Every finding on record at The American Heartland Hospice Corp.

Upon patient record review, 3 of 19 (Patient #3,5,13) 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: An order for Miralax 17g daily by mouth was entered on 11/03/2023 No evidence that a diluent was added to MAR. Patient 5: Duplicate drug therapy: Milk of magnesium 400mg/5ml 30ml daily PRN for constipation. Bisacodyl 10mg daily PRN for constipation. No evidence that instructions were given on which medication should be given first for constipation. Patient 13: Duplicate drug therapy: Lactulose 10g/15ml 15ml daily PRN for constipation. Bisacodyl 10mg daily PRN for constipation. No evidence that instructions were given on which medication should be given first for constipation.

Upon patient record review, 5 of 19 (Patient #1,4,8,9,11) 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 1: No evidence that an initial bereavement risk assessment was completed within 5 days of admit. Admitted on 03/05/2023, assessment completed on 04/04/2023. Patient 4: No evidence that an initial bereavement risk assessment was completed within 5 days of admit. Admitted on 07/28/2022, assessment completed on 08/12/2022. Patient 8: No evidence that an initial bereavement risk assessment was completed within 5 days of admit. Admitted on 09/05/2023, assessment completed during survey. Patient 9: No evidence that an initial bereavement risk assessment was completed within 5 days of admit. Admitted on 01/27/2023, assessment completed on 02/04/2023. Patient 11: No evidence that an initial bereavement risk assessment was completed within 5 days of admit. Admitted on 01/27/2023, assessment completed on 02/04/2023.

Upon patient record review, 5 of 19 (Patient #1,2,3,6,11) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 1: Wounds were inactivated on 01/04/2023. No evidence that wound care orders were removed from the active plan of care. Patient 2: Patient identified as a risk for falls upon admit and ongoing via RN assessments. No evidence that risk for falls was added to the plan of care. Patient 3: History of seizures. Currently on Keppra 500mg daily. No evidence of risk for seizures was added to the plan of care. Patient 6: Patient identified as a risk for falls upon admit and ongoing via RN assessments. No evidence that risk for falls was added to the plan of care. Patient 11: Patient identified as a risk for falls upon admit and ongoing via RN assessments. No evidence that risk for falls was added to current plan of care.

Upon patient record review, 1 of 19 (Patient #3) 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: An order for Miralax 17g daily by mouth was entered on 11/03/2023. No evidence that a diluent was added at that time.

Upon patient record review, 2 of 19 (Patient #1,9) 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 1: Wounds were inactivated on 01/04/2023. No evidence wound supplies were removed from the active plan of care. Patient has active foley catheter supply orders on the current plan of care. No evidence that patient has a foley catheter in place. Patient currently has an external catheter that is not listed on the current plan of care. Patient 9: Wound care supplies on current plan of care. Wound care discontinued on 07/2023.

Upon patient record review, 1 of 19 (Patient #8) 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 8: Plan of care has patient listed as full code with interventions listed for the SW to address the patient being a full code. Patient has a DNR signed by the medical director on 10/03/2023 uploaded to the chart.

Upon client record review, 2 of 19 (Patient #7,11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 7: Chaplain was refused at the time of admit. Chaplain services were started with 01/05/2024 with a frequency of once a month. No evidence that the family requested chaplain services and family has refused all chaplain visit attempts since those services were started. Patient 11: No evidence that patient received a visit from the social worker for the month of September 2023. Current plan of care has frequency ordered as once a month for the SW.

Upon client record review, 1 of 19 (Patient #15) did not have evidence that the hospice forwarded a summary and a copy of the patient record, if requested, to a facility when transferring the patient to that facility. Patient 15: No evidence that transfer summary and patient record was sent to receiving hospice.

Upon client record review, 2 of 19 (Patient #4,12) 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 4: Plan of care has Chaplain frequency as 2 times a month. No evidence that 2 visits occurred for the month of November 2023. Missed visit note entered, stating that the chaplain was unable to make the visit. No evidence that the visit was refused by the patient or the caregiver. Patient 12: Plan of care has Chaplain frequency as 4 times a month. No evidence that 4 visits occurred for the month of January 2024. No evidence that an order to decrease visits was obtained or a missed visit note saying that the family refused the visit.