Every finding on record at Signature Hospice Bend, LLC

Based on patient record review, it was determined that the agency failed to complete a bereavement assessment, which is part of the initial comprehensive assessment, in the timeframe as stipulated in the requirements of this standard. --- Findings:Review of 14 patient medical records revealed that 7 patient records (#1, #2, #7, #8, #11, #13, and #14) lacked documentation of a bereavement assessment completed with the initial comprehensive assessment.Review of Patient medical record #1 with an election of hospice care date of 02/03/2026, revealed the bereavement assessment was not completed until 02/11/2026, which exceeds the 5 calendar days after the election of hospice care.Review of Patient medical record #2 with an election of hospice care date of 04/01/2026, revealed the bereavement assessment was not completed until 04/07/2026, which exceeds the 5 calendar days after the election of hospice care.Review of Patient medical record #7 with an election of hospice care date of 02/18/2026, revealed the bereavement assessment was not completed until 02/27/2026, which exceeds the 5 calendar days after the election of hospice care.Similar findings were identified for Patients #8 and #11-14.

Upon patient record review, 1 of 7 (Patient #5) 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 #5: Had an order for Oxygen. Oxygen was not included on the Medication Profile.

Upon patient record review, 4 of 7 (Patient #1, #2, #3 and #5) 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: This patient had a bed-side commode. This item was not included on the Plan of Care. Patient #2: This patient had a cane, bedrail and shower chair. These items were not included on the Plan of Care. Patient #3: This patient had an oxygen concentrator, wheel chair and Hoyer lift. These items were not included on the Plan of Care. Patient #5: The record reflected that this patient had a shower chair. This item was not included on the Plan of Care.

Upon personnel record review, 2 of 7 applicable (Personnel #1 and #7) did not have evidence the hospice employees have received orientation on the hospice philosophy. Personnel #1 and #7: Did not have evidence in their personnel files that they were orientated to Hospice Philosophy.

Upon personnel record review, 2 of 6 applicable (Personnel #3 and #8) did not have evidence that the hospice employees have received orientation on their specific job requirements. Personnel #3: Did not have RN Job description in employee file. Job description updated on 7-7-22. Corrected on Site. Personnel #8 Did not have HHA job description in employee file. Job description updated on 7-7-22. Corrected on Site.

Upon personnel record review, 2 of 7 applicable (Personnel #3 and #7 ) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel #3: Did not have RN Competency Validation in their file. There was Clinical Manager and Nurse Practitioner validation only. Personnel #7: Did not have VC, BR, Vol Competency Validation in their file. There was MSW Validation only.

Upon patient client record review, 1 of 7 (Patient #4) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #4: The Beneficiary elected to receive the "Patient Notification of Hospice Non Covered Items" at start of care (SOC). The hospice did not furnish this addendum within 5 days as required. The SOC was 3-23-22. The addendum was furnished on 3-31-22.

Upon patient client record review, 1 of 7 (Patient #3) 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 #3: The Medical record reflected the Hospice Nurse Practitioner (NP) as primary physician, not the Medical Director. The family chose Medical Director as the primary physician as evidenced on Election of Benefit form in space provided, not the NP. The agency corrected this record during survey.