Every finding on record at Senior Care Living Solutions, LLC

Upon patient record review, 1 of 14 (Patient 4) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable state law.

Upon patient record review, 4 of 14 (Patient 1, 2, 7 & 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 medication profile includes "Bactroban ointment topically to affected areas as ordered by MD" with no frequency and no location identified. Patient 2 medication profile includes "Silvadene cream topically to affected areas as ordered by MD" with no frequency, and no location identified. Patient 7 medication profile includes duplicate entries of "O2 @ 3LMP as needed for SOB" and no route. Patient 10 medication profile includes "Miralax 17gm scoop 1 scoop orally daily as needed if no BM in 2-3 days" with no mixing instructions.

Upon patient record review, 2 of 14 (Patient 4 & 5) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient 4 plan of care includes "MSW initial eval and as needed" with no specified number of prn visits and "SC initial eval and as needed" with no specified number of prn visits" Patient 5 plan of care includes "MSW initial eval and as needed" with no specified number of prn visits and "SC initial eval and as needed" with no specified number of prn visits.

Upon patient record review, 4 of 14 (Patient 1, 2, 7 & 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 medications and treatments. Patient 1 plan of care includes "Bactroban ointment topically to affected areas as ordered by MD" with no frequency and no location identified. Patient 2 plan of care includes "Silvadene cream topically to affected areas as ordered by MD" with no frequency, and no location identified. Patient 7 plan of care includes duplicate entries of "O2 @ 3LMP as needed for SOB" and no route. Patient 10 plan of care includes "Miralax 17gm scoop 1 scoop orally daily as needed if no BM in 2-3 days" with no mixing instructions.

Upon patient record review 5 of 14 (Patient 5, 7, 8, 12 & 13) 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 • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 5 plan of care CHHA 3 x week" with only 1 visit made week of 9/10-9/16/23. Patient 7 "CHHA 3 x week" with no evidence of visit 8/13-8/19/23. Patient 8 "CHHA 3 x week" with no evidence of visits 7/30-8/5, 8/6-8/12, 8/13-8/19/23. Patient 12 "CHHA 3 x week" with no evidence of visits 4/30-5/6/23. Patient 13 "CHHA 2 x week" with 3 x week visits made throughout benefit period.

Upon patient client record review, 1 of 14 (Patient 5) 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 Patient 5 had no evidence of the effective date of the election.

Upon client record review, 2 of 14 (Patient 13 & 14) 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