Every finding on record at Tru Hospice Inc.

Upon patient record review 1 of 14 (Patient #13) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient 13: There is no evidence of initial spiritual assessment in the medical record.

Upon patient record review, 4 of 14 (Patient #1,2,3,4) 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: Identified needs without problems, goals, interventions on the plan of care: insomnia, agitation. COS Patient 2: Identified needs without intervention on the plan of care: oxygen use. COS Patient 3: Identified needs without problems, goals, interventions on the plan of care: depression, confusion. COS Patient 4: Identified needs without problems, goals, interventions on the plan of care: confusion.

Upon patient record review, 1 of 14 (Patient #6) 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 6: There is no evidence of DME on the plan of care, despite identified need: shower chair. COS

Upon patient record review, 1 of 14 (Patient #6) 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 6: There is no evidence of documented hospice election date on Hospice Notice of Election.

Upon SNF/NF contract review, 1 of 2 (Inglewood contract) did not have a delineation of the hospice's responsibilities, which include, but are not limited to the following: providing medical direction and management of the patient; nursing; counseling (including spiritual, dietary and bereavement); social work; provision of medical supplies, durable medical equipment and drugs necessary for the palliation of pain and symptoms associated with the terminal illness and related conditions; and all other hospice services that are necessary for the care of the resident's terminal illness and related conditions. Inglewood contract: There is no evidence of delineation of responsibilities as it relates to: providing medical direction and management of the patient; nursing; counseling (including spiritual, dietary and bereavement); social work; provision of medical supplies, durable medical equipment and drugs necessary for the palliation of pain and symptoms associated with the terminal illness and related conditions; and all other hospice services that are necessary for the care of the resident's terminal illness and related conditions.

Upon SNF/NF contract review, 1 of 2 (Inglewood contract) did not have a delineation of the responsibilities of the hospice and the SNF/NF to provide bereavement services to SNF/NF personnel. There is no evidence of responsibility delineation in the SNF contract. Further, there is no evidence that the contract states hospice will provide bereavement services to SNF staff.

Upon patient record review, 1 of 5 (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 equipment and supply needs. Patient 3: There is no evidence of the patient's medical equipment in the plan of care. The patient requires a hospital bed, walker, and wheelchair for management of the terminal illness. (corrected onsite)

Upon patient record review, 1 of 1 applicable (Patient #4) did not have evidence in the patient record that hospice aide assignments and duties are: • 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 4: The aide care plan, dated 01.22.2022, does not specify a frequency for bed bath, shampoo, and nail care.