Every finding on record at Sunset Hospice Services, 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 Patient 1: The medication list indicated docusate 100mg 2 caps po PRN as stool softener. There was no indication of a frequency for the use of this medication. The medication list also indicated Miralax powder, but the instructions for reconstitution were not included on the medication list. (corrected onsite)

Upon patient record review, 2 of 14 (Patient #4, 5) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual's attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient's progress toward desired outcomes • Reassessment of the patient's response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient 4: The patient was admitted on 04.29.2024 and a complete comprehensive assessment was performed by a RN. There was no evidence that a RN has seen the patient since that time to update the complete assessment. To be clear, a LVN has seen the patient 2 x weekly since admission to address all needs and provide ongoing care. Patient 5: The patient was seen on 04.05.2024 by a RN for a comprehensive assessment; the next update to the comprehensive assessment by a RN was on 05.07.2024. This exceeded the 15 day threshold for an update to the assessment. To be clear, a LVN has seen the patient 1 x weekly during that time to address all needs and provide ongoing care.

Upon patient record review, 2 of 14 (Patient #1, 10) 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 plan of care indicated docusate 100mg 2 caps po PRN as stool softener; there was no indication of a frequency for the use of this medication. (corrected order was obtained during survey) Patient 10: A physician's order was activated for use of Roxanol from the comfort pak. However, the Roxanol in the order was written as 02mg/1mL SL q 2 hrs PRN pain/SOB rather than Roxanol 20mg/1mL. (order clarification was entered during survey)

Upon client record review, 1 of 14 (Patient #3) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 3: On admission for hospice services, discipline orders for SN services were entered for 2 x weekly. However, a SN has seen the patient 1 x weekly consistently since admission. The RN case manager provided clarification that the patient requires SN visits 1 x weekly, and the order for 2 x weekly was an error. (order updated during survey)

Upon patient record review 2 of 14 (Patient #6, 7) 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 6: The HA was ordered to visit the patient 2 x weekly; however, during the week of 05.05.2024, there is only evidence of 1 visit by the HA being performed on 05.07.2024. There was no evidence of a missed visit notation. Patient 7: The HA was ordered to visit the patient 2 x weekly; however, during the week of 05.05.2024, there is only evidence of 1 visit by the HA being performed on 05.07.2024. There was no evidence of a missed visit notation.