and Morphine 100mg/5ml per g-tube but all medications were given orally per documentation by the facility staff. Patient #20 - POC dated 03/10/2022 did not contain IV solution or infusion rate for Ceftriaxone 2gm daily. Normal saline flush after each infusion did not include amount.

Upon client record review, 1 of 20 (Patient #12) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient #12 - Patient admitted 05/16/2022, next IDG collaboration on 06/01/2022 - 16 days later.

Upon patient record review, 1 of 20 (Patient #15) 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 #15 - New eye infection dated 04/27/2022 but POC not updated with new problem.

Upon client record review, 5 of 13 applicable (Patient #1, 7, 12, 17 and 19) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1 - POC dated 03/02/2022, MSW visit frequency 1 week 2, 1 every other week 10. No visit week 10 or documentation of missed visit. Patient #7 - POC dated 04/15/2022, MSW visit frequency 1week 1, 1 every 4 weeks. No visit week 5 or 9 or documentation of missed visit. SN visit frequency effective 04/17/2022 3 week 1, 2 week 10. Only 2 visits made week of 04/17/2022 - no documentation of missed visit. Patient #12 - POC dated 05/16/2022, SN visit frequency 4 week 1, 2 week 7, 1 week 1. Only 3 visits made week 1 - no documentation of missed visit. Patient #17 - POC 02/12/2022 - Pleurx catheter order did not contain site care or frequency, but dressing changed on 03/23/2022 and 03/25/2022. Patient #19 - POC 04/15/2022 Pleurx catheter order did not contain site care, amount to remove or frequency. Catheter drained and dressing changed on 04/21/2022, 04/29/2022 and 05/03/2022. No order to increase O2 from 2L/min to 4L/min.

Upon patient record review, 2 of 18 applicable patients (Patient #9, 14) 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 Patient #9 - Oxygen and fall precautions not on aide care plan. Patient #14 - Oxygen, bleeding and aspiration precautions not on aide care plan.

Upon patient record review 1 of 18 applicable (Patient #5) 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 #5 - CNA visit frequency 1 week 11 effective 04/03/2022 - no evidence of any visits made week of 05/01/2022.

Upon patient client record review, 1 of 20 (Patient #17) 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 #17 - Plurex cath 03/19/2022. SN visit dated 03/23/2022, 03/25/2022 and 03/28/2022 did not document dressing procedure - "documented dressing changed" did not document site or drainage appearance.

Upon client record review, 2 of 7 applicable patients (Patient #2 and 20) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #2 - POC dated 04/06/2022 MSW visit frequency 1 week 1, 1 every other week 12. No visit noted or documentation of missed visit on week 7 or 9. Patient #20 - PICC line removed 03/21/2022 but no order noted. SN did not assess PICC line site on 03/11/2022 or 03/16/2022, ordered weekly.