Every finding on record at Silver Stone Hospice Inc

Upon patient record review, 1 of 5 (Patient #3) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient's life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination: • The primary terminal condition • Related diagnosis • Current subjective and objective medical findings • Current medication and treatment orders • Information about the medical management of any of the patient's conditions unrelated to the terminal illness Patient #3: The CTI was signed greater than 15 days prior to the SOC. The medical director signed the CTI on 8/5/2023, when patient was admitted on 8/25/2023,

Upon patient record review, 2 of 5 (Patient #1, 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 Patient 1: The medication list indicates Miralax 17g once daily po PRN constipation. There are no required instructions for reconstitution of the powdered medication, though the instructions are present on the physician's signed orders. (corrected onsite) Patient 5: The medication list indicates Voltaren topical gel 1% bid PRN pain. There is no indication of an application site for the topical medication, though the signed physician's orders contain instructions for use on bilateral knees.

Upon patient record review, 1 of 5 (Patient #1) 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 1: The comprehensive initial assessment, dated 09.20.2022, indicates the patient utilizes a walker, requires assistance with ADLs, and is a high risk for falls. The CTI provided by the physician also indicates the patient requires caregiver assistance in the home and must utilize the walker during ambulation. However, no care plan has been developed related to safety/fall prevention. (corrected onsite)