Every finding on record at Royal Hospice Care, LLC

Upon patient record review 3 of 14 records reviewed (Patient #3, #8, #9) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #3: The record indicated the start of care for hospice was on 04/10/24. There was no evidence of a comprehensive psychosocial assessment being completed until 04/19/24. The nursing assessment did not have evidence of a full comprehensive psychosocial assessment being completed. Patient #8: The record indicated the start of care was on 06/18/24. There was no evidence of a comprehensive psychosocial assessment being completed until 06/24/24. Patient #9: The record indicated the start of care was on 03/21/22. There was no evidence of a fully completed comprehensive psychosocial assessment being completed at the time on 3/25/24 when the social worker completed the assessment, the financial, legal assessment and environmental assessment was left blank. This was also left blank and not included on the nursing comprehensive assessment.

Upon patient record review, 10 of 14 charts reviewed (patient #1-10) 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 Patient #1-10: The record indicated that these patients had a medication profile with multiple medications listed. There was no evidence of a review being complete for drug to drug interactions, duplicate drug therapy and or a review to include drug therapy currently associated with laboratory monitoring. COS.

Upon patient record review, 3 of 14 records reviewed (Patient #3, #4, #7) 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 #3: The record indicated the patient was taking Coumadin 1mg 2 tabs po on Monday and Friday and 1mg 1 tab po on Tuesday, Wednesday, Thursday, Saturday and Sunday. There was no evidence of an individualized written plan of care for bleeding precautions. COS. Patient #4. The record indicated the patient was taking Eliquis 2.5mg po Q Day. There was no evidence of an individualized written plan of care for bleeding precautions. COS. Patient #7: The record indicated the patient had a foley catheter at the start of care on 12/18/24. There was no evidence this was included on the plan of care. COS.

Upon patient record review, 1 of 14 (Patient #7) 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: The record indicated on admission the patient had a foley. There was no evidence in the chart of an order to keep and/or for maintaining the foley catheter, balloon size and type and amount of solution to put in the balloon. COS.

Upon patient record review, 2 of 14 (Patient #1,4) 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 record indicated the patient was receiving briefs and wipes. There was no evidence these items were listed in the plan of care. COS. Patient #4: The record indicated the patient was receiving briefs. There was no evidence of this item listed in the plan of care. COS.

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. Patient #1: During the home visit the nurse sanitized her hands and placed all medical equipment needed for the patients assessment on a clean barrier. Post assessment she cleaned all the assessment equipment and placed it back on the dirty barrier then placed the equipment in her bag. Per Policy No. 6-013.2 #2 Prior to administering care, alcohol-based hand rub or soap and paper towels will be removed, and hands will be washed. These supplies will be left at the sink for hand washing at the end of the visit. Hand washing will always be completed before opening the bag. The nurse did not wash her hands prior to opening the bag and or at the end of the visit.

Upon personnel record review, 1 of 16 records reviewed (Personnel #7) 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 Record #7: The personnel record indicated the hospice aide competency was checked off "in the office." There was no evidence in the personnel record of the hospice aide having a competency check off with a patient and or a pseudo-patient.

Upon patient record review, 2 of 14 (Patient #3, #4) 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 #3: The record indicated the patient was taking Coumadin 1mg 2 tabs po on Monday and Friday and 1mg 1 tab po on Tuesday, Wednesday, Thursday, Saturday and Sunday. There was no evidence for bleeding precautions on the hospice aide plan of care. COS. Patient #4: The record indicated the patient was taking Eliquis 2.5mg po Q Day. There was no evidence of bleeding precautions on the hospice aide care plan. COS.

Upon patient record review, 4 of 11 (Patient #4, #6, #10, #11) 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 Patient #4: On 2/17/22 Lidoderm cream "topical" was transcribed to the medication profile without specifying the application site. COS Patient #6: On 7-12-21 Arthricream "topical" and Bacitracin "affected area" were transcribed to the medication profile without specifying the application site. COS Patient #10: On 12-27-21 Voltaren gel "topically" was was transcribed to the medication profile without specification of the application site. COS Patient #11: On 1-9-21 Diclofenac Na 1% was transcribed to the medication profile without an area of application. COS