Every finding on record at Rose Garden Hospice, Inc.

Upon patient record review, 2 of 15 (Patient #7,8) 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 Patient #7 Order dated 1/22/25 Triamcinolone cream to be applied daily, no evidence of specific location on medication profile. Patient #8 Order dated 11/15/24 for Diclofenac 1% Gel to be applied daily, no evidence of specific location on medication profile.

Upon patient record review, 1 of 15 (Patient #1) 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 #1 Order dated 4/29/25 for Ciprofloxacin QDx5D due to family expressing concern via phone call of eye irritation and new orders obtained, no evidence of follow up from agency on new orders or assessment of patient.

Upon patient record review, 2 of 15 (Patient #7,8) 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 #7 Order dated 1/22/25 Triamcinolone cream to be applied daily, no evidence of specific location on POC. Patient #8 Order dated 11/15/24 for Diclofenac 1% Gel to be applied daily, no evidence of specific location on POC.

Upon client record review, 3 of 15 (Patient #8,10,11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #8 Orders dated 3/6/24 for SC visits 1x/month, no visits made after 5/6/24 and no evidence of orders being discontinued due to family declined SC visits after that date. Patient #10 POC dated 6/6/24 stated family declined any further SC visits, no evidence of orders being discontinued due to family declined SC visits after that date. Patient #11 POC dated 5/9/24 for SC visits 1x/month, no evidence of visits completed in June or July 2024.

Upon client record review, 1 of 15 (Patient #10) 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 Patient #10 Discharge summary dated 10/4/24 do not state which physician received the discharge summary and copy of patient record.