Every finding on record at Smart Choice Hospice Inc

Upon patient record review, 1 of 14 (Patient #1) 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: Upon record review, MAR has "Icy Hot 1 patch 'orally' once a day at night for arthritis". No evidence that correct route was updated on MAR. Corrected on site.

Upon patient record review, 1 of 14 (Patient #1) 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: 04/07/2023 Medication order has "Icy Hot 1 patch 'orally' once a day at night for arthritis". No evidence that route was updated. Corrected on site.

Upon client record review, 2 of 14 (Patient #11,12) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 11: Plan of care order has SN frequency as 4 visits per week for 3 months. SN nurse visits occurred once weekly. No evidence of missed visit notes on record. No evidence that an order was obtained to change SN frequency. Patient 12: Plan of care order has MSW visit frequency as one visit per month for 3 months. No evidence that MSW visits occurred once a month, only the initial evaluation occurred on 01/18/2023. No evidence of missed visit notes on record. No evidence that MSW visits occurred for the remaining months within the benefit period. No evidence that an order was written to discontinue visits.

Upon patient record review 2 of 14 (Patient #13 and 14) 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 • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 13: Plan of care order for aide twice a week. Aide wrote one missed visit note on 05/10 stating that the family refused her services and would let the office know when they were ready to receive aide services. No evidence that an order was written to stop aide visits at that time. Aide visits were restarted on 05/29. Aide visited patient 3 times a week for the weeks of 05/29 and 06/05. Patient 14: Plan of care order for aide once a week. Aide visits twice a week for the weeks of 09/19, 09/26, and 10/03. No evidence that an order was written to increase frequency.