Every finding on record at Trusted Hospice Care, Inc.

Upon patient record review 2 of 13 (Patient #4,7) 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 4: Psychosocial assessment completed on 08/23/2021, SOC on 08/3/2021. Patient 7: Psychosocial assessment completed on 04/02/2020, SOC on 03/16/2020.

Upon patient record review 5 of 13 (Patient #4,5,7,10,11) 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 4: No evidence that spiritual assessment occurred. Patients 5,7,10,11: No evidence that spiritual and psychosocial assessments occurred.

Upon patient record review, 1 of 13 (Patient #1) 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 Admitted 6/17/22 bereavement assessment was completed on 07/09/2022.

Upon patient record review, 2 of 13 (Patient #3 and 8) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient 3 and 8 no evidence of follow-up on the bereavement plan of care or bereavement services. RN noted the family accepted bereavement services no evidence it was provided.

Upon patient record review, 1 of 13 (Patient #7) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • 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 7: Ordered for twice a week and ordered for three times a week on first week of benefit period.

Upon patient client record review, 3 of 13 (Patient #5,7,11) 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 5: No date on Election of Benefit form. Patient 7: Date on Election of Benefit form has 06/6/2021. SOC date was 08/06/2021. Patients caregiver also dated election form as 08/06/2021. Patient 11: No date on Election of Benefit form.

Upon client record review, 1 of 13 (Patient #5) 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.

Upon client record review, 1 of 13 (Patient #4) 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 • The patient's clinical record, if requested Patient 4: Discharged due to revocation. No evidence that complete discharge summary was sent to attending MD.

Upon client record review, 1 of 13 (Patient #4) did not have evidence that the discharge summary includes all required information. Patient 4: Discharged due to revocation and the discharge summary did not include latest physician orders and a summary of the patient's hospice stay.