Every finding on record at Tabitha Home Health & Hospice, LLC - A Collaboration With Immanuel

Upon patient record review, 4 of 14 (Patient #3,4,8,10) 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 3: Current Medication record includes orders for Calmoseptine topical ointment & Nystatin Topical powder. Dose(s) are written “per instructions”. Current Medication record includes Amoxicillin ordered 12/23/25 to be taken x7 days for a dental procedure. Order remains active on the patient record as of 02/10/26. Patient 4: Current Medication record includes orders for Calmoseptine topical ointment. Dose is written “per instructions”. Patient 8: Current Medication record includes orders for Calmoseptine topical ointment and Muscle rub 15%. Dose(s) are written “per instructions”. Patient10: Current Medication record includes orders for Miralax 17gram oral powder packet, order does not include a diluent.

Upon patient record review, 4 of 14 (Patient #3,4,8,10) 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 3: Current POC record includes orders for Calmoseptine topical ointment & Nystatin Topical powder. Dose(s) are written “per instructions”. Patient 4: Current POC includes orders for Calmoseptine topical ointment. Dose is written “per instructions”. Patient 8: Current POC includes orders for Calmoseptine topical ointment and Muscle rub 15%. Dose(s) are written “per instructions”. Patient10: Current POC includes orders for Miralax 17gram oral powder packet, order does not include a diluent.

Upon patient record review, 1 of 14 (Patient #3) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient 3: Current POC includes Amoxicillin however, patient is no longer taking this medication therefore plan of care has not been updated.

Upon personnel record review, 1 of 12 (Personnel #4) 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.) ·(C) Shampoo, sink, tub, and bed Personnel #4: The competency form utilized by the agency simply states shampoo. It does not differentiate among the different types of shampoo, and therefore the competency is not documented as confirmed.

Upon patient record review 1 of 11 (Patient #3) 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 #3: Nail care assigned weekly, but documented as performed every visit (2xw): 2/27/23, 3/2/23, 3/6/23, 3/9/23.

Upon patient client record review, 2 of 11 (Patient #1, 5) 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, 5: Effective date is blank on Consent for Election of Medicare/Medicaid Benefit.