Every finding on record at Tiny Oasis Hospice Inc.

Upon patient record review 5 of 14 (Patient #1,4,6,7,10) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #1,4,6,7,10, SC frequency every certification, Initial assessment document states under narrative, patient/family declined SC. No evidence of spiritual assessment completed on RN initial assessment.

Upon patient record review, 10 of 14 (Patient #1,2,3,4,5,6,7,8,9,10) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient #1,2,3,4,5,6,7,8,9,10, No evidence of assessment of imminence of death documented in the comprehensive assessment.

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 • Drug therapy currently associated with laboratory monitoring Patient #1, SN note on 8/4/25 documents patient has a headache. Patient rates pain at 4/10. RN assessed and documented patient takes aspirin 325mg 1 tablet 1x/day as needed. Medication profile documents aspirin 325mg daily, listing reason as blood thinner. No evidence patient was prescribed aspirin for headache.

Upon patient record review, 10 of 14 (Patient #1,2,3,4,5,6,7,8,9,10) 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 #1,2,3,4,5,6,7,8,9,10, MSW documents funeral home pending initial assessment, documenting in narrative note no funeral home plans, declined to disclose. No evidence of goals and interventions for finalizing funeral home plans.

Upon client record review, 4 of 14 (Patient #1,2,3,4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1, SC documents patient declined visit on initial assessment. SC frequency documented as every certification period. Visit on 8/8/25 and 10/10/25 signed by SC and note left empty. No evidence of visit was completed and no evidence of order to change the frequency. Patient #2, SN frequency 1x/week. LVN made visits on 10/20/25 and 10/23/25. No evidence frequency was followed as two visits completed this week and marked as routine visits. Patient #3, SN frequency 1x/week. LVN made visits on 11/9, 11/12, 11/16, 11/20/25. No evidence frequency was followed with two visits each week and all visits documented as routine visits. Patient #4, SN frequency 1x/week. LVN made visits on 10/6, 10/9/25. No evidence frequency was followed as two visits completed this week and marked as routine visits.

Upon home visit observation 3 of 3, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #1, Upon home visit, LVN used vital sign equipment that was laid in the clean area and returned to clean area. Patient #2,3,Upon home visit, LVN re-entered the nursing bag without sanitizing hands prior to re-entry of nursing bag.