Every finding on record at Transitions Hospice, Inc.

Upon patient record review, 1 of 14 (Patient #3) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #3 "Admission Consent" forms under “Right to Choose an Attending Physician” is incomplete. Patient's option to choose/acknowledge choice of attedning is blank.

Upon patient record review 1 of 14 (Patient #3) did not have evidence that the hospice Registered Nurse must complete an initial assessment within 48 hours after the election of hospice care in accordance with §418.24 Patient #3 "Election of Medicare Hospice Care Benefit" was signed by patient on 02/21/2023 and RN initial assessment not completed until 3/3/2023.

Upon patient record review, 5 of 14 (Patient #3, #8, #9, #12 and #14) 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 medication profile includes "Tylenol Extra Strength 500 mg Gelcap 2 tabs po as needed" with no frequency and "Acetaminophen 650mg rectal supp 1 supp PR every 6 hours as needed for mild pain and fever" with no daily dosage limit. Patient #8 medication profile includes "Tylenol 8 hour 650mg cap 1 cap orally every 8 hours" and "Acetaminophen 650 mg rectal supp 1 supp PR every 6 hours as needed for mild pain or fever" with no daily dosage limit. Patient #9 medication profile includes "Clotrimazole/Betamethasone Dipropionate 1%-0.05% topical cream 0.05% topically twice a day for itchiness" with no location specified. Patient #12 medication profile included "Fleet Disposable Rectal Enema 1 enema rectally as needed" with no frequency. Patient #14 medication profile included "Mupirocin 2% topical cream 1 cream topically as needed for wound infection" with no location identified. "Santyl 250 unit/g topical ointment 250 U 1 ointment topically once daily for wound infection" with no location identified. "TAO plus 500u 1 ointment topically as needed for wound infection" with unclear dosage, no frequency and no location identified.

Upon patient record review, 8 of 14 (Patient #2, #3 #6, #7, #8, #9, #10, #12) 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 #2, #3, and #6 does not show evidence in the patient record the comprehensive assessment was updated including and by the hospice interdisciplinary group, changes that have taken place since the initial assessment, information on the patients progress toward desired outcomes and reassessment of the patients response to care. Patient #2 and #3 comprehensive assessment for dates 5/11/23, 4/27/23 and 4/13/23 is copied and pasted. Patient #6 Psychosocial assessment is copied and pasted for 4/27/23 and 5/11/23. Patient #8 most recent interdisciplinary group assessment update documented was dated 04/13/2023 Patient #9 most recent interdisciplinary group assessment update documented was dated 01/06/2023. Patient #7, #10 and #12 had no indication of interdisciplinary group assessments since start of care.

Upon patient record review, 7 of 14 (Patient #4, #5, #6, #7, #8, #10 and #12) 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 #4, #5, #6, #7, and #8 plan of care includes “Social worker initial visit within 5 days and prn, SC initial visit within 5 days and prn and SN once a week and as needed" with no specific number of prn visits for each discipline identified. Patient #10 plan of care includes "MSW 1 time then prn and SC one time then prn" with no specified number of prn visits identified. Patient #12 plan of care included "MSW 1 time then prn" with no specific number of prn visits identified.

Upon patient record review, 5 of 14 (Patient #3, #8, #9, #12 and #14) 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 plan of care includes "Tylenol Extra Strength 500 mg Gelcap 2 tabs po as needed" with no frequency and "Acetaminophen 650mg rectal supp 1 supp PR every 6 hours as needed for mild pain and fever" with no daily dosage limit. Patient #8 plan of care includes "Tylenol 8 hour 650mg cap 1 cap orally every 8 hours" and "Acetaminophen 650 mg rectal supp 1 supp PR every 6 hours as needed for mild pain or fever" with no daily dosage limit. Patient #9 plan of care includes "Clotrimazole/Betamethasone Dipropionate 1%-0.05% topical cream 0.05% topically twice a day for itchiness" with no dose and location specified. Patient #12 plan of care included "Fleet Disposable Rectal Enema 1 enema rectally as needed" with no frequency. Patient #14 plan of care included "Mupirocin 2% topical cream 1 cream topically as needed for wound infection" with unclear dosage and no location identified. "Santyl 250 unit/g topical ointment 250 U 1 ointment topically once daily for wound infection" with unclear dosage and no location identified. "TAO plus 500u 1 ointment topically as needed for wound infection" with unclear dosage, no frequency and no location identified.

Upon patient client record review, 1 of 14 (Patient #3) 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 #3 "Admission Consent" forms under “Right to Choose an Attending Physician” is incomplete. Patient's option to choose/acknowledge choice of attending is blank.

Upon client record review, 1 of 14 (Patient #11) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary Patient #11 discharge summary dated for 3/21/2023 shows no evidence or documentation of forwarding to patient's attending Physician.

Upon client record review, 2 of 14 (Patient #11 and #12) did not have evidence that the discharge summary includes all required information. Patient #11 and #12 discharge summary incomplete. Discharge summary did not include: A summary of the patient's stay, including treatments, symptoms and pain management The patient's current plan of care The patient's latest physician orders

Upon patient record review, 3 of 14 (Patient #7, #10 and #12 ) did not have evidence in the patient record the interdisciplinary group, as part of the review of the plan of care, determines the ability of the patient and/or family to safely self-administer drugs and biologicals to the patient in his or her home. If the patient and/or family are not capable of safely administering drugs and biologicals in the home, the hospice must address this issue in the patient's plan of care.