Every finding on record at Sincere Hospice LLC

Upon patient record review, 2 of 9 (Patients #1,2) 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: The record reflected patient was using oxygen. This is not listed on med profile or as an order. Patient #2: Miralax 17 gm powder with no diluent included on med profile or order.

Upon patient record review, 5 of 9 (Patients #1,2,4,7,9) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #1: The Initial Bereavement Risk Assessment was not timely. SOC 10/24/23. Bereavement Risk Assessment completed on 11/2/23. Patient #2: The Initial Bereavement Risk Assessment has not been completed to date. Patient #4: The Initial Bereavement Risk Assessment has not completed to date. The Post Bereavement Risk Assessment had been completed only after death. Patient #7: The Initial/Post Death Bereavement Risk Assessment was not completed to date. Patient #9: The Initial Bereavement Risk Assessment has not completed to date. The Post Bereavement Risk Assessment had been completed only after death.

Upon patient record review, 2 of 9 (Patients #1,2) 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: The record reflected patient was using oxygen. This is not listed on med profile or as an order. Patient #2: Miralax 17 gm powder with no diluent included on med profile or POC order.

Upon patient record review, 3 of 9 (Patients #1,2,6) 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, bedside table, O2 concentrator and fall mat. These were not included on the Plan of Care. Patient #2: This patient had an APP mattress. This item was not included on the Plan of Care. Patient #6: The record reflected that this patient had oxygen 2l/min order. The O2 equipment was not included on the Plan of Care.

Upon personnel record review, 1 of 11 (Personnel #8) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: ·Nail and skin care Personnel #8: Did not have nail/skin care checked off on skills competency form as observed/demonstrated. The agency indicated they did this on 10/19/23 per signature & date at bottom of form. However, specific tasks were not checked off in body of form. The space next to these tasks for initial and date were not filled in.

Upon patient client record review, 3 of 9 (Patient #1,2,6) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #1: The Hospice SOC was 10/24/23. The EOB form indicated SOC of 10/25/23. Patient #2: The Hospice SOC was 12/4/23. The EOB form indicated SOC 11/30/23 Patient #6: The EOB form indicated SOC "TBD on hospital D/C". There was not a start date in space provided on form.