Every finding on record at Skylar Hospice Care Inc.

Upon patient record review, 1 of 14 (Patient #7) did not have evidence that each patient and family received education and training provided as appropriate to their responsibilities for the care and services identified in the plan of care. Patient #7: Feb 5, 12, 19, 27, March 5, 12, 19, RN initiated 500 ml weekly IV infusions for hydration as physician ordered. The RN educated patient caregiver (daughter) that once infusion is complete, for her to "remove needle and apply direct pressure and call RN if problem". Requested policy/procedure regarding infusion and discontinuance, but not provided. Upon interview with RN, verified that intravenous catheter remained in place for infusion and no actual needle was to be removed. Other related infusion education was documented generally and no specifics to include bag positioning for gravity infusion and monitoring for signs/symptoms of possible infiltration when infusion continued after nurse exited.

Upon patient record review, 10 of 14 (Patient #1, 2, 3, 4, 5, 6, 7, 8, 9, 10) 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 #1: Initial and ongoing Volunteer frequency as needed for additional companion/assistance. 8/9/24 order for MSW frequency of visits as needed per patient/family request and re-cert for psychosocial needs. A discipline's ordered visit frequency cannot include a PRN visit frequency, without a baseline frequency to support it. Patient #2: Initial and ongoing Volunteer frequency as needed for companionship and assistance MSW as needed and recert. A discipline's ordered visit frequency cannot include a PRN visit frequency, without a baseline frequency to support it. Patient #3: 8/12/24 order Vol as needed. 8/12/24 MSW as needed and recert for psychosocial and emotional needs as well as additional resources. A discipline's ordered visit frequency cannot include a PRN visit frequency, without a baseline frequency to support it. Patient #4,5: Vol as needed. MSW as needed per patient/family request and recert for psychosocial needs. A discipline's ordered visit frequency cannot include a PRN visit frequency, without a baseline frequency to support it. Patient #6: Vol 1 as needed. MSW as needed and recert. A discipline's ordered visit frequency cannot include a PRN visit frequency, without a baseline frequency to support it. Patient #7: 2/4/24 MSW services will provide as needed and recert. A discipline's ordered visit frequency cannot include a PRN visit frequency, without a baseline frequency to support it. Patient #8: Vol as needed. MSW 1month and as needed. Patient #9: Vol services as needed. 4/15/24 MSW frequency of visit once/month and as needed. A discipline's ordered visit frequency cannot include a PRN visit frequency, without a baseline frequency to support it. Patient #10: Vol services as needed. 8/10/24 MSW frequency as needed per patient request and recert for psychosocial needs. A discipline's ordered visit frequency cannot include a PRN visit frequency, without a baseline frequency to support it.

Upon client record review, 1 of 14 (Patient #7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #7: LVN Visit 3/21/24 No evidence wound care was provided and no documented evidence assessed patient caregiver had provided and/or was compliant with daily wound care and/or education this visit.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. The LVN donned gloves to perform patient assessment, including skin checks and direct contact. He did not change gloves at end of assessment and proceeded to clean equipment and return equipment to nursing bag with same gloves

Upon personnel record review, 1 of 15 (Personnel #14 ) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel #14: There is no specification for shampoo competency at sink, tub, bed.

Upon contract review, 1 of 5 (Wound Masters contract) did not have evidence the agreement to furnish any services under arrangement included that the hospice must retain administrative and financial management, and oversight of staff and services for all arranged services, to ensure the provision of quality care. Arranged care/services are supported by written contract/agreement that requires all care/services are: • Authorized by the hospice • Furnished in a safe and effective manner by qualified personnel • Delivered in accordance with the patient's plan of care Wound Masters providing specialized wound care to Patient #7. There is no contractual arrangement in place and no documentation if wound was related or unrelated.

Upon patient record review, 4 of 10 (Patient #2, 7, 8, 10) 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 Patients #2, 7, 8, 10: Initial CTI is completed only by attending physician and not by hospice medical director or other hospice physician. (all admitted in 1st 90 day benefit period)

Upon patient client record review, 3 of 14 (Patient #1, 2, 9) 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 #1, 2, 9: Patient chose to receive Hospice Items and Service Not Covered addendum. Addendums provided do not include non-covered medications as specified on medication profiles

Upon patient client record review, 4 of 14 (Patient #1, 2, 7, 9) 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 #1: The POLST form dated 5/13/24 has X in Attempt CPR box, but has blackened/filled in Do not attempt resuscitation/DNR (allow natural death). in Section A. Patient #2: The POLST Form is signed by patient daughter 6/5/24, but by physician 7/18/24. Says form prepared 6/5/24. Patient #7: Documentation incomplete regarding weekly insertion of peripheral IV and specifics of wound care. There is no specific documentation regarding the insertion of peripheral IV by RN for weekly 500 ml IV hydration for visit dates: Feb 5, 12, 19, 27, March 5, 12, 19, but simply states "infusion on right arm" or "infusion on left arm" each visit note. Nurse interviewed understands should have been specific to procedure . Patient #9: Patient had order for SC monthly, but IDGs said SC declined in frequency section (Sept 13, 27, Oct 11, 25 meeting dates)

Upon client record review, 2 of 14 (Patient #7, 8) did not have evidence that the hospice forwarded a summary and a copy of the patient record, if requested, to a facility when transferring the patient to that facility. Patients #7, 8: Revocation forms identified reasons for revocation as "transfer to another hospice" and "transfer to home health respectively". There was no documented evidence of agency's coordination - or offer to coordinate - with receiving agency.

Upon client record review, 4 of 14 (Patient #7, 8, 9, 10) did not have evidence that the discharge summary includes all required information. Patient #7, 8, 9, 10: Discharge summaries do not include comprehensive clinical review of the patient's stay with hospice, including treatment, symptoms and pain management.

Upon client record review, 2 of 5 (Patient #1,#4) did not have evidence the IDG ensured care and services are provided in accordance with the plan of care. Patient #1 The spiritual care frequency was for an assessment upon admission and follow-up as indicated. A spiritual assessment was completed on 8/24/21 (admission) and 11/22/21. There was no evidence of an order for the 11/22/2021 assessment. Patient #4 The medical social worker frequency was for 1 time a month. A medical social worker assessment was completed on 8/5/2021 (admission) and 8/19/21. There was no order for the 8/19/2021 assessment.

Upon observation, 1 of 3 applicable home visits (Patient #3) did not have evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #3, RN: Upon observed home visit staff member dropped the wrist blood pressure machine on the floor and proceeded to use the equipment and assess the patient without sanitizing the equipment prior to using.