Every finding on record at Summit Hospice, Inc.

Upon patient record review, 2 of 5 (Patient #1, 4) did not have evidence that the patient chooses a health care provider, including an attending physician. The section was left blank.

Upon patient record review, 1 of 5 (Patient #2) 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 #2 no evidence of initial bereavement risk assessment as part of the comprehensive assessment.

Upon patient record review, 1 of 5 (Patient #4) 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 #4: There is no signed physician certification statement and/or narrative statement completed by physician.

Upon patient client record review, 2 of 5 (Patient #1, 4) 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, 4: The election statement contains no effective date. The space is left blank. The election statement contains no physician of patient's choice. The space is left blank.

Upon patient client record review, 1 of 5 (Patient #4) 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 #4: "There is a physician order dated 2/18/22 Patient to be discharged from hospice services due to absence of vital signs as of 2/18/22 at 16:11." The patient expired 2/22/22.

Upon client record review, 2 of 5 (Patient #1, 4) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed. Patient 1, 4: The acknowledgement forms signed by patient, to specify written policies and procedures for managing controlled drugs, was left blank.