Every finding on record at Rgv Hospice Care LLC

It is required that medical social services are provided by a qualified social worker per the plan of care; This standard was not met as evidenced by clinical record review and interview. In 2 of 19 (11%) clinical record review of patients that had social worker services revealed that the agency did not ensure the social worker provided care as ordered on the plan of care. CLINICAL RECORD 8: The clinical record review lacked evidence that the social worker was following the frequency ordered on the plan of care. During the benefit period from 02/09/2025 to 04/09/2025, the social worker documented patient visits twice in March (03/10/1015 and 03/18/2025). However, the care plan specified that the frequency order was once a month. CLINICAL RECORD 11: The clinical record review lacked evidence that the social worker was following the frequency ordered on the plan of care. During the benefit period from 01/23/2025 to 04/22/2025, the social worker documented patient visits twice in February (02/04/2025 and 02/05/2025). However, the care plan specified that the frequency was once a month. During an interview on 09/25/2025, the administrator (Personnel Record 7) stated that they will educate the social workers on how to enter frequency and the importance of following frequency as ordered in the plan of care.

It is required that counseling services include an organized program for providing bereavement services delivered by or under the supervision of a qualified professional with experience or education in grief or loss counseling. The bereavement services reflect the needs of the bereaved per a bereavement plan of care that includes the types of bereavement services to be offered and the frequency of service delivery. This standard was not met as evidenced by clinical record review and interview. In 3 of 3 (100%) clinical record review of bereavement records revealed the agency did not ensure that a bereavement plan of care that included services offered and the frequency of service was present. CLINICAL RECORD 15: The hospice benefit was elected on 10/10/2024 and date of death 07/06/2025. The clinical record review lacked evidence of a bereavement plan of care. The record contained documentation of bereavement activity but no bereavement plan of care specify the services offered or the frequency of those services. CLINICAL RECORD 16: The hospice benefit was elected on 06/02/2025 and date of death 06/16/2025. The clinical record review lacked evidence of a bereavement plan of care. The record contained documentation of bereavement activity but no bereavement plan of care specify the services offered or the frequency of those services. CLINICAL RECORD 17: The hospice benefit was elected on 04/22/2025 and date of death 05/01/2025. The clinical record review lacked evidence of a bereavement plan of care. The record contained documentation of bereavement activity but no bereavement plan of care specify the services offered or the frequency of those services. During an interview on 09/24/2025, the administrator (Personnel Record 7) stated that they changed to a new EMR in May 2025 and are learning the system, but they will be doing additional education to review how to add the bereavement plan of care.

It is required that a hospice aide provides services, ordered by the Interdisciplinary Group, included in the plan of care, permitted to be performed under state law and regulation, and consistent with the hospice aide training. CONTINUING PRIOR REQUIRED ACTION. This standard was not met as evidenced by a review of clinical records and interviews. 1 of 6 (17%) records reviewed of patients receiving aide services revealed the agency did not ensure that the hospice aide provided services as ordered by the interdisciplinary group with regards to the aide frequency included in the plan of care. Record 2: The aide Plan of Care (POC) dated 01/18/2023 ordered the aide frequency "three times a week." A review of the clinical records revealed aide visits were completed four (4) times the week of 01/22/2023 through 01/28/2023. There was no documented evidence of communication with the Physician to change the aide frequency, or obtain new order. During an interview with Administrator on 01/31/2022, she confirmed that the Aide had not followed the POC. She stated that the RN did not update the aide frequency when the POC was updated. CONTINUING PRIOR REQUIRED ACTION.

It is required that the hospice conducts and documents a patient-specific comprehensive assessment that identifies the patient’s need for hospice care and services and the patient’s need for physical, psychosocial, emotional, and spiritual care. The assessment includes all areas of hospice care related to the palliation and management of the terminal illness and related conditions. THIS IS A CMS CONDITION LEVEL DEFICIENCY. This CONDITION was not met as evidenced by a review of clinical records and interviews with the Administrator and Director of Clinical Services. The Registered Nurse failed to conduct a medication review that included the patient's current medications as a component of the comprehensive assessment [HCPC.15.I/L530]; and the Interdisciplinary Group failed to complete an initial bereavement assessment [HCPC.13.I/L531]. The cumulative effect of these deficiencies demonstrates a lack of oversight of the plan of care and could negatively impact the agency's ability to provide quality, safe end-of-life patient care by not identifying significant issues from the comprehensive assessment in order to meet the patient's and family's needs.

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over the counter (OTC) drugs. This standard was not met as evidenced by a review of clinical records, document review, and interviews. 6 of 13 (46%) clinical records reviewed revealed the agency did not ensure that the initial or subsequent comprehensive assessments included a drug profile that contained the patient's current prescription and over the counter (OTC) drugs. The agency policy #PC.17 "Medication List and Monitoring" read in part, "Agency will maintain a current, accurate list of all prescription and over the counter (OTC) medications taken by the patient." Clinical Record 1: The patient elected hospice care on 10/13/2022. The initial comprehensive assessment completed on 10/13/2022 documented the patient was using "oxygen at 3 liters via nasal cannula continuously." The current medication profile documented the patient was using "oxygen at 4 liters via nasal cannula (NC) continuous effective 10/13/2022." Clinical Record 2: The patient elected hospice care on 05/14/2022. The plan of care dated 05/14/2022 and the updated plans of care listed oxygen under medical equipment. Oxygen was not included on the patient's medication profile as of 12/21/2022. The nursing visit note dated 05/14/2022 documented the patient was using "oxygen at 2-4 liters per minute via nasal cannula as needed for shortness of breath." Clinical Record 4: The patient elected hospice care on 11/07/2022. The nursing assessment dated 12/18/2022 documented the patient was using "oxygen at 2 liters per minute via nasal cannula as needed for shortness of breath." Oxygen was not listed on the medication profile as of 12/21/2022. Clinical Record 5: was reviewed and identified the patient elected hospice care on 10/25/2022. The initial comprehensive assessment dated 10/25/2022 and the nursing assessment dated 11/10/2022 documented the patient was using "oxygen at 2 liters per minute via nasal cannula as needed for shortness of breath." Oxygen was not listed on the medication profile as of 12/21/2022. Clinical Record 7: The patient elected hospice care on 11/11/2022. The initial comprehensive assessment dated 11/11/2022 documented the patient was using "oxygen at 2 liters per minute via nasal cannula as needed for shortness of breath." Oxygen was not listed on the medication profile as of 12/21/2022. Clinical Record 13: The patient elected hospice care on 10/28/2022. The initial comprehensive assessment dated 10/28/2022 documented the patient was using "oxygen at 2 liters per minute via nasal cannula as needed for shortness of breath." Oxygen was not listed on the medication profile as of 12/21/2022. During an interview on 12/21/2022, the Director of Clinical Services confirmed the finding stating the medication profiles were not current.

It is required that the comprehensive assessment includes an initial bereavement assessment of 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. This standard was not met as evidenced by a review of clinical records, document reviews, and interviews. 11 of 13 (85%) records reviewed revealed the hospice did not ensure an initial bereavement assessment was completed. The agency policy #PC.26 "Bereavement" read in part, "The initial bereavement risk assessment will be completed as part of the comprehensive health assessment. The bereavement risk assessment will be performed on admission." Clinical Record 1: The patient elected hospice care on 10/13/2022. The 10/13/2022 nursing assessment, the 10/15/2022 social work assessment, and the 10/15/2022 chaplain assessment visit notes did not include a bereavement assessment. A review of the record revealed there was no initial bereavement assessment documented as of 12/21/2022. Clinical Record 4: The patient elected hospice care on 11/07/2022. The 11/07/2022 nursing assessment, 11/09/2022 social work assessment, and the 11/08/2022 chaplain assessment visit notes did not include a bereavement assessment. A review of the record revealed there was no initial bereavement assessment documented as of 12/21/2022. Clinical Record 5: The patient elected hospice care on 10/25/2022. The 10/25/2022 nursing assessment, 10/27/2022 social work assessment, and the 10/26/2022 chaplain assessment visit notes did not include a bereavement assessment. A review of the record revealed there was no initial bereavement assessment documented as of 12/21/2022. Clinical Record 6: The patient was admitted to hospice on 11/17/2022. The 11/17/2022 nursing assessment visit note did not include a bereavement assessment. A review of the record revealed there was no initial bereavement assessment documented as of 12/21/2022. Clinical Record 7: The patient elected hospice care on 11/11/2022. The 11/11/2022 nursing assessment and the 11/12/2022 chaplain assessment visit notes did not include a bereavement assessment. A review of the record revealed there was no initial bereavement assessment documented as of 12/21/2022. Clinical Record 8: The patient elected hospice care on 09/26/2022. The 09/26/2022 nursing assessment, 09/30/2022 social work assessment, and the 09/28/2022 chaplain assessment visit notes did not include a bereavement assessment. A review of the record revealed there was no initial bereavement assessment documented as of 12/21/2022. Clinical Record 9: The patient elected hospice care on 03/22/2022. The 03/22/2022 nursing assessment, 03/22/2022 social work assessment, and the 03/24/2022 chaplain assessment visit notes did not include a bereavement assessment. Review of the record revealed there was no initial bereavement assessment documented as of 12/21/2022. Clinical Record 10: The patient elected hospice care on 10/19/2022. The 10/19/2022 nursing assessment and the 10/22/2022 social work assessment visit notes did not include a bereavement assessment. A review of the record revealed there was no initial bereavement assessment documented as of 12/21/2022. Clinical Record 11: The patient elected hospice care on 10/29/2022. The 10/29/2022 nursing, 10/30/2022 social work and the 11/01/2022 chaplain assessment visit notes did not include a bereavement assessment. A review of the record revealed there was no initial bereavement assessment documented as of 12/21/2022. Clinical Record 12: The patient elected hospice care on 10/03/2022. The 10/03/2022 nursing assessment and the 10/04/2022 chaplain assessment visit notes did not include a bereavement assessment. A review of the record revealed there was no initial bereavement assessment documented as of 12/21/2022. Clinical Record 13: The patient elected hospice care on 10/28/2022. The 10/28/2022 nursing assessment and the 10/29/2022 chaplain assessment visit notes did not include a bereavement assessment. A review of the record revealed there was no initial bereavement assessment documented as of 12/21/2022. During an interview on 12/21/2022, the Administrator confirmed the finding and stated that the initial bereavement assessments had not been completed.

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including a detailed statement of the scope and frequency of services necessary to meet specific patient and family needs. This standard was not met as evidenced by a review of clinical records, document reviews, and interviews. 2 of 13 (15%) records reviewed revealed the hospice did not ensure the plan of care included a detailed scope and frequency of services necessary to meet specific patient and family needs. The agency policy #PC.6 "Plan of Care Process" read in part, "The Plan of Care (POC) includes but is not limited to a detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs, including level of care." Clinical Record 1: The patient elected hospice care on 10/13/2022. The plans of care dated 10/13/2022 and 12/12/2022 included the chaplain frequency of "prn" effective 10/13/2022. The plan of care did not include the scope and frequency of services for the chaplain services. Clinical Record 7: The patient elected hospice care on 11/11/2022. The plan of care dated 11/11/2022 did not include the frequency of nursing and aide services to be provided. During an interview on 12/21/2022, the Administrator confirmed the findings and stated the record had been reviewed and "as needed" frequency was noted and the plans of care were updated with the detailed frequency as required per agency policy.

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by a review of clinical records and interviews. 7 of 13 (54%) records reviewed revealed the hospice did not ensure the written plan of care included the drugs and treatments necessary to meet the needs of the patient. Clinical Record 2: The patient elected hospice care on 05/14/2022. The initial comprehensive assessment dated 05/14/2022 and the subsequent assessments documented the patient had a gastrostomy tube. There was no order related to care of the gastrostomy tube noted in the plan of care as of 12/21/2022. Clinical Record 4: The patient elected hospice care on 11/07/2022. The nursing assessment dated 12/18/2022 documented the patient was using "oxygen at 2 liters per minute via nasal cannula as needed for shortness of breath." There was no physician order for oxygen and oxygen was not included in the plan of care as of 12/21/2022. Clinical Record 5: The patient elected hospice care on 10/25/2022. The initial comprehensive assessment dated 10/25/2022 and the nursing assessment dated 11/10/2022 documented the patient was using "oxygen at 2 liters per minute via nasal cannula as needed for shortness of breath." There was no physician order for oxygen and oxygen was not included in the plan of care as of 12/21/2022. Clinical Record 6: The patient elected hospice care on 11/17/2022. The nursing visit note dated 12/14/2022 documented the receipt of a new physician order that ordered "betadine gauze three times a day to right heel." There was no evidence of the order for wound care in the clinical record and the plan of care as of 12/21/2022. Clinical Record 7: The patient elected hospice care on 11/11/2022. The initial comprehensive assessment dated 11/11/2022 documented the patient was using "oxygen at 2 liters per minute via nasal cannula as needed for shortness of breath." There was no physician order for oxygen and oxygen was not included in the plan of care as of 12/21/2022. Clinical Record 8: The patient elected hospice care on 03/22/2022. The plan of care dated 09/26/2022 ordered "Nystatin topical ointment apply to affected area as needed." The plan of care did not include the indications for the "as needed" use of the Nystatin topical ointment. Clinical Record 11: The patient elected hospice care on 10/29/2022. The plan of care dated 10/29/2022 included the following medications: Lorazepam, Morphine Sulfate, Acetaminophen, Zofran, Atropine, and Dulcolax with the administration frequency of "as needed." The plan of care did not include the indications for the "as needed" use of the medications. During an interview on 12/21/2022, the Administrator confirmed the findings and stated the missing Oxygen orders and complete treatment orders had been inadvertently omitted from the hospice plan of care and had since been corrected.

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by a review of clinical records and interviews. 2 of 13 (15%) records reviewed revealed the hospice did not ensure that the plan of care included medical supplies and appliances necessary to meet the needs of the patient. Clinical Record 4: The patient elected hospice care on 11/07/2022. The plan of care dated 11/07/2022 and subsequent updates included a blank for durable medical equipment (DME). The nursing assessment dated 12/18/2022 documented that the patient was using "oxygen at 2 liters per minute via nasal cannula as needed for shortness of breath." There was no physician order for oxygen and oxygen was not included in the plan of care as of 12/21/2022. Clinical Record 5: The patient elected hospice care on 10/25/2022. The plan of care dated 11/07/2022 and subsequent updates included a blank for durable medical equipment (DME). The initial comprehensive assessment dated 10/25/2022 and the nursing assessment dated 11/10/2022 documented the patient was using "oxygen at 2 liters per minute via nasal cannula as needed for shortness of breath." There was no physician order for oxygen and oxygen was not included in the plan of care as of 12/21/2022. During an interview on 12/21/2022, the Administrator stated equipment had been inadvertently omitted from the hospice plan of care.

It is required that nursing care and services are provided by or under the supervision of a registered nurse and per the patient plan of care. Nursing services ensure that the nursing needs of the patient are met as identified in the patient’s initial assessment, comprehensive assessment, and any updated assessments. This standard was not met as evidenced by a review of clinical records and interviews. 1 of 13 (8%) records reviewed revealed the hospice did not ensure that nursing care and services were provided in accordance with the plan of care. Clinical Record 4: The patient elected hospice care on 11/07/2022. The plan of care dated 11/07/2022 ordered a nurse frequency of "two times per week." A review of the clinical record revealed nursing visits were completed one time a week for the period of 11/23/2022 through 12/21/2022. There was no evidence of communication with the physician to change the nursing visit frequency. During an interview on 12/21/2022, the Administrator confirmed the finding and stated nursing visits were not being made as per the plan of care and the frequency order had since been entered to reflect the current frequency,

It is required that counseling services include an organized program for providing bereavement services delivered by or under the supervision of a qualified professional with experience or education in grief or loss counseling. Bereavement services are available to the family and other individuals up to one (1) year following the death of the patient. Bereavement counseling extends to residents of a SNF/NF (skilled nursing facility/nursing facility) or ICF/IDF (intermediate care facility/intellectual disability facility) when appropriate and identified in the bereavement plan of care. The bereavement services reflect the needs of the bereaved per a bereavement plan of care that includes the types of bereavement services to be offered and the frequency of service delivery. This standard was not met as evidenced by a review of clinical records, document reviews, and interviews. 2 of 2 (100%) records reviewed in which bereavement services were provided by the hospice revealed the hospice did not ensure bereavement services reflected the needs of the bereaved per a bereavement plan of care. The agency policy #PC.26 "Bereavement" read in part, 'Following the death, the Agency will develop and implement the bereavement plan of care based on the post death risk assessments. The plan of care will include delineation of services and frequency to be provided which may include, but not be limited to, the following: contact with the family through cards, phone calls, letters; attendance at the funeral; visits; referral to counseling services and physician." Clinical Record 10: The patient elected hospice care on 10/19/2022. The patient expired on 11/26/2022. There was documentation of one bereavement contact made per assigned interventions identified on a spreadsheet. There was no evidence of a bereavement plan of care as of 12/21/2022. Clinical Record 11: The patient elected hospice care on 10/29/2022. The patient expired on 11/21/2022. There was documentation of one bereavement contact made per assigned interventions identified on a spreadsheet. There was no evidence of a bereavement plan of care as of 12/21/2022. During an interview on 12/21/2022, the Administrator confirmed the findings, stating the hospice used a spreadsheet and interventions based on risk level assessments and a plan of care was not created as per agency policy.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group; included in the plan of care; permitted to be performed under state law and regulation; and is consistent with the hospice aide training. THIS IS A CMS CONDITION-LEVEL DEFICIENCY This CONDITION was not met as evidenced by a review of clinical records and interview of the Administrator and the Director of Clinical Services which revealed that the agency failed to ensure written patient care instructions for the hospice aide [HCDT.15.I/L625]; and failed to ensure the hospice aides followed the established aide plan of care [HCDT.16.I/L626]. The cumulative effect of these deficiencies could place the patient in jeopardy for a safety risk or for a lack of quality care.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group and written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by a review of clinical records and interviews. 8 of 12 (67%) records of patients receiving aide services revealed the agency did not ensure the aide assignments included a specific task frequency. Clinical Record 2: The aide care plan assigned on 10/30/2022 by the registered nurse (RN) did not include a frequency for the assigned task: comb/brush hair. The task frequency for nail care was documented as needed (PRN). The "PRN" task frequency assigned was not specific. Clinical Record 5: The aide care plan assigned on 10/25/2022 by the RN included a task frequency of "weekly and prn" for nail care. The "PRN" task frequency assigned was not specific. Clinical Record 6: The aide care plan assigned on 11/17/2022 by the RN did not include frequencies for the assigned tasks; peri care, oral care, skin care, shave, tidy patient area, tidy bathroom, feeding assist, linen change, and provide companionship. Clinical Record 7: The aide care plan assigned on 11/28/2022 by the RN did not include a frequency for the assigned tasks. Clinical Record 8: The aide care plan assigned on 12/13/2022 by the RN included the frequency "PRN" for the task: shave. The "PRN" task frequency assigned was not specific. Clinical Record 9: The aide care plan assigned on 09/07/2022 by the RN included the frequency of PRN for the task of feeding assist. The "PRN" task frequency assigned was not specific. Clinical Record 11: The aide care plan assigned on 10/29/2022 by the RN included the frequency "PRN" for the task: shave. The "PRN" task frequency assigned was not specific. Clinical Record 12: The aide care plan assigned on 10/04/2022 by the RN did not include frequencies for the tasks assigned. Linen change was assigned "weekly or PRN." The assigned tasks did not include specific frequencies. During an interview on 12/21/2022, the Administrator stated task frequencies were not provided and have since been corrected.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by a review of clinical records, and interviews. 8 of 12 (67%) records reviewed revealed the agency did not ensure that the hospice aide provided services that were ordered by the interdisciplinary group and included in the plan of care. Clinical Record 2: The aide care plan dated 10/30/2022 assigned the aide the tasks: shower, linen change, and shampoo Monday, Wednesday, and Friday (MWF) and partial bed bath Tuesday, Thursday (T, TH). For the visits dated 11/01/2022 through 12/21/2022, the aide documented completion of the bed bath, linen change, and shampoo at every visit. Clinical Record 3: The aide care plan dated 10/19/2022 assigned the aide the tasks: shower, linen change, and shampoo Monday, Wednesday, and Friday (MWF) and partial bed bath Tuesday, Thursday (T, TH). For the visits dated 11/03/2022 through 12/21/2022, the aide documented completion of the bed bath, linen change, and shampoo at every visit. Clinical Record 5: The aide care plan dated 10/25/2022 assigned the aide the tasks: shower Monday, Wednesday, and Friday (MWF) and bed bath Tuesday, and Thursday (T, TH). For the visits dated 10/28/2022 through 12/21/2022, the aide documented the completion of the bed bath at every visit. Clinical Record 6: The aide care plan dated 11/17/2022 assigned the aide the tasks: shower and shampoo Monday, Wednesday, and Friday (MWF) and bed bath Tuesday, and Thursday (T, TH). For the visits dated 11/22/2022 through 12/21/2022, the aide documented the completion of a shower and shampoo at every visit. Clinical Record 9: The aide care plan dated 09/07/2022 assigned the aide the tasks: shower, shave, and linen change Monday, Wednesday, and Friday (MWF) and bed bath Tuesday, and Thursday (T, TH). For the visits dated 09/21/2022 through 10/24/2022, the aide documented completion of a shower, linen change, and shave at every visit. Clinical Record 10: The aide care plan dated 10/20/2022 assigned the aide the tasks: shower, shampoo, and linen change Monday, Wednesday, and Friday (MWF) and bed bath Tuesday, and Thursday (T, TH). For the visits dated 10/20/2022 through 11/25/2022, the aide documented the completion of a shower and linen change at every visit. In addition, no shampoo was provided through 12/21/2022. Clinical Record 11: The aide care plan dated 10/29/2022 assigned the aide the tasks: shower and shampoo Monday, Wednesday, and Friday (MWF) and bed bath Tuesday, and Thursday (T, TH). For the visits dated 10/31/2022 through 11/18/2022, the aide documented the completion of a shampoo at every visit. Clinical Record 13: The aide care plan dated 10/28/2022 assigned the aide the tasks: bed bath Monday, Wednesday, and Friday (MWF) and shower Tuesday, and Thursday (T, TH). For the visits dated 10/31/2022 through 11/07/2022, the aide documented the completion of a bed bath at every visit. During an interview on 12/21/2022, the Administrator confirmed the finding and stated the aide had not followed the plan of care.

It is required that all entries in the patient record are legible, complete, and appropriately authenticated and dated by the person performing the care/service in accordance with hospice policy and with currently acceptable standards of practice. This standard was not met as evidenced by a review of clinical records, document review, and interviews. 8 of 13 (62%) records reviewed revealed the agency did not ensure that all entries in the medical record included credentials with the associated clinician signature and date. The agency policy #IM.7 "Authorization and Authentication of Medical Record Entries" read in part, 'Each medical record entry will be dated and signed with the complete name and title/credential of the person making the entry. Clinical Record 1: The patient elected hospice care on 10/13/2022. The chaplain visit notes dated 10/15/2022 through 12/21/2022 did not include the title/credential of the persons making the entries. Clinical Record 2: The patient elected hospice care on 5/14/2022. The hospice aide (HA) and the chaplain visit notes dated 11/10/2022 through 12/21/2022 did not include the titles/credentials of the persons making the entries. Clinical Record 3: The patient elected hospice care on 8/05/2022. The HA visit notes dated 11/03/2022 through 12/21/2022 and the nursing visit notes dated 11/17/2022 through 11/28/2022 did not include the titles/credentials of the persons making the entries Clinical Record 9: The patient elected hospice care on 3/22/2022. The HA visit notes dated 09/21/2022 through 10/10/2022,10/12/2022 through 10/18/2022, and 10/11/2022 did not include the title/credential of the persons making the entries. In addition, the nursing visits notes dated 10/03/2022 through 10/24/2022 did not include the dates of the visits or the signatures and credentials of the person making the entry. Clinical Record 10: The patient elected hospice care on 10/19/2022. The HA visit notes dated 11/01/2022 through 10/25/2022 and the nursing visits notes dated 11/18/2022 through 11/24/2022 did not include the titles/credentials of the persons making the entries. Clinical Record 11: The patient elected hospice care on 10/29/2022. The HA visit notes dated 10/31/2022 through 11/18/2022 did not include the dates of the visits or the signatures and credentials of the persons making the entries. Clinical Record 12: The patient elected hospice care on 10/03/2022. The HA visit notes dated 10/04/2022 through 10/14/2022 did not include the signatures and credentials of the persons making the entries. Clinical Record 13: The patient elected hospice care on 10/28/2022. The HA visit notes dated 10/31/2022 through 11/07/2022 did not include the dates of the visits or the signatures and credentials of the persons making the entries. During an interview on 12/20/2022, the Director of Clinical Services confirmed the findings and stated credentials were missing and have since been corrected in the electronic medical record clinician profile.