Every finding on record at Synergy Hospice Care, Inc.

Upon patient record review, 2 of 14 (Patient #1, 8) did not have evidence that the patient chooses a health care provider, including an attending physician. Patients #1, 8: No documented evidence patient chose attending physician.

Upon patient record review, 11 of 14 (Patient #2, 3, 4, 5, 6, 7, 10, 11, 12, 13, 14) 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 #2, 3, 4, 5, 6, 7, 10, 11, 12, 13, 14: MSW and SC frequencies are documented as 1 visit every recertification and as needed. PRN visits are not quantified there forwhis is not a detailed statement of the scope and frequency.

Upon patient record review, 1 of 14 (Patient #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 #10: Home patient admitted 4/16/24. 4/16/24 wound care order for wound care to sacrococcyx 3x week and as needed, unclear who is to perform. SN frequency only twice/week and patient had consult to Wound Pro. 4/16/24 order for Foley catheter 16 Fr 10 cc balloon to gravity drainage. Change catheter bag as needed when bag is soiled or catheter is dislodged. Unclear if change refers to bag only or catheter as well what solution to use to fill balloon.

Upon client record review, 4 of 14 (Patient #3, 4, 10, 12) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #3: Patient admitted 9/15/23. Initial SC assessment 9/15/23 SC documented that patient declined SC at this time; however, POC frequency is prn and recert. Each recert period SC documented phone communication with facility caregiver who reported patient continued daily regimen of prayer. There is no evidence of visits with patient/family. Patient #10: Plan of Care frequency for MSW is as needed and recertification. Patient was seen 4/17, 4/24, 4/26, 4/27/24 for safety/wellness checks. Orders not updated to include increased frequency based on updated assessment. Patient #12: Nursing frequency is LVN 1/wk and 1 prn. There is no ordered frequency specified for SN or RN visits made 2/3 and 2/17/24.

Upon patient record review, 2 of 14 (Patient #6, 10) did not have evidence that the IDG shares information on a on-going basis with non-hospice healthcare providers furnishing services unrelated to the terminal illness and related conditions. Patients #6,10: Patients' problems included wounds and services of The Wound Pros, whose notes are uploaded to EMR, but there is no documented evidence of ongoing and comprehensive coordination of care among hospice, Board and Care and family caregiver and The Wound Pros.

Upon client chart review, 2 of 14 (#3, 11) did not have evidence the agency has offered and/or provided spiritual counseling in accordance with the patient/family desires. Patient #3: Patient admitted 9/15/23. Initial SC assessment 9/15/23 SC documented that patient declined SC at this time; however, POC frequency is prn and recert. Each recert period SC documented phone communication with facility caregiver who reported patient continued daily regimen of prayer. There is no visit/ interaction with patient or family each recert period to assess patient/family's current needs/desire for service and there is no change in ordered frequency. Patient #11: SNF resident admitted 3/8/34. Initial SC assessment SC documentation that SC provided active listening, spoke words of encouragement and faith. Pt appeared more relaxed and at peace at the end of the visit. SC will continue to make follow up visits every recertification for spiritual support to the patient and family. Each recert period SC documented phone communication with facility caregiver as opposed to patient and/or family, to assess current need/desire for service. There is no visit/ and there is no change in ordered frequency.

Upon personnel record review, 1 of 13 (Personnel #6) 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 #6: Personnel Competency form utilized by agency does not specify types of shampoo, only shampoo

Upon patient record review, 1 of 14 (Patient #2) 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 #2: 9/11/24 aide frequency aide once weekly then twice weekly starting week of 9/15/24. Aide assignment sheet says 1/week (Visits made 2x/week) IDG/POC updated. to 2x/week, but not aide assignment sheet.

Upon patient record review 1 of 14 (Patient #5) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient #5: Admitted 12/10/24 with hospice aide twice weekly. RN visits supervisory visit 12/24/24 declined by patient. Subsequent RN supervisory visits 12/31/24 and 1/21/25 exceeding 14 days.

Upon contract review, agency did not have evidence of an agreement with Wound Pros 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 Patients #6, 10, 12, 14: Receiving specialized wound care services from The Wound Pros. There is no contractual arrangement.

Upon patient client record review, 6 of 14 (Patient #1, 4, 8, 11, 12, 13) 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: Form used for this patient does not have space allocated for choice of physician Patient #4, 11, 12, 13: Requested hospice addendum, but unclear if provided. Completed form included ICD Diagnosis Codes, not actual diagnosis, therefore not useful for patient. Medication list blank for #4 and #11,12,13. Staff reports they mail list of medications covered/non-covered. Patient #12 received services of The Wound Pro. Patient #8: Choice of physician is left blank for both options of I choose and for I do not wish to choose.

Upon patient client record review, 2 of 14 (Patient #4, 13) 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: SNF resident admitted 3/15/24. 1/7/25 and 1/13/25 notes repeat wound treatment order and is not clear whether treatment was actually provided. Patient #13: DC summary not signed/authenticated.

Upon client record review, 1 of 14 (Patient #11) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #11: SNF resident admitted 3/8/34. Initial SC assessment SC documentation that SC provided active listening, spoke words of encouragement and faith. Pt appeared more relaxed and at peace at the end of the visit. SC will continue to make follow up visits every recertification for spiritual support to the patient and family. Each recert period SC documented phone communication with facility caregiver as opposed to patient and/or family. There is no evidence of visits with patient/family.

Upon client record review, 1 of 14 (Patient #4) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient #4: SNF resident admitted 3/15/14. 12/30/24 wound care order for daily treatment to right shin. Accountability is not clear in the order. 1/31/25 order for wound care to cheek. Gently cleanse the wound with normal saline or an appropriate wound cleanser. Pat dry the surrounding skin with a sterile gauze. Apply collagen particles directly to the wound bed to manage active bleeding to promote hemostasis. Cover the collagen particles with non-adherent dressing to protect the wound and maintain dressing in place. Secure with a secondary layer such as a sterile gauze and secure it using tape or a bandage. Change the dressing every 3 days or as needed if saturated with blood or drainage. SN to provide wound care at every visit. The order, as written, is not clear regarding accountability / coordination of wound care with facility. SN 1/wk.

Upon patient record review, 1 of 5 (Patient #2) 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. Patient #2 Patient had oxygen in the home and on POC that was not included on the medication record.

Upon patient record review, 1 of 5 (Patient #2) 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 #2 This patient had wheel chair that was not included on the plan of care.

Upon client record review, 1 of 5 (Patient #5) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #5 Had Visit Frequency order (9/15/21) for RN visit once every 14 days. The RN visited 9/15/21 only. Patient discharged on 10/2/21 which was greater than 14 days. RN did not meet visit frequency.