Every finding on record at Sirius Hospice Inc.

Upon patient record review, 2 of 14 (Patient #7 and #8) 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 #7: The SC services indicated noted on POC "As Needed" The MSW indicated plan for visits at"Recent and As Needed." These orders did not specify frequency for these disciplines. Patient #8: The SC services were declined and noted on POC "will continue to offer." The MSW indicated plan for visits at"Recent and As Needed." These orders did not specify frequency for these disciplines.

Upon patient record review, 4 of 14 (Patients #1,2,3,9) 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 bedside table, hospital bed and wheel chair. These were not included on the Plan of Care. Corrected on Site. Patient #2: This patient had a Hoyer Lift and side rails. These were not included on the Plan of Care. Corrected on Site. Patient #3: This patient had a shower chair, wheelchair, walker and side rails These were not included on the Plan of Care. Corrected on Site. Patient #9: The record reflected that this patient had an oxygen and nebulizer order. The oxygen and nebulizer equipment were not listed on Plan of Care. Corrected on Site.

Upon client record review, 4 of 14 (Patients #2. #3,#4 and #5) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2: The SC services were declined per POC. The SC visited the patient on 9/21/23, 11/20/23, 1/15/24 and 3/19/24. Patient #3: The Plan of Care (POC) indicated MSW and SC visits as 1X per month (12/5/23). The MSW did not visit the months of January or February. The SC did not visit the month of February. These discipline did not follow frequencies ordered on the POC. Patient #4: The POC listed SC visit frequency of, 1 X's per month. The SC visited patients 2X's in month of August (8/12/23, 8/24/23). The SC did not follow visit frequency indicated on POC. Patient #5: The POC listed SC visit frequency of, 1 X's per month. The SC visited patients 2X's in months of September and November (9/6/23, 9/74/23, 1121/23 and 11/28/23). The SC did not follow visit frequency indicated on POC.

Upon patient record review, 2 of 14 (Patients #8 and #14) 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 #8: The Aide Visit Frequency indicated 2X's per week + 1PRN (1/24/23). The aide is not able to decide if a visit can be made and the order did not have include the cognition of patient ability to make PRN choice. Patient #14: The Aide Visit Frequency indicated "X" per week. The order did not include number of visits per week. The Aide does visit this patient 2X's per week.

Upon patient record review 4 of 14 (Patients #1, #4, #6 and #12) 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 Patient #1: The POC listed Aide visit frequency of, 2 X's per week (7/29/23). There were no visits made by the Aide the 1st Benefit Week. Patient #4: The POC listed Aide visit frequency of, 2 X's per week (6/9/23). There were no visits made by the Aide until 6/27/23. Patient #6: The POC listed Aide visit frequency of, 2 X's per week (1/14/23). There were no visits made by the Aide the 1st Benefit Week. Patient #12: The POC listed Aide visit frequency of, 2 X's per week (2/28/23). There was one visit made the 1st Benefit Week on 3/2/23 only.

Upon patient client record review, 9 of 14 (Patients #1, #3, #4, #5, #6, #7, #9, #10 and #11) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patients #1,3,4,5,7,9 and 11: Elected to receive "Notification of Non-Covered Items" at Start of Care. There is no evidence in patient records that this was provided. Patient #6: The Election of Benefit form had patient initials (not date) were written in space provided on the form for "effective date/SOC." Patient #10: The Election of Benefit form was left blank in space provided on the form for "effective date/SOC." Additionally, the Notification of Non Covered items was not provided when beneficiary signed document.